PHEM Cast

APRIL 27, 2023

– Wiles – 2017 – Anaesthesia Blood pressure management in trauma: from feast to famine? : Anesthesia & Analgesia Blood pressure in trauma resuscitation: ‘pop the clot’ vs. ‘drain the brain’?

Resuscitation 52

Resuscitation Shock Operations Hospitals 52

Don't Forget the Bubbles

OCTOBER 7, 2024

Was the patient thrown from the source (suggestive of DC shock and may result in further blunt force trauma)? Children, especially toddlers, may insert objects into outlets, leading to shocks or burns. Electrical devices used near water sources can cause severe shocks. Was the voltage high or low (as below)?

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 66

Sepsis Shock Resuscitation Fluid Resuscitation 66

Pediatric EM Morsels

APRIL 5, 2024

However, it is often overlooked that tickborne illnesses are among the most common travel-related illnesses globally (CDC Traveller’s Health 2017). 2017 Nov 3;11(11):e0006062. We frequently ask children and their parents if they have had recent tick bites when they present for fever after a recent camping activity.

CDC 161

CDC Infectious Diseases Pediatrics Wellness 161

ACEP Now

JULY 7, 2023

However, between four and five percent of cases of VT or VF will be refractory to standard management, with nonperfusing arrhythmia persisting despite repeated shocks. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. amiodarone or lidocaine). Resuscitation. Sakai T, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Pediatric Emergency Playbook

FEBRUARY 1, 2020

2017; 4:91. 2017; 50(1):60-65. Mathis E et al. Pediatric Thermal Burns and Treatment: A Review of Progress and Future Prospects. Osuka A et al. Glycocalyx shedding is anhanced by age and correlates with increased fluid requirement in patients with major burns. Sebastian R et al.

Burns 52

Burns Pediatrics Shock 52

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

EMDocs

OCTOBER 9, 2023

6 However, due to the vasoconstrictive effects, hydrocortisone may be useful in refractory shock. Corticosteroids in septic shock: a systematic review and network meta-analysis. Published 2017 Mar 28. Published 2017 Oct 12. 8 Prednisone is a prodrug and is converted in the liver to prednisolone. 2015;116(6):960-975.

Basic Life Support 81

Basic Life Support CPR Fractures Emergency Department 81

Pediatric EM Morsels

JULY 21, 2023

Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. Fun fact for animal lovers!- cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! 2008 Apr;39(4):1347-8. doi: 10.1161/STROKEAHA.107.498345.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Don't Forget the Bubbles

NOVEMBER 18, 2024

Check electrolytes and consider the diagnosis, especially if the infant shows signs of shock or has a family history suggestive of CAH. Noradrenaline Due to its potent vasoconstrictive effects, noradrenaline is indicated for severe hypotension and shock, particularly when it does not respond to other inotropes. El-Khuffash, A.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

RebelEM

JANUARY 9, 2024

Except for patients with poor gut absorption or those with critical infectious processes such as septic shock or necrotizing fasciitis, this belief appears to be unfounded. Pneumonia 2017. This feels intuitive as the IV route seems like it would be stronger, faster, and fix the patient better than the oral route.

Infectious Diseases 100

Infectious Diseases Pediatrics EMS Administration 100

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2. That’s where we’re at.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Dr. Smith's ECG Blog

JANUARY 1, 2024

AslangerE A 65-year-old gentleman presented to the emergency department after experiencing two recent ICD shocks in the preceding hours. The subsequent ECG, taken 5-10 minutes post-shock, depicted a soothing of ST deviation. This was contributed by Co-editor Emre Aslanger, an interventional cardiologist in Turkey.

EKG/ECG 97

EKG/ECG Shock Administration Emergency Department 97

The Skeptics' Guide to EM

NOVEMBER 18, 2017

[display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al. Fever in the Emergency Department Predicts Survival of Patients With Severe Sepsis and Septic Shock Admitted to the ICU. Critical Care Medicine 2017. display_podcast] Date: November 11th, 2017 Reference: Sundén-Cullberg et al.

Sepsis 52

Sepsis Emergency Department Seizures Pediatrics 52

Critical Care Now

APRIL 7, 2022

Notable is the patient’s feeling that their “heart stopped” or the sensation of an “electric shock”. The large benefit with using diltiazem is that there is no association with the “electric shock” or “heart stop” feeling that is synonymous with adenosine. Published 2017 Oct 12. What is the Alternative? 2017;10(10):CD005154.

Administration 52

Administration Resuscitation Shock Emergency Department 52

PHEM Cast

APRIL 16, 2018

The outcomes from different resuscitative interventions in a haemorrhagic shock model in porcine model: From: Watts et al. EMJ 2017; 34: 860-900. Epidemiology and aetiology of TCA in England… Resuscitation; 110 (2017): 90-94. Use of CPR in hemorrhagic shock, a dog model. 2012; 73: 102-10. Resuscitation. 2016; 105: 52-58.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

Dr. Smith's ECG Blog

JUNE 23, 2024

They shocked him twice before return of spontaneous circulation. This is a critically important determination because of the 2017 AHA/ACC/HRS Guidelines for Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death. His daughter immediately started CPR and another family member called EMS.

EKG/ECG 108

EKG/ECG CPR EMS Hospitals 108

Mind The Bleep

AUGUST 5, 2023

Complications Short bowel syndrome (following significant resection, and more common following removal of the ileocaecal valve) Intestinal stricture Sepsis / shock DIC Intestinal perforation Mortality (1, 3) References Ginglen JG, Butki N. fetalneonatal-2017-313113 (2017). Necrotizing Enterocolitis. Updated 2022 Aug 8].

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

ACEP Now

JUNE 8, 2023

In 2017, the Society of Critical Care Medicine (SCCM) and the European Society of Intensive Care Medicine (ESICM) stated, “We suggest the use of corticosteroids for 5–7 days at a daily dose <400 mg intravenous hydrocortisone or equivalent in hospitalized patients with CAP,” citing moderate-quality evidence. Intensive Care Med. Andre C.

Infectious Diseases 59

Infectious Diseases Administration Hospitals Shock 59

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Outcomes 52

Mind The Bleep

JULY 15, 2023

If a child presents acutely unwell with nephrotic syndrome they are likely to be in hypovalaemic shock, have an infection, or both. This is typically steroid resistant and diagnosed on renal biopsy. Pathophysiology of Focal Segmental Glomerulosclerosis. Paediatric Nephrology , 350-354. Tapia C, B. 2023, July 15). Nephrotic Syndrome.

Allergic Reactions 52

Allergic Reactions Shock Hospitals Wellness 52

RebelEM

JUNE 26, 2023

Lancet Haematol 2017. Reversal of Trauma-Induced Coagulopathy Using First-Line Coagulation Factor Concentrates or Fresh Frozen Plasma (RETIC): A Single-Centre Parallel-Group, Open-Label Randomised Trial. PMID: 28457980 Jehan F et al. J Trauma Acute Care Surg 2018.

Administration 145

Administration Outcomes Resuscitation Radiology 145

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. Neurologic and neuropsychological symptoms during the first year after an electric shock: results of a prospective multicenter study. Click to enlarge.) and five percent workplace-related deaths.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

The Skeptics' Guide to EM

APRIL 28, 2018

December 2017. December 2017. Background: There have been a large number of trials on steroids for a variety of conditions in the last year and we have covered some of them on the SGEM: * The ADRENAL trial on steroids in septic shock demonstrating no all-cause mortality benefit at 90 days ( SGEM#208 ). December 2017.

Hospitals 40

Hospitals Emergency Department Outcomes Shock 40

Northwestern EM Blog

FEBRUARY 21, 2022

Emergency doctors know intuitively what trajectory patients are on, a chronically ill elderly patient presenting with shock requiring pressors have an extremely high mortality risk and we should be clear with families about that. UpToDate, www.uptodate.com/contents/discussing-goals-of-care Ganta, Niharika, et al. SGIM Forum, vol.

Dehydration 52

Dehydration Shock Hospitals Wellness 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ).

EKG/ECG 113

EKG/ECG Shock Hospitals Sepsis 113

Don't Forget the Bubbles

JULY 26, 2023

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. Eur Heart J 38, 1872–1882 (2017). Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. To start with there are apparently 5 types of cardiorenal syndrome. I’ll let that sink in. – Mullens, W.,

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

The Skeptics' Guide to EM

DECEMBER 7, 2018

He is unsuccessfully shocked. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation. JAMA 2009, Hagihara et al. JAMA 2012 and Cournoyer et al.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

EMDocs

JULY 17, 2023

Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients. However, surgical consultation should not be delayed while waiting for imaging in a patient who is in shock, appears toxic, or has signs of peritonitis. -In

Operations 76

Operations EMS Fluid Resuscitation Resuscitation 76

RebelEM

AUGUST 14, 2023

in both groups Mean APACHE II score was 12 in both groups Almost half of the patients had septic shock at enrollment Mean time from sepsis identification to randomization was 1.4 The Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3). 1,817 enrolled and randomized 911 randomized to the XBJ cohort.

Sepsis 98

Sepsis Outcomes Administration EMS 98

RebelEM

NOVEMBER 3, 2022

In 2017, a single-centered, retrospective study found a lower incidence of clinical hypotension with ketamine compared to etomidate following endotracheal intubation in septic patients. ( Van Berkel 2017) In 2020 the NEAR study reported peri-intubation hypotension rates of 18.3% in the ketamine cohort compared to 12.4%

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

EMDocs

MARCH 30, 2024

Intervertebral disks lie between vertebrae and act as shock absorbers. September 30, 2017. Answer : Thoracic and Lumbar Spine Trauma Epidemiology: Approximately half of the vertebral injuries that are seen in the emergency department are thoracic and lumbar injuries. 2 Males experience injuries to this region at an incidence of 3:1.

EMS 89

EMS Fractures Emergency Department Dislocations 89

EB Medicine

MARCH 4, 2020

No 1996 AAP guidelines, 2016 ACG guidelines, and 2017 IDSA guidelines all note diarrhea illness but may be vomiting predominant. IV hydration for patients with severe dehydration, hypovolemic shock, septic shock, or failed oral rehydration. Hemoglobin and platelets are helpful if HUS is suspected.

Emergency Department 40

Emergency Department Dehydration Poisoning Allergic Reactions 40

RebelEM

MARCH 2, 2023

Essentially there was no difference, meaning we wouldn’t expect to find a difference in outcomes Although not patient oriented, why is there no breakdown of how many patients had cardiogenic shock, congestive heart failure, echocardiographic findings, or even troponin levels. that was barely statistically significant. Circulation 2014.

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52