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A Beginner’s Guide to Vasoactive Drug use in Children with Septic Shock

Don't Forget the Bubbles

What is Shock? Shock is defined as a type of circulatory failure where lack of oxygen leads to dysfunction of vital organs. There are many types of shock which may affect children, and management is specific to the type of shock. The overall goal in managing any cause of shock is to restore oxygen delivery to the organs.

Shock 143
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Glasgow Coma Scale in Children

Pediatric EM Morsels

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.

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Updates in the Management of Refractory Ventricular Tachycardia or Ventricular Fibrillation Arrest

ACEP Now

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). References Tsao CW, et al.

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Major Trauma – Injuries by Assault

Don't Forget the Bubbles

In trauma patients, the primary sources of bleeding are external haemorrhage (blood on the floor), chest, abdomen, pelvis, and long bones in paediatrics brain is also included (infants with open sutures can bleed a significant amount intracranially) Shock The most common cause in trauma is haemorrhage.

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REBEL Cast Ep 118: The PROCOAG Trial – 4F-PCC for Trauma Patients?

RebelEM

Lancet Haematol 2017. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03 PMID: 28457980 Jehan F et al.

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Journal Club - Tranexamic Acid in Trauma

Downeast Emergency Medicine

MI or stroke). When looking at the subgroups with severe shock, there was an 18.5% When stratifying TXA administration time after injury and qualifying shock incidence, there appeared to be a lower 30 d mortality if TXA was given within 1 hour of the incident. DOES TXA IMPROVE OUTCOMES IN PATIENTS WITH TBI?

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Diagnostics: Inflammatory Markers

Taming the SRU

In contrast, an 2017 Cochrane Review update regarding using PCT to initiate or discontinue antibiotics found PCT-guided therapy had a statistically significant d ecrease in mortality for hospitalized patients by 1.4% (primary endpoint) and a statistically significant decrease in antibiotic exposure by 2.4 2017 Dec 14;9(6):7204-7218.