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

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 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

However, if the infant is well-perfused, cardiovascularly stable, and showing no signs of organ dysfunction, active treatment may not be necessary. Check electrolytes and consider the diagnosis, especially if the infant shows signs of shock or has a family history suggestive of CAH. This can manifest as hypotension. El-Khuffash, A.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

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

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? Jeff : So get this -- one study showed that out-of-hospital shock index and respiratory rate were highly predictive of ICU admission.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Lancet Haematol 2017. Some clinicians have advocated for early administration of 4-factor prothrombin complex concentrate (4F-PCC) based on limited observational data. High-quality studies are needed to determine the utility of this intervention. to 3.33; P = 0.72

Administration 145

Administration Outcomes Resuscitation Radiology 145

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. There are of course much more complex neurohumoral, inflammatory type cytokiney thingies going on but as you can tell they are well over my head so I’ve skipped them for now. Eur Heart J 38, 1872–1882 (2017). – Mullens, W.,

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

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

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

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. Anticipatory guidance is not just for well-child checks ! SGIM Forum, vol. Transitions/Goals of Care.”

Dehydration 52

Dehydration Shock Hospitals Wellness 52

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. We now have a patient who is in sustained SVT but with no features of shock. Family history.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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

Mind The Bleep

JULY 15, 2023

As well as synthesising more albumin, the liver also increases its production of LDL and VDL and lipoprotein which causes hypercholesterolaemia and hypertriglyceridaemia. If a child presents acutely unwell with nephrotic syndrome they are likely to be in hypovalaemic shock, have an infection, or both. Paediatric Nephrology , 350-354.

Allergic Reactions 52

Allergic Reactions Shock Hospitals Wellness 52

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 Demographics, severity of illness, and comorbidities were well balanced between groups and the intervention and control groups have the same prognosis.

Sepsis 98

Sepsis Outcomes Administration EMS 98

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

There is some upwards concave ST segment elevation in the inferior leads with what seems to be well formed J-waves. maybe not seen well on these echo-loops) The CW doppler at the tricuspid valve showed a maximum TR velocity of 2,55m/s with a TRP gradient of 26mmHg. 21, 2017 ). Not much difference from 1st ECG. The RV > LV.

EKG/ECG 96

EKG/ECG COPD Wellness Shock 96

Taming the SRU

MAY 3, 2023

During the admission, she completed a course of broad-spectrum antibiotics and as the underlying shock state improved, she was also weaned off all vasopressor support. She was noted to have improvement in her underlying respiratory status as well and was extubated approximately three weeks later.

Wellness 52

Wellness Hospitals Shock Outcomes 52

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. doi:10.1155/2017/6014967 Light RW. J Emerg Trauma Shock. Published 2017 Sep 7. References Onuki T, Ueda S, Yamaoka M, et al. Can Respir J.

Fractures 95

Fractures COPD Hospitals Emergency Department 95

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. 2017 Dec 1;30(4):191-201. C or 100.4 mg/kg, max 0.4 2024 Mar 12;14(1):5978.

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

RebelEM

SEPTEMBER 26, 2022

A meta-analysis of fifteen RCTs comparing blood product transfusion rates of cardiothoracic and surgery patients found significantly lower transfusion rates of FFP in TEG/ROTEM guided group compared to traditional tests, with no difference in survival rates (Fahrendorff 2017). Published 2017 Apr 13. Article: Kumar M et al.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

EMDocs

APRIL 22, 2024

However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). If RV pressure is extreme, it can exceed LV pressure causing paradoxical septal wall motion toward the LV as well. A thin wall (diameter <5mm) is suggestive of an acute etiology”.

Ultrasounds 81

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 81

Don't Forget the Bubbles

MAY 10, 2023

A shocked friend is being ushered out of the way. And then the debrief runs through STOP : Situation – a recap of the resuscitation, including the reasoning behind decisions made Things that went well Opportunities to improve Points of action – equipment issues, or whether a case review is needed And so after the hot debrief, you pause.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 2017 Dec 14;9(6):7204-7218. Cochrane Database of Systematic Reviews 2017, Issue 10. They are used clinically to detect pathological inflammation or measure response to treatment [1-2]. days (secondary endpoint) [51]. Oncotarget.

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

EMDocs

JUNE 3, 2023

For a broader overview of pelvic trauma, please review Dr. Lupez’s 2017 article here: [link]. 4 Patients with pelvic fractures are considered unstable when systolic blood pressure < 90mmHg and heart rate >120bpm, or in those with dyspnea, altered mental status, or skin findings of shock. Published 2017 Jan 18.

Fractures 54

Fractures Resuscitation Operations EMS 54

Mind The Bleep

APRIL 20, 2024

Cyanosis can be peripheral, central or both and it can be seen in cases of shock and cyanotic congenital heart disease. 2017, April 14). Peri-oral cyanosis can be observed when oxygen saturations fall < 85%. Retrieved from MRCPCH Clinical Revision: [link] Bonfield, A. 2018, October 8). Respiratory exam. 2023, October 28).

Shock 52

Shock Wellness 52

Downeast Emergency Medicine

APRIL 26, 2021

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. MI or stroke). DOES TXA IMPROVE OUTCOMES IN PATIENTS WITH TBI?

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. Anemia ; 2015.DOI:10.1155/2015/791498.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

JANUARY 10, 2024

3,950 children were recruited between September 2014 to May 2017. These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Many of these issues were described in a prior post by Dr. Angie Lobo ( @aloboMD ) (For open-access reviews of this literature, see Saw 2016 , Saw 2017 , or Hayes 2018.) On the other hand , high-risk lesions appear to do well with aggressive treatment. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock.

EKG/ECG 52

EKG/ECG Wellness Shock Ultrasounds 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

The patient went into cardiogenic shock and ultimately died of this MI. For clarity — I have combined in Figure-1 the first 2 ECGs done in the ED, as well as the prior tracing done on this patient. Regional wall motion abnormality (WMA): Regional WMA: Inferobasal (this is another name for posterior), akinetic, small. Sandoval Y et al.

EKG/ECG 52

EKG/ECG Emergency Department Wellness Shock 52

Advanced Emergency Nursing from AENJ

FEBRUARY 19, 2017

How great must be her shock. Tears welled up while doing so as I thought of my own toddlers. Yet, there is increased physical wear and tear, and increased psychic wear and tear may well occur with extended hours, increased fatigue, and decreased rest or decompression. Some have called this "Compassion Fatigue."

Emergency Nursing 40

Emergency Nursing Military Hospitals Resuscitation 40

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. You will be running the show today, and you want to use your preparation time well. 2017 Dec;83(6):1136-1141. But unfortunately for Ranulf, as Tarquin stood, he slipped on a blob of spilt quince jelly. The trauma call goes out. So, what are your key priorities? Trials 23, 384 (2022).

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. 2017 Nov;35(4):525-537. There appears to be some ST elevation in leads II and aVF, as well as to a lesser extent in the lateral chest leads. J Am Soc Echocardiogr.

EKG/ECG 52

EKG/ECG Ultrasounds Documentation/Coding COPD 52

EB Medicine

SEPTEMBER 1, 2018

Both are at the University of Florida Jacksonville, and they reviewed a total of 120 articles from 2006-2017, in addition to reviews from both Cochrane and Dare. Unfortunately, this myokymia may not respond to antivenom administration and myokymia of the chest well and torso can necessitate intubation in extreme cases.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Nachi: Taken all together, the rising rates of obesity and the rising success and availability of bariatric procedures has led to an increased number of bariatric procedures, with 228,000 performed in the US in 2017. In 2017, these were performed 60%, 18%, and 3% of the time.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52