EMDocs

JULY 1, 2023

We’ll keep it short, while you keep that EM brain sharp. 2018; 3: e41-e45. link] The post EM@3AM: Kawasaki Disease appeared first on emDOCs.net - Emergency Medicine Education. Kawasaki disease: epidemiology and etiology. In: Post TW, ed. UpToDate;2022. Accessed December 31, 2022. link] Ramphul, K., Arch Med Sci Atheroscler Dis.

EMS 84

EMS Infectious Diseases Pediatrics Research 84

The Trauma Pro

AUGUST 22, 2023

The EMS report indicates that your incoming patient is in shock. A simple one is the use of any of your blood refrigerator products or emergency release blood , or a calculated score such as the ABC score or shock index (SI). Shock index (SI) is defined as the heart rate divided by the SBP. Sometimes, it’s obvious.

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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). Circulation. 2018;137(12).

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

The Skeptics' Guide to EM

FEBRUARY 24, 2018

[display_podcast] Date: February 14th, 2018 Reference: Venkatesh S et al. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018. He writes an […] The post SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock first appeared on The Skeptics Guide to Emergency Medicine.

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Shock Sepsis Emergency Department Resuscitation 40

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

A b rief chart review revealed his most recent echo in 2018, with LV EF 67%, “very small” inferior wall motion abnormality. Shocked x 2 without effect. Warning: if this is VT, a calcium channel blocker can result in shock and death. Read this post: Idiopathic Ventricular Tachycardias for the EM Physician 2. K returned 3.6

EKG/ECG 140

EKG/ECG Shock Academics Documentation/Coding 140

RebelEM

JANUARY 18, 2024

septic shock) earlier antibiotics most likely makes a difference in morbidity and mortality, however earlier antibiotics in all patients who meet SIRS criteria may not be a good thing and potentially cause more harms than good. appeared first on REBEL EM - Emergency Medicine Blog.

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Sepsis Hospitals Administration Outcomes 130

Ken Grauer, MD

JULY 15, 2023

These symptoms persisted for over an hour, which led the patient to contact EMS. Synchronized shock successfully converted the rhythm to sinus — but there was marked ST depression on the 12-lead ( Figure-2 ). Surprisingly — he was hemodynamically stable with minimal discomfort at the time his initial ECG in Figure-1 was recorded.

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EKG/ECG Shock EMS 195

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 More on this Topic: First10EM: Finally, a cure for sepsis: Herbs REBEL EM: Sepsis 3.0 2018 Mar;36(3):480-487. Epub 2018 Jan 16. Am J Emerg Med.

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Sepsis Outcomes Administration EMS 97

The Skeptics' Guide to EM

AUGUST 14, 2021

Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Date: August 12th, 2021 Reference: Daya et al.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

RebelEM

JUNE 26, 2023

J Trauma Acute Care Surg 2018. appeared first on REBEL EM - Emergency Medicine Blog. Lancet Haematol 2017. PMID: 28457980 Jehan F et al. The Role of Four-Factor Prothrombin Complex Concentrate in coagulopathy of Trauma: A Propensity Matched Analysis. PMID: 29664892 Zeeshan M et al.

Administration 139

Administration Outcomes Resuscitation Radiology 139

The Skeptics' Guide to EM

DECEMBER 7, 2018

Date: December 6th , 2018 Reference: Perkins et al. Date: December 6th , 2018 Reference: Perkins et al. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). He is unsuccessfully shocked. Reference: Perkins et al.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. Resuscitation 2018.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation CPR EMS 104

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.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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

The Skeptics' Guide to EM

JUNE 18, 2022

Resuscitation with blood products in patients with trauma-related haemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomised, controlled, phase 3 trial. Should we give our shocked patient saline or plasma / red cells en route to the ED?” First10EM and REBEL EM both did a review of the COMBAT trial.

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Shock Resuscitation Administration Emergency Department 40

RebelEM

JANUARY 29, 2024

JACC Cardiovasc Interv 2018. appeared first on REBEL EM - Emergency Medicine Blog. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. Am J Cardiol 2013.

Stroke 133

Stroke Outcomes Hospitals Administration 133

Dr. Smith's ECG Blog

MAY 13, 2020

A 60-something man presented by EMS with 5 hours of fairly typical sounding substernal chest pain. Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS.

EKG/ECG 52

EKG/ECG EMS Shock Ultrasounds 52

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. Emerg Med Pract.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

RebelEM

NOVEMBER 20, 2023

Military practice guidelines recommend REBOA for profound shock (SBP <90mmHg) 1 and ACEP along with the American College of surgeons recommend REBOA for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation. J Spec Oper Med.

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Resuscitation Operations Outcomes Hospitals 91

Dr. Smith's ECG Blog

MAY 5, 2022

Submitted and written by Destiny Folk MD , peer reviewed by Meyers, Smith, Grauer, McLaren A man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. 72; Issue 9; 2018. Another Shark Fin. With a twist.

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EKG/ECG Fluid Resuscitation EMS Shock 52

Dr. Smith's ECG Blog

OCTOBER 28, 2022

Unfortunately, many or most physicians, including EM and cardiology, do not know this and too many also are too arrogant to learn from a paramedic. He went into cardiogenic shock and is intubated in the cardiac ICU. Great job!! You should get followup on the case. Cortland : Thank you so much for your reply!

EKG/ECG 52

EKG/ECG EMS Shock Wellness 52

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. Eur Heart J 2018. that was barely statistically significant.

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. Baraniuk S, Tilley BC, del Junco DJ, Fox EE, van Belle G, Wade CE, Podbielski JM, Beeler AM, Hess JR, Bulger EM, Schreiber MA, Inaba K, Fabian TC, Kerby JD, Cohen MJ, Miller CN, Rizoli S, Scalea TM, O’Keeffe T, Brasel KJ, Cotton BA, Muskat P, Holcomb JB; PROPPR Study Group.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

JANUARY 25, 2024

A 2018 systematic review and meta-analysis of 25 studies focusing on the accuracy of emergency lung ultrasound showed sensitivity of 85-95% and specificity of 75-90% for pneumonia, sensitivity of 78% and specificity of 94% for COPD/asthma, and sensitivity of 75-90% and specificity of 80-90% for acute heart failure [4]. Lancet Respir Med.

Ultrasounds 125

Ultrasounds Outcomes COPD Hospitals 125

EB Medicine

NOVEMBER 1, 2018

In total, they pulled references from 1966 until 2018. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. Pay attention to the entry and exit sites, as the pathway of the shock is predictive of the potential for myocardial injury and arrhythmia. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

RebelEM

SEPTEMBER 26, 2022

What They Did Single-center randomized controlled study design performed by the Department of Hepatology & Liver transplantation in New Delhi Study participants, investigator clinicians, data collectors, and data analysts were blinded Investigators recruited participants from February 27, 2016 – March 3, 2018.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

Dr. Smith's ECG Blog

MARCH 15, 2023

We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion. For more on SSS — See My Comment at the bottom of the page in the July 5, 2018 post in Dr. Smith’s ECG Blog.

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

EB Medicine

JUNE 6, 2019

Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. You can also use the shock index, which as a reminder is simply the HR/SBP. The greatest value of a lactate level is to detect occult shock and sepsis. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EB Medicine

SEPTEMBER 1, 2018

I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations. If EMS has placed bandages, leave them in place until antivenom and resuscitative equipment is ready.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Dr. Smith's ECG Blog

AUGUST 3, 2018

Nurses found him with a BP of 50/30 and heart rate of 130 and called EMS. However, he was in shock and we had to take the risk of cardioversion. In the evening, a middle-aged man complained of chest pain at the nursing home. He was awake, with a pulse of 130 and BP of 50/30. Fluids were started. His chest pain was vague.

EKG/ECG 40

EKG/ECG Ultrasounds Stroke Shock 40

EB Medicine

AUGUST 6, 2019

Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Jeff: That is simply shocking! Nachi: Next up is recombinant coagulation factor Xa (brand name Andexxa), which was approved in 2018 for the FXa inhibitors. Let’s also talk lab studies.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EMDocs

JANUARY 6, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University School of Medicine, St. Louis, MO); Jessica Pelletier, DO (EM Education Fellow, Washington University School of Medicine, St. We’ll keep it short, while you keep that EM brain sharp. A 64-year-old male presents by EMS to the ED with shortness of breath.

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EMS Infectious Diseases Shock Emergency Department 80

EMDocs

FEBRUARY 12, 2024

Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. 2018 Mar;33(3):176-181. Epub 2018 Mar 7. J Intensive Care Med.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

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 95

Operations EMS Fluid Resuscitation Resuscitation 95

Dr. Smith's ECG Blog

APRIL 6, 2018

EMS report was that the patient had unknown down time with unwitnessed arrest, found initially in VFib arrest, defibrillated x1 followed by PEA arrest alternating with asystolic arrest during transport. Each time we shocked it back to sinus rhythm. She did not perform chest compressions prior to EMS arrival. Learning Points: 1.

Shock 52

Shock EMS Wellness Outcomes 52

RebelEM

DECEMBER 19, 2022

This procedure involves applying another set of pads attached to a second defibrillator to a patient and shocking them in hopes of terminating the rhythm. At REBEL EM, we’ve done an extensive write up that details some of the different types of DED and the electrophysiology behind it.

EMS 52

EMS CPR Shock Resuscitation 52

RebelEM

MAY 15, 2024

2018 May;26(5):1465-1470. Epub 2011 Apr 22 Coyne CJ, Le V, Brennan JJ, Castillo EM, Shatsky RA, Ferran K, Brodine S, Vilke GM. Rezaie, MD (Twitter/X: @srrezaie ) The post REBEL Core Cast 122.0 – Neutropenic Fever appeared first on REBEL EM - Emergency Medicine Blog. Give appropriate fluids, vasopressors, and antibiotics.

Infectious Diseases 90

Infectious Diseases Administration Sepsis Anaphylaxis 90