Emergency Medicine Journal

OCTOBER 26, 2023

Objective Over 300 000 cases of out-of-hospital cardiac arrests (OHCAs) occur each year in the USA and Europe. Methods We investigated four 18-month periods between 2005 and 2018. Primary outcome was survival at hospital discharge with a good neurological outcome.

Resuscitation 75

Resuscitation Basic Life Support Hospitals CPR 75

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. 6 What Can I Do Outside of Repeated Shocks and Standard ACLS?

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Greater Sydney Area HEMS

FEBRUARY 20, 2024

Obtaining access in shocked trauma patients can be notoriously difficult due to circulatory collapse. Those who are shocked, shut down with limited or no other options for peripheral access require central access. Anesthesiology 2018; 128 : 38–43. [v] Medicine 2018; 97 : e13661. Green et al. October 2023. [vi]

Ultrasounds 98

Ultrasounds Shock Research Operations 98

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Figure B At this point, with the ECG changing from diffuse ST depression to widespread ST elevation and the patient presenting in cardiogenic shock, left main coronary artery (LMCA) occlusion is the likely diagnosis. Complete LMCA occlusion is associated with clinical shock and/or cardiac arrest. This is an ominous sign.

EKG/ECG 129

EKG/ECG Shock Emergency Department Ambulance Services 129

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. Referring to Figure-1 — this 53-year old woman who presented in extremis with cardiogenic shock and an initial pH = 6.9, This was sent by a reader. and K was normal. Here was the ECG: There is sinus tachycardia.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

Taming the SRU

JANUARY 10, 2024

Additionally, ED boarding is a now a larger factor than in 2018. There are 38 states where it currently is a felony of some level to assault a healthcare worker BUT there is currently no federal law that protects hospital employees from assault or intimidation. Current bills in progress: US H.R.2663 2663 & S.1176 2584 & S.2768

EKG/ECG 93

EKG/ECG Shock Fractures Emergency Department 93

EMDocs

MAY 24, 2023

He and his physician are shocked at the report and the lack of follow-up. A lawsuit is filed against the emergency physician, radiologists, PCP, and hospital. Plaintiff : You (the hospital) had no system in place regarding non-congruent over-reads by “nighthawk” radiologists. Vincent’s University Hospital, Dublin, Ireland.

Radiology 85

Radiology Radiology EKG/ECG Patient Safety 85

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 1.4 001) Hospital mortality: Placebo 22.8% 2018 Mar;36(3):480-487. Epub 2018 Jan 16. 2018 Mar 19;2018:2989846. vs. XBJ 14.2% 2017.12.007.

Sepsis 97

Sepsis Outcomes Administration EMS 97

RebelEM

JANUARY 29, 2024

JACC Cardiovasc Interv 2018. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below). PMID: 30025734 Sharifi M et al. Moderate Pulmonary Embolism Treated with thrombolysis (from the “MOPETT” Trial).

Stroke 133

Stroke Outcomes Hospitals Administration 133

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

The Skeptics' Guide to EM

DECEMBER 7, 2018

Date: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. Date: December 6th , 2018 Reference: Perkins et al. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. He is unsuccessfully shocked. published in Resuscitation 2011.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

Don't Forget the Bubbles

FEBRUARY 5, 2025

All hospitals will have different makeups of trauma teams and possibly different levels of activation) Do I need any additional expertise outside of who would typically be in the trauma team? Some specific considerations could be: Team Who will be the trauma team leader? Do I need a trauma team activation?

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

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

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

The Skeptics' Guide to EM

APRIL 28, 2018

[display_podcast] Date: April 25th, 2018 Reference: Stern A et al, Corticosteroids for pneumonia (Review). display_podcast] Date: April 25th, 2018 Reference: Stern A et al, Corticosteroids for pneumonia (Review). Cochrane Database of Systematic Reviews. December 2017. Case: A 72-year-old gentleman presents to your emergency department.

Hospitals 40

Hospitals Emergency Department Outcomes Shock 40

Thinking Critical Care

JUNE 5, 2024

This applies to any hospitalized patients, whether in the ED, the wards or the ICU, so that’s why this year, the H and the R will spend the first day together doing all things VExUS and venous congestion, along with the corresponding workshops, again so that participants can leave with some actionable knowledge and skills.

Shock 59

Shock Hospitals Wellness Resuscitation 59

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. Fludrocortisone Is Associated With a Higher Risk of All-Cause Hospitalizations Compared With Midodrine in Patients With Orthostatic Hypotension.

Basic Life Support 103

Basic Life Support CPR Fractures Emergency Department 103

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].

Ultrasounds 125

Ultrasounds Outcomes COPD Hospitals 125

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. For those listening, my hospital probably looks a little bit like yours. Roughly half of in-hospital mortality is associated with septic in some fashion. At our hospital in northern Manhattan they like to breath around 18.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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. 2018, Kuttab, Lykins et al. 2018, Kuttab, Lykins et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Mind The Bleep

DECEMBER 19, 2023

Majority of DKA patients are in a fluid deficit and present acutely with shock. Signs of shock to be mindful for are tachycardia, hypotension, prolonged CRT, pallor, and a weak thready pulse. Fluid boluses are given according to local guidelines, but generally shocked patients should receive a 10ml/kg 0.9% 2018, November ).

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

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.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

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?” Date: June 18th, 2022 Reference: Crombie et al.

Shock 40

Shock Resuscitation Administration Emergency Department 40

EMDocs

JANUARY 16, 2024

He subsequently walks out of the hospital with a normal neurologic exam two weeks after admission. 10 The score predicts the probability of survival to hospital discharge using a number of factors including CPR duration, serum potassium, core temperature, age, and suspected mechanism of hypothermia. Resuscitation 2018.

Hyperthermia / Hypothermia 106

Hyperthermia / Hypothermia Resuscitation CPR EMS 106

The Skeptics' Guide to EM

AUGUST 26, 2018

[display_podcast] Date: August 25th, 2018 Guest Skeptic: Dr. Neil Parry is an Associate Professor of Surgery and Critical Care at Western University. He is the Medical Director of the Trauma Program for London Health Sciences Centre and the Site Chief of Surgery at Victoria Hospital.

Shock 40

Shock Administration Resuscitation Hospitals 40

The Skeptics' Guide to EM

FEBRUARY 10, 2018

[display_podcast] Date: February 6th, 2018 Reference: Foster SJ et al. Lancet January 2018 Guest Skeptic: Dr. Tessa Davis is a Pediatrician specialising in Pediatric Emergency Medicine and currently practicing in a central London hospital. display_podcast] Date: February 6th, 2018 Reference: Foster SJ et al.

Emergency Department 40

Emergency Department Pediatrics Sepsis Hospitals 40

Don't Forget the Bubbles

NOVEMBER 15, 2023

She had septic shock on presentation and was resuscitated with 60ml/kg of balanced crystalloid solution and escalating vasoactive medications. Principles of fluid management and stewardship in septic shock: it is time to consider the four D’s and the four phases of fluid therapy. 2018 Apr;44(4):409-417. Epub 2018 Mar 27.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

EMDocs

JULY 1, 2023

Patients should be admitted to the hospital and cardiology consulted early in their course. Kawasaki disease: two case reports from the Aga Khan Hospital, Dar es Salaam-Tanzania. 2018; 3: e41-e45. The Royal Children’s Hospital Melbourne. Corticosteroids are controversial and not currently recommended. Lakhani, N.

EMS 87

EMS Infectious Diseases Pediatrics Research 87

ACEP Now

JUNE 8, 2023

Categories of pneumonia have included CAP, hospital-acquired (HAP), ventilator-associated (VAP), and, beginning in 2005, health care-acquired (HCAP). Additionally, those with a hospitalization and receipt of parenteral antibiotics in the last 90 days should receive extended coverage for MRSA and/or P. aeruginosa.

Infectious Diseases 59

Infectious Diseases Administration Hospitals Shock 59

The Skeptics' Guide to EM

MARCH 10, 2018

[display_podcast] Date: March 6th, 2018 Reference: Zahed et al. AEM March 2018. Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. display_podcast] Date: March 6th, 2018 Reference: Zahed et al. AEM March 2018.

Blood Transfusions 40

Blood Transfusions Emergency Department Shock Hospitals 40

Taming the SRU

FEBRUARY 19, 2024

A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. Arterial lines require specialized monitoring and nursing resources which are not available in all hospital settings. Shock 40(6):p 527-531, December 2013. | PMID: 35338337.

Shock 59

Shock Resuscitation Ultrasounds Research 59

ACEP Now

MAY 9, 2024

1,2 You’ll also find the story of Sheila Powell, a woman who suffered a pneumothorax during her 2018 Miami BBL and whose 16-year-old daughter worried that in “just a blink of the eye, I could have lost my mom.” This should be suspected in patients with intraoperative cardiac arrest or shock. References Garcia SE.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Can J of Cardiol 2018, 34: 132-145 Here are some other cases: LVH, LBBB, RBBB, and RVH may manifest ST depression without any ischemia! An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease?

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Taming the SRU

AUGUST 30, 2023

In a small study involving 79 hospitalized children, PCT was found to be elevated in bacterial infections, with a decrease after appropriate antibiotic therapy, and decreased in viral infections [24]. 2018 Aug 1;10(8):a028456. Epub 2018 Oct 19. 2018 Jul 31;138(5):e78-e79. ng/mL, 0.25-0.5 ng/mL, and >0.5 2018.09.070.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

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. Dr. Koo is faculty and an emergency physician at MedStar Washington Hospital Center in Washington, D.C., Mary’s Hospital in Leonardtown, Maryland. 2018 Nov;20(11):1-20. Click to enlarge.)

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

PulmCCM

JULY 10, 2023

A 2018 meta-analysis reviewed here suggested that prolonged infusion of antipseudomonal beta-lactams reduced mortality by 30% compared with shorter infusions, and more observational data has accumulated since that time. Mortality was about 30% in each group, and most patients had hospital-acquired sepsis.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 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. Low O2 protocol: 3.1%

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52