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.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

Emergency Medicine Journal

OCTOBER 26, 2023

Methods We investigated four 18-month periods between 2005 and 2018. Inclusion criteria were non-traumatic cardiac arrests treated with at least one external electric shock with an automated external defibrillator from the basic life support team and resuscitated by a physician-staffed ALS team.

Resuscitation 75

Resuscitation Basic Life Support Hospitals CPR 75

Thinking Critical Care

JUNE 5, 2024

while the R side will deep-dive bedside hemodynamics and our 4-interface model of shock management. The energy that comes out of this is really quite unique, and the sheer number of successful collaborations that have stemmed from it since 2018 is really impressive.

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Shock Hospitals Wellness Resuscitation 72

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

Pediatric EM Morsels

APRIL 5, 2024

Globally, ticks are the second most common vector to transmit illnesses after mosquitos (Parola 2018). 2018 Mar; 3(1): 8. Travel Medicine and Infectious Disease, 2018, 26, pp.1-2. There are species of ticks found on every continent and carrying a variety of vectors capable of infecting humans. John H, Jian J, RIchards AL.

CDC 161

CDC Infectious Diseases Pediatrics Wellness 161

ALiEM

NOVEMBER 1, 2023

Critical illness requiring intubation and propofol sedation Cyanide toxicity requiring sodium thiosulfate Iron toxicity treated with deferoxamine Refractory vasoplegic shock treated with methylene blue Septic shock treated with vancomycin and cefepime Reveal the Answer 3. 22 Aug 2018. 2000 Jun;59(6):1233-50.

Shock 64

Shock Poisoning Pediatrics 64

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

Sensible Medicine

SEPTEMBER 18, 2023

The title gives away the results: Here is what they did: They took 159 patients who had severe TR and were operated on from 2004-2018. Comments: I show you this study because it shocks me. I am shocked that academic researchers would publish such an exercise. These were operations solely for the tricuspid valve.

Operations 125

Operations Academics Shock Outcomes 125

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. We are told that " the Patient was Shocked X2 Without Effect." However, this is not SVT.

EKG/ECG 136

EKG/ECG Shock Documentation/Coding Academics 136

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. In general, radial artery readings in patients with shock likely underestimate central pressure which can lead to increasing vasopressor dosing. 2018 Mar;19(2):364-371.

Shock 59

Shock Resuscitation Ultrasounds Research 59

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

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. Until that time, the best evidence indicates that in the sickest patients (i.e.

Sepsis 121

Sepsis Hospitals Administration Outcomes 121

Dr. Smith's ECG Blog

MAY 3, 2024

She was found by medics agitated, hypotensive, diaphoretic, and in shock. But this time the Queen gets it wrong (thinks it is not OMI): There were runs of VT: Tha patient arrived in profound shock and had an ED ECG: Now there is some evolution to include the ST elevation (rather than ST depression) in V4-V6.

Shock 113

Shock EKG/ECG Hospitals EMS 113

EMDocs

FEBRUARY 12, 2024

First, there can be a poor correlation between venous and arterial gases in states of shock, hemodynamic instability, or extremes of acid-base disturbances, due to poor cardiac output/circulatory failure impairing venous and arterial flow, with associated poor gas exchange as well as hypercapnia and acidemia at the tissue level (8).

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

Pediatric Emergency Playbook

FEBRUARY 1, 2020

2018; 441-458. Glycocalyx shedding is anhanced by age and correlates with increased fluid requirement in patients with major burns. 2017; 50(1):60-65. Sebastian R et al. Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: The best alternative? 2015; e24-227 Sherren PB et al. Lethal triad in severe burns.

Burns 52

Burns Pediatrics Shock 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

Ken Grauer, MD

OCTOBER 21, 2023

Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiac arrest; shock or profound hypotension; GI bleeding; anemia; "sick patient" , etc. ). The July 31, 2018 post in Dr. Smith's ECG Blog ( Please scroll down to the bottom of the page to see My Comment ).

EKG/ECG 256

EKG/ECG Shock Wellness 256

ALiEM

JUNE 5, 2023

Glucocorticoid therapy should be considered in anthrax meningitis, cutaneous anthrax with extensive tissue edema involving the head and neck, or anthrax with vasopressor-resistant shock [9]. Current Opinion in Infectious Diseases 31(3):p 257-262, June 2018. | When should you administer post-exposure prophylaxis (PEP)? DOI: 10.1097/QCO.0000000000000446

Infectious Diseases 102

Infectious Diseases CDC PPE Military 102

The Skeptics' Guide to EM

DECEMBER 7, 2018

Date: December 6th , 2018 Reference: Perkins et al. Date: December 6th , 2018 Reference: Perkins et al. He is unsuccessfully shocked. A Randomized Trial of Epinephrine in Out-of-Hospital Cardiac Arrest. Guest Skeptics: Jay Loosley is the Superintendent of Education at Middlesex-London Paramedic Service.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 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

The Skeptics' Guide to EM

JUNE 15, 2018

[display_podcast] Date: June 12th, 2018 Reference: DeMeester S et al. AEM June 2018 Guest Skeptic: Dr. Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. display_podcast] Date: June 12th, 2018 Reference: DeMeester S et al.

Emergency Department 52

Emergency Department Fluid Resuscitation Hospitals Sepsis 52

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. display_podcast] Date: August 25th, 2018 Guest Skeptic: Dr. Neil Parry is an Associate Professor of Surgery and Critical Care at Western University.

Shock 52

Shock Administration Resuscitation Hospitals 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. October 19, 2018. Given its mineralocorticoid properties, hydrocortisone is traditionally used for adrenal insufficiency. 2015;116(6):960-975.

Basic Life Support 81

Basic Life Support CPR Fractures Emergency Department 81

EMDocs

MAY 24, 2023

He and his physician are shocked at the report and the lack of follow-up. A 2018 survey of EP’s showed that many do not: 30% for plain films and 57% for advanced imaging like CT and MRI. A new chest CTA reveals a mass surrounding the vena cava. The patient is treated for metastatic germ cell cancer but dies 3 years later.

Radiology 64

Radiology Radiology EKG/ECG Hospitals 64

EMDocs

JUNE 25, 2024

National Burn Repository 2019 Update, Report of data from 2009–2018. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. References American Burn Association. link] (2019). Cartotto R, Johnson LS, Savetamal A, Greenhalgh D, Kubasiak JC, Pham TN, Rizzo JA, Sen S, Main E. J Burn Care Res.

Burns 73

Burns Fluid Resuscitation Resuscitation Poisoning 73

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.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Emergency Medicine Ireland

FEBRUARY 25, 2021

Firstly the poor unfortunate soul who starts with a benign illness and gets some antibiotics and develops a fulminant colitis and shock needing colectomy and an ICU admission. They’ve developed new shock and there’s some diarrhoea and you’re worried about c.

Shock 40

Shock 40

Ken Grauer, MD

JULY 15, 2023

Synchronized shock successfully converted the rhythm to sinus — but there was marked ST depression on the 12-lead ( Figure-2 ). Since the patient was hemodynamically stable — brief trial with Amiodarone is reasonable and was attempted, but when this did not convert the rhythm — synchronized cardioversion was applied.

EKG/ECG 195

EKG/ECG Shock EMS 195

The Skeptics' Guide to EM

MARCH 10, 2018

[display_podcast] Date: March 6th, 2018 Reference: Zahed et al. AEM March 2018. display_podcast] Date: March 6th, 2018 Reference: Zahed et al. AEM March 2018. AEM March 2018. shock, a bleeding visible vessel, renal disease, or lack of consent. Intervention: Anterior packing with a 15cm cotton pledget s.

Blood Transfusions 40

Blood Transfusions Emergency Department Shock 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

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. 2018 Nov;20(11):1-20. Neurologic and neuropsychological symptoms during the first year after an electric shock: results of a prospective multicenter study. Click to enlarge.) Critical Care Medicine.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

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

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). Jenkins and Frick — or additional procedures may be ordered and/or patients shocked for artifact simulating VT/VFib ). The January 30, 2018 post — for PTA. We can see enough to make out that the rhythm is sinus tachycardia.

EKG/ECG 66

EKG/ECG Wellness Point-of-Care Testing Shock 66

The Skeptics' Guide to EM

SEPTEMBER 21, 2019

SGEM#88 : Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol) * SGEM#133 : Just Beat It (Atrial Fibrillation) with Diltiazem or Metoprolol? Background: Atrial fibrillation is the most commonly encountered significant dysrhythmia in the emergency department (1). We have covered this topic a number of times on the SGEM.

Emergency Department 52

Emergency Department Academics Stroke Shock 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. Many institutions have created protocols for extended infusions of beta lactam antibiotics, available online.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

ACEP Now

JUNE 8, 2023

2 Interestingly, the 2019 IDSA guidelines recommended that adults with CAP, including those with severe pneumonia, not routinely receive corticosteroids in the absence of refractory septic shock. 1 What do we do with conflicting recommendations? Many clinicians, including myself, opted to wait for additional data–which we now have.

Infectious Diseases 59

Infectious Diseases Administration Hospitals Shock 59

EMDocs

JUNE 27, 2024

2018 Aug;46(3):144-151. Epub 2018 Oct 17. May substitute levofloxacin if allergic to cephalosporin Anti-viral medications if indicated Oseltamivir for influenza Patients >14 days old Remdesivir for COVID Patients >28 days old and at least 7lbs (3.2 Sickle Cell Disease: A Review. 2022 Jul 5;328(1):57-68. PMID: 35788790.

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75