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]

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Ultrasounds Shock Research Operations 98

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. The patient was in clinical shock with a lactate of 8. This confirms inferior, posterior, lateral, and RV MI RV MI often leads to shock and (systolic) hypotension. RVMI explains part of the shock. For review — GO TO: The June 4, 2018 post ( LA-LL reversal ).

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Shock EKG/ECG Academics Stroke 78

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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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.

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EKG/ECG Shock Emergency Department Ambulance Services 127

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.

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CDC Infectious Diseases Pediatrics Wellness 161

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).

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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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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.

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EKG/ECG Shock Academics Documentation/Coding 136

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 ).

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EKG/ECG Shock Wellness 248

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.

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Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

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.

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Resuscitation Basic Life Support Hospitals CPR 75

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.

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Sepsis Hospitals Administration Outcomes 132

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.

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Operations Academics Shock Outcomes 119

EMDocs

DECEMBER 1, 2024

Ischemic Hepatitis and Septic Shock Secondary to Murine Typhus Infection in Pregnancy. 2018 Oct-Dec;55(4):258-264. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Answer : Murine Typhus Epidemiology: Murine typhus is endemic in several parts of the U.S.: Clinical Infectious Diseases , vol.

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EMS Infectious Diseases Shock Resuscitation 83

Taming the SRU

JANUARY 10, 2024

Additionally, ED boarding is a now a larger factor than in 2018. Physicians believe the biggest factors contributing to ED violence are a lack of adequate punitive consequences toward the attacker and the absence of adequate protective mechanisms for staff.

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EKG/ECG Shock Fractures Emergency Department 92

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)?

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Burns Fluid Resuscitation Shock Resuscitation 80

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.

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EKG/ECG Shock EMS 195

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.

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Shock Poisoning Pediatrics 64

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 61

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

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Infectious Diseases CDC PPE Military 102

EMDocs

NOVEMBER 13, 2024

Management: Patients can rapidly progress to septic shock and multiorgan failure. C (100° F), or if the ascitic fluid ANC is > 250 cells/mm 3 Mortality increases by 8-10% for every hour delay in antibiotics for patients with cirrhosis and septic shock. 2018 Apr;36(4):689-698. 2018 Dec;15:41-47. Long B, Koyfman A.

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Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 80

RebelEM

JUNE 26, 2023

J Trauma Acute Care Surg 2018. 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.

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Administration Outcomes Resuscitation Radiology 145

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 ).

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Dehydration Fluid Resuscitation Shock Resuscitation 98

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.

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Sepsis Shock Administration Resuscitation 52

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. That’s where we’re at.

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Sepsis Shock Fluid Resuscitation Hospitals 40

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.

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Shock CPR Hyperthermia / Hypothermia EMS 52

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.

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Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 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 2018 Mar;36(3):480-487. Epub 2018 Jan 16. 2018 Mar 19;2018:2989846. 1,817 enrolled and randomized 911 randomized to the XBJ cohort.

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Sepsis Outcomes Administration EMS 98

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

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.

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Anaphylaxis Shock Sepsis Resuscitation 52

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.

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Shock Resuscitation Ultrasounds Research 59

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.

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Shock Resuscitation Administration Emergency Department 40

Sensible Medicine

SEPTEMBER 23, 2024

In 2018, three modern trials comparing asa vs placebo for primary prevention were published. Update on Sensible Medicine: Vinay, Adam and I remain shocked at the success of this newsletter. This was one of the trials that got aspirin use established as a preventive medicine. All were nonsignificant.

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Stroke Academics Outcomes Shock 90

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

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.

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Basic Life Support CPR Fractures Emergency Department 82

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 A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. PMID: 30025734 Sharifi M et al. Am J Cardiol 2013. PMID: 23102885 Aykan AC et al.

Stroke 136

Stroke Outcomes Hospitals Administration 136

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.

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Shock Administration Resuscitation Hospitals 40