Ken Grauer, MD

AUGUST 16, 2024

PEARL # 2: In the absence of associated heart failure ( cardiogenic shock ) — sinus tachycardia is not a common finding in acute MI. Excellent review of diagnostic testing for acute PE ( Moore et al — Cardiovasc Diagn Ther 8(3):225-243, 2018 ). For now — Let's continue with ECG signs consistent with and suggestive of acute RV "Strain".

EKG/ECG 394

EKG/ECG Wellness Shock 394

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

PulmCCM

NOVEMBER 18, 2024

Intermediate-risk patients are generally defined as having clinically significant PE without shock but with elevated troponin and acute right ventricular strain (i.e., The optimal approach to management of patients with intermediate-risk pulmonary embolism remains unknown. systolic dysfunction) on echocardiogram or CT.

Shock 52

Shock Wellness 52

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 127

EKG/ECG Shock Emergency Department Ambulance Services 127

Sensible Medicine

JUNE 17, 2024

PFA destroys myocardium with electricity (shocks). Every “application” is actually a shock. PFA is especially concerning because the shocks in the left atrium create intense microbubbles. It’s expected to grow at high rates, powered largely by expansion of catheter ablation.

Shock 125

Shock Stroke Operations Ultrasounds 125

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

Pediatric EM Morsels

JULY 21, 2023

cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! 2018 Jun;128(6):1612-1620. Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. 2018): 192–200. Fun fact for animal lovers!-

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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

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

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

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

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.

Shock 65

Shock Hospitals Wellness Resuscitation 65

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

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

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

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

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.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 80

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 137

EKG/ECG Shock Documentation/Coding Academics 137

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 126

Operations Academics Shock Outcomes 126

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

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.

EKG/ECG 92

EKG/ECG Shock Fractures Emergency Department 92

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 132

Sepsis Hospitals Administration Outcomes 132

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.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 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.

Stroke 94

Stroke Academics Outcomes 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 248

EKG/ECG Shock Wellness 248

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

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.

Sepsis 98

Sepsis Outcomes Administration EMS 98

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

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 82

Basic Life Support CPR Fractures Emergency Department 82

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 65

Radiology Radiology EKG/ECG Hospitals 65

Critical Care Now

APRIL 7, 2022

Notable is the patient’s feeling that their “heart stopped” or the sensation of an “electric shock”. In addition, a Cochrane systematic review of seven randomized control trials published in 2018, found similar rates of conversion to normal sinus rhythm between adenosine and non-dihydropyridine CCBs (90% vs 93%).

Administration 52

Administration Resuscitation Shock Emergency Department 52