Sensible Medicine

SEPTEMBER 23, 2024

In 2018, three modern trials comparing asa vs placebo for primary prevention were published. The rate of the composite primary outcome of CV death, MI, unstable angina, stroke or transient attack was 4.29% with asa vs 4.48% with placebo. Update on Sensible Medicine: Vinay, Adam and I remain shocked at the success of this newsletter.

Stroke 110

Stroke Academics Outcomes Shock 110

RebelEM

JUNE 26, 2023

J Trauma Acute Care Surg 2018. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03 Lancet Haematol 2017.

Administration 139

Administration Outcomes Resuscitation Radiology 139

Don't Forget the Bubbles

FEBRUARY 5, 2025

In trauma patients, the primary sources of bleeding are external haemorrhage (blood on the floor), chest, abdomen, pelvis, and long bones in paediatrics brain is also included (infants with open sutures can bleed a significant amount intracranially) Shock The most common cause in trauma is haemorrhage.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

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. There’s a period of time after ischemic stroke when damaged cerebral blood vessels are susceptible to bleeding.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

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 Stroke Academics Shock 52

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 Shock 52

Taming the SRU

AUGUST 30, 2023

A 2018 USA multi-center prospective RCT involving 1,656 adult patients published in NEJM used varying PCT cut-offs to guide antibiotic initiation in the emergency department. 2018 Aug 1;10(8):a028456. Epub 2018 Oct 19. 2018 Jul 31;138(5):e78-e79. 2018 May;18(5):496-497. ng/mL, 0.25-0.5 ng/mL, and >0.5

Infectious Diseases 89

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

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

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Administration 40

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

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. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. First are pregnant patients.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Dr. Smith's ECG Blog

AUGUST 3, 2018

There is some risk of stroke when converting atrial flutter. However, he was in shock and we had to take the risk of cardioversion. But this is unlikely to be PSVT, so we did not use adenosine. Electrical cardioversion. We had no medical records. Chemical cardioversion. I’ll focus my comments on arrhythmia diagnosis.

EKG/ECG 40

EKG/ECG Ultrasounds Stroke Shock 40

EB Medicine

AUGUST 1, 2018

I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the August 2018 issue of Emergency Medicine Practice. Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 First up is the link between cannabis use and stroke or TIA.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. Stroke Authors’ Recommendation: CTA head/neck should be acquired in patients with stroke symptoms presenting within 24 hours of symptom onset.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

Don't Forget the Bubbles

JULY 5, 2023

The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke. Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

PulmCCM

JANUARY 2, 2025

The ADAPT-Sepsis Trial Between 2018 and 2024 at 41 centers in the U.K., In a stroke, the much larger ADAPT-Sepsis trial cast those provisional conclusions into doubt. Then, in late 2024, a single randomized trial more than doubled the size of the evidence base for that equivocal Cochrane review. What can we conclude?

Sepsis 98

Sepsis Outcomes Stroke Shock 98

EMDocs

JANUARY 6, 2025

Based on available hospital resources, the patient is treated for septic shock secondary to pneumonia and an infected wound using broad-spectrum antibiotics and IV crystalloid fluids. She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI.

Infectious Diseases 72

Infectious Diseases CDC PPE Rapid Diagnostic Testing 72