Sensible Medicine

JUNE 17, 2024

PFA destroys myocardium with electricity (shocks). Every “application” is actually a shock. Europeans do PFA ablation in well under an hour. PFA is especially concerning because the shocks in the left atrium create intense microbubbles. Sensible Medicine is a reader-supported publication.

Shock 126

Shock Stroke Operations Ultrasounds 126

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

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. 6 What Can I Do Outside of Repeated Shocks and Standard ACLS? amiodarone or lidocaine).

Resuscitation 98

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.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

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. Montreal, May 21-24.

Shock 65

Shock Hospitals Wellness Resuscitation 65

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? 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.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

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

Pediatric EM Morsels

APRIL 5, 2024

Globally, ticks are the second most common vector to transmit illnesses after mosquitos (Parola 2018). Menoza 2024) Diagnosis depends on high clinical suspicion as well as testing of both serum and CSF. 2018 Mar; 3(1): 8. Travel Medicine and Infectious Disease, 2018, 26, pp.1-2. John H, Jian J, RIchards AL.

CDC 161

CDC Infectious Diseases Pediatrics Wellness 161

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . 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.

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

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

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

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 138

EKG/ECG Shock Academics Documentation/Coding 138

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. Well more than a million views per month far exceeds are expectations. All were nonsignificant. We remain an advertisement-free site.

Stroke 91

Stroke Academics Outcomes Shock 91

Ken Grauer, MD

OCTOBER 21, 2023

P EARL # 2: As noted above — ECG #1 is remarkable for the presence of diffuse ST depression ( in more than 7 leads! ) — with ST elevation in lead aVR ( as well as in lead V1 ). 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

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? Jeff : So get this -- one study showed that out-of-hospital shock index and respiratory rate were highly predictive of ICU admission.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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 Demographics, severity of illness, and comorbidities were well balanced between groups and the intervention and control groups have the same prognosis.

Sepsis 98

Sepsis Outcomes Administration EMS 98

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). While awaiting transfer to the cath lab, STAT echocardiogram was performed and showed LVEF 30-35%, as well as anterior, inferior, and apical hypokinesis, and apical thrombus. There are also diagonal branches which are not well visualized.

EKG/ECG 64

EKG/ECG Wellness Point-of-Care Testing Shock 64

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. J Trauma Acute Care Surg 2018. Some clinicians have advocated for early administration of 4-factor prothrombin complex concentrate (4F-PCC) based on limited observational data. High-quality studies are needed to determine the utility of this intervention.

Administration 145

Administration Outcomes Resuscitation Radiology 145

EMDocs

JUNE 25, 2024

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. 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.

Burns 73

Burns Fluid Resuscitation Resuscitation Poisoning 73

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. We now have a patient who is in sustained SVT but with no features of shock. Family history. What if this does not work?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 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

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. As well as considering volume, hyponatraemia is a harmful consequence of incorrect administration of fluids. 2018 Apr;44(4):409-417. Epub 2018 Mar 27. Ann Intensive Care.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

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

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. She has epistaxis that has not resolved despite twenty minutes of well applied anterior pressure. AEM March 2018.

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

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. 2018 Aug;46(3):144-151. Epub 2018 Oct 17. C or 100.4 mg/kg, max 0.4

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

Dr. Smith's ECG Blog

OCTOBER 28, 2022

I believed this met modified Sgarbossa in II, III and aVF with excessive discordance as well as reciprocal in aVL. He went into cardiogenic shock and is intubated in the cardiac ICU. That said — I favor beginning with a qualitative approach , which has served me well over a period of decades.

EKG/ECG 52

EKG/ECG EMS Shock Wellness 52

Dr. Smith's ECG Blog

APRIL 6, 2018

We caught it though: The person manning the defibrillator was about to press shock when we remembered something very important to check in this scenario. Upon closer inspection, the defibrillator's monitor had assigned a spike for every large T wave as well as every QRS complex. Each time we shocked it back to sinus rhythm.

Shock 52

Shock EMS Wellness Outcomes 52

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. The sudden death of an apparently healthy child is a devastating tragedy, and if it’s preventable, the costs of supine sleep may be worthwhile.

CDC 75

CDC Sepsis Research Pediatrics 75

EMDocs

JULY 1, 2023

2018; 3: e41-e45. Early consultation with a specialist is recommended in these cases 7,8 Workup: Lab tests can support the diagnosis of KD, especially in incomplete KD cases as above. Kawasaki disease: epidemiology and etiology. In: Post TW, ed. UpToDate;2022. Accessed December 31, 2022. link] Ramphul, K., Arch Med Sci Atheroscler Dis.

EMS 65

EMS Infectious Diseases Pediatrics Research 65

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 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.

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

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]. vs. 18.3%).

Ultrasounds 130

Ultrasounds Outcomes COPD Hospitals 130

PEMBlog

JUNE 5, 2024

Infants can get a cervical spine injury during breech delivery or, unfortunately, during non accidental trauma as well. You should also consider the possibility of quote unquote spinal shock. than it is spinal shock. And hypotension, bradycardia, or temperature instability can result from hemorrhagic and or spinal shock.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

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

Dr. Smith's ECG Blog

MAY 8, 2023

There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessively discordant TE in V2-V4. Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. He expired 4 days later.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Dr. Smith's ECG Blog

MARCH 15, 2023

But when you see this, you should suspect that the AV node is not well. 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 Wellness 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Many of these issues were described in a prior post by Dr. Angie Lobo ( @aloboMD ) (For open-access reviews of this literature, see Saw 2016 , Saw 2017 , or Hayes 2018.) On the other hand , high-risk lesions appear to do well with aggressive treatment. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock.

EKG/ECG 52

EKG/ECG Wellness Shock Ultrasounds 52