RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

FEBRUARY 24, 2025

13 That is to say nothing of the effect that the type and response to shock has on the individual patients involved in these studies. As seen in the Andromeda Shock Trial, and multiple other trials involving shocked patients, capillary return also reigns supreme regarding physical examination. Jan 2019; PMID: 30138573.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

RebelEM

FEBRUARY 19, 2024

Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. REBEL EM: Peripheral Vasopressors – Safe or Dangerous? Crit Care Med 2021.

Administration 137

Administration Sepsis EMS Shock 137

EMDocs

DECEMBER 6, 2024

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality. McGraw Hill; 2019.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

Pediatric EM Morsels

MARCH 17, 2023

Judge 2019) Best when given within 4 hours of the bite, but still effective within 24 hours Always give an entire vial of antivenom, never a partial vial. J Emerg Trauma Shock. Published November 13, 2019. as far west as Texas Cottonmouths/Water Moccasins live in the southeastern U.S. 2008;1(2):97-105. Published June 28, 2021.

CDC 130

CDC Poisoning Pediatrics Shock 130

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9%

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

RebelEM

NOVEMBER 30, 2023

Current SSC guidelines recommend fluid resuscitation with at least 30mL/kg IV crystalloid in patients with sepsis induced hypoperfusion or septic shock within the first three hours of resuscitation, regardless of comorbidities. May 1, 2019 , A5999-A5999. Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Crit Care Med.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. PMID: 32109843 For More Thoughts on This Topic Checkout: REBEL EM: Is ATLS Wrong About Palpable Blood Pressure Estimates? appeared first on REBEL EM - Emergency Medicine Blog. to 1.12; p = 0.03 to 0.99; p <0.01 to 1.09; p = 0.01 to 1.37; p <0.01

Resuscitation 125

Resuscitation Outcomes EMS Sepsis 125

RebelEM

JANUARY 9, 2024

You decide she is stable to be discharged home on levofloxacin (See REBEL EM for antibiotic coverage in CAP ) but consider giving her a first dose intravenously. Except for patients with poor gut absorption or those with critical infectious processes such as septic shock or necrotizing fasciitis, this belief appears to be unfounded.

Infectious Diseases 99

Infectious Diseases Pediatrics EMS Administration 99

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. Written By Magnus Nossen — with edits by Ken Grauer and Smith.

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Respir Crit Care Med 2019. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Respir Crit Care Med 2019. Max is then going to Georgetown to be an attending in both EM and ICU.

Sepsis 52

Sepsis Shock Resuscitation Administration 52

RebelEM

JUNE 26, 2023

J Trauma Acute Care Surg 2019. appeared first on REBEL EM - Emergency Medicine Blog. Four-Factor Prothrombin Complex Concentrate is Associated with Improved Survival in Trauma-Related Hemorrhage: A Nationwide Propensity-Matched Analysis. Background: Hemorrhage is the leading cause of mortality in trauma patients.

Administration 145

Administration Outcomes Resuscitation Radiology 145

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 More on this Topic: First10EM: Finally, a cure for sepsis: Herbs REBEL EM: Sepsis 3.0 2019 Sep;47(9):e735-e743. 906 randomized to the Placebo cohort.

Sepsis 98

Sepsis Outcomes Administration EMS 98

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. 2009;338:b2085.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. The TOMAHAWK Investigators.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

RebelEM

APRIL 22, 2024

Adverse events in the ICU within 90 days (new shock, cerebral ischemia, myocardial infarction, or intestinal ischemia). Read More REBEL EM: COVID-19 Archive EMRAP: Coronavirus 2019 (COVID-19 ) Post Peer-Reviewed By: Marco Propersi DO (Twitter/X: @marco_propersi ) The post How Much O2 Is Right in COVID?

Outcomes 74

Outcomes Best Practices EMS Shock 74

RebelEM

JUNE 8, 2023

Epub 2019 Jul 3. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. Am J Emerg Med. 2022 2022 Sep 5. PMID: 36108346 Cole JB, et al. J Med Toxicol. PMID: 31270748 Maheshwari K, et al. Intensive Care Med. 2018;44(6):857–67. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

ALiEM

JULY 17, 2023

sought to identify program factors associated with unfilled post-graduate year 1 (PGY-1) emergency medicine (EM) positions in the 2023 Match [1]. Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., A staggering 131 (47%) EM residency programs had unfilled PGY-1 positions among in 2023 [7].

EMS 52

EMS Burns Emergency Department Shock 52

RebelEM

MARCH 30, 2023

The TOMAHAWK (Desch 2021), COACT (Abella 2019), and PEARL (Lemkes 2019) trials examined patients with OHCA without ST elevation with a shockable rhythm, and investigators found no difference in delayed versus emergency angiogram. Cerebral unresponsiveness CPC 5: Brain death. Apnea, areflexia, EEG silence, etc. S., & Gaieski, D.

Hospitals 66

Hospitals Outcomes EKG/ECG Resuscitation 66

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

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. 2019 Dec 2;102(10):34-38. POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. Published on March 4, 2019. Emerg Med J.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

RebelEM

NOVEMBER 20, 2023

Military practice guidelines recommend REBOA for profound shock (SBP <90mmHg) 1 and ACEP along with the American College of surgeons recommend REBOA for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation. Published 2019 Sep 20.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

RebelEM

AUGUST 12, 2024

2020 Mar 14; PMID: 32183395 Post Peer Reviewed By : Salim Rezaie, MD (Twitter/X: @Srrezaie ) The post The PROTECTION Trial – A Randomized Trial of Intravenous Amino Acids for Kidney Protection appeared first on REBEL EM - Emergency Medicine Blog.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Dr. Smith's ECG Blog

MAY 13, 2020

A 60-something man presented by EMS with 5 hours of fairly typical sounding substernal chest pain. Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS.

EKG/ECG 52

EKG/ECG EMS Shock Ultrasounds 52

ACEP Now

NOVEMBER 7, 2023

EMS physicians report he was found in ventricular fibrillation. Double sequential external defibrillation (DSED) is a technique in which rapid sequential shocks are placed from two defibrillators, with defibrillation pads in two planes, such as anterior-lateral and anterior-posterior. Simon EM, Tanaka K. 2005;28:3-7.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

The paramedic notes called STEMI into question: “EMS disagree with monitor for STEMI callout. With both EMS and ED computer interpretations reading ‘STEMI’, the emergency physician activated the cath lab. Comparing J-point between leads noted no significant ST elevation or depression, with QRS prolongation from RBBB.”

EKG/ECG 73

EKG/ECG EMS Shock Ultrasounds 73

Dr. Smith's ECG Blog

OCTOBER 7, 2019

This is by one of our outstanding 3rd year residents , Aaron Robinson, with some edits and comments by Smith EMS responded to a reported seizure in a 42 year old male. One of our EMS Fellows along with a Senior EM Resident were on duty that evening, and arrived on the scene with the Fire Department. Why is the patient in shock?

Seizures 40

Seizures EKG/ECG Shock EMS 40

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. Baraniuk S, Tilley BC, del Junco DJ, Fox EE, van Belle G, Wade CE, Podbielski JM, Beeler AM, Hess JR, Bulger EM, Schreiber MA, Inaba K, Fabian TC, Kerby JD, Cohen MJ, Miller CN, Rizoli S, Scalea TM, O’Keeffe T, Brasel KJ, Cotton BA, Muskat P, Holcomb JB; PROPPR Study Group. Emerg Med Australas.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

EMDocs

APRIL 22, 2024

EMS verbalized concern to EPs that an “intracranial bleed” may have precipitated the event. However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). 2019 Oct-Dec;29(4):169-171. RV pressures > LV pressures. de Gregorio C, Stanzione A.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

RebelEM

OCTOBER 31, 2022

Fowler 2019) This concept and study design provided the framework for the Lessening Organ Dysfunction with Vitamin C (LOVIT) clinical trial. Hydrocortisone, vitamin C, and thiamine for the treatment of severe sepsis and septic shock: a retrospective before-after study. Chest 2017; 151:1229-38.

Sepsis 52

Sepsis Outcomes Research Shock 52

RebelEM

MARCH 27, 2023

2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU? 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. Paper: Owyang CG, et al. J Crit Care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

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. IF the Patient is Younger and Athletic: The mechanism of AFib in younger, athletic individuals is often heavily influenced by increased vagal tone ( Rao and Shipon — ACC, 2019 — and — Calvo et al — Br J Sports Med, 2012 ).

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

RebelEM

SEPTEMBER 26, 2022

Hayes-Larson 2019). Rezaie, MD (Twitter: @srrezaie ) The post TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding appeared first on REBEL EM - Emergency Medicine Blog. Significant coagulopathy: INR > 1.8 Table 1 Analysis: Simply put, Table 1 defines “Who is in this study?”

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

EB Medicine

DECEMBER 4, 2019

Nachi: As we are just about to see one of the busiest travel days of the year, that would be the Wednesday before Thanksgiving, we thought there would be no better time to discuss the September 2019 issue of EMP: Assisting With Air Travel Medical Emergencies: Responsibilities and Pitfalls. Nachi: So, I fly about 4 times a month for work.

Dehydration 40

Dehydration EMS Wellness Burns 40

EB Medicine

JULY 8, 2019

I’m Jeff Nusbaum and I’m back with Nachi Gupta for the 30 th episode of EMplify and the first Post-Ponte Vedra Episode of 2019. Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

JANUARY 20, 2024

We’ll keep it short, while you keep that EM brain sharp. Symptoms of heart failure and cardiogenic shock may develop in more severe cases. A 67-year-old female with past medical history of hypertension presents with acute onset of chest pain without associated symptoms.

EMS 101

EMS Fluid Resuscitation Shock EKG/ECG 101

EMDocs

JULY 15, 2023

We’ll keep it short, while you keep that EM brain sharp. link] The post EM@3AM: Erysipelas appeared first on emDOCs.net - Emergency Medicine Education. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. pneumoniae , S. Rosh Review Website Link References Bonnetblanc, J.-M., M., & Bédane, C. link] Brindle, R.,

EMS 92

EMS Infectious Diseases Shock Ultrasounds 92