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. Outcomes: Primary Outcome: Reduction of dyspnea measured on a verbal dyspnea scale (VDS) from 0 to 10 recorded at enrollment, then at 2, 4, and 5 hours after arrival.

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

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. Peripheral Administration of Norepinephrine: A Prospective Observational Study.

Administration 132

Administration Sepsis EMS Shock 132

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. Date: June 2nd, 2020 Reference: Permpikul et al. increase in MAP).

Sepsis 52

Sepsis Shock Resuscitation Administration 52

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. patients with more discrepant readings had NIBP checked more frequently) Some patients were on multiple vasopressors, but for an unclear reason the authors decided to only evaluate the dose of norepinephrine MAP discrepancy is not a patient oriented outcome (i.e.

Resuscitation 113

Resuscitation Outcomes EMS Sepsis 113

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Date: September 11th, 2019 Reference: Putzu et al. The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Date: September 11th, 2019 Reference: Putzu et al. You wonder if giving vitamin C will affect her outcome?

Sepsis 52

Sepsis Shock Outcomes Stroke 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 Secondary Outcome Results: ICU mortality: placebo 20.0% The primary outcome was patient oriented. 906 randomized to the Placebo cohort.

Sepsis 96

Sepsis Outcomes Administration EMS 96

RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 97

Administration Emergency Department Outcomes Documentation/Coding 97

RebelEM

APRIL 22, 2024

Intervention: Target PaO2 = 60 mm Hg Control: Target PaO2 = 90 mm Hg Outcome (primary): Absolute number of days without life support in 90 days defined as the absence of mechanical ventilation, circulatory support, or kidney replacement. Outcomes (secondary): 90-day all-cause mortality. CI) Secondary Outcomes 90-day Mortality 34.7%

Outcomes 74

Outcomes Best Practices EMS Shock 74

RebelEM

AUGUST 12, 2024

PMID: 36038001 Clinical Question: In patients undergoing cardiac surgery with cardiopulmonary bypass, does the administration of intravenous amino acid therapy lead to lower occurrence of postoperative AKI when compared to placebo?

Outcomes 81

Outcomes Hospitals Operations Shock 81

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.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

RebelEM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Article: How-Berlemont C, Lamhaut L, Diehl J, et al. 1.15; P= 0.32 1.15; P= 0.31

Hospitals 57

Hospitals Outcomes EKG/ECG Resuscitation 57

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 88

Poisoning Fluid Resuscitation Seizures Resuscitation 88

The Skeptics' Guide to EM

DECEMBER 11, 2021

Back in 2019 we were talking about Vitamin C for sepsis ( SGEM#268 ). Fujii et al ( VITAMINS RCT) JAMA 2020: n=216 patients with septic shock. No statistical difference in their primary outcome for duration of time alive and free of vasopressor administration up to day 7 or the secondary outcome of 90-day mortality.

Sepsis 40

Sepsis Shock Outcomes Research 40

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

She arrives in the emergency department (ED) with decreased level of consciousness and shock. There is evidence that taking those patients with ROSC and EKG showing STEMI directly for angiography +/- angioplasty is associated with positive patient-oriented outcomes.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

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

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Am J Med 2019, 132(5):622-630. An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Now there is a paper published in 2019 that proves the point beyond doubt, though makes it clear that this pattern is associated with very high mortality. J Electrocardiol 2013;46:240-8 2. Left main?

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

PulmCCM

JULY 10, 2023

In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours). A sequel to that trial, BLING III, is underway. access, etc.,

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. Proper stabilization and detailed communication with the burns centre are essential for optimal patient outcomes. 2019 Nov;34(4):276-281. Epub 2019 Nov 29. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% J Med Toxicol.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Emergency Medicine Ireland

OCTOBER 30, 2023

Primary outcome here was kidney based rather than mortality. Nagendran 2019 in CCM. Vasopressin versus norepinephrine infusion in patients with septic shock. Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial. Gordon, A. Nagendran, M.

Shock 52

Shock Sepsis Wellness Outcomes 52

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Lancet 2019; Vol 394, Iss 10210, P 1713-1723[ Full Text ]. There were no differences found in the secondary outcomes.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

ALiEM

JULY 17, 2023

Match Data The unprecedented numbers of unfilled PGY-1 EM residency training positions in the NRMP Match results shocked the specialty these last two years. In contrast, the greatest number of unfilled PGY-1 positions in the last decade was 30 (1.2%) in 2019 [6]. NRMP Program Results 2019-2023 Main Residency Match.

EMS 52

EMS Burns Emergency Department Shock 52

ACEP Now

APRIL 3, 2024

1,2 However, the European TTM1 trial in 2013 showed similar outcomes for those cooled to 33 degrees Celsius compared to 36 degrees Celsius, leading to a 2015 AHA class I recommendation of “cooling between 32 degrees Celsius-36 degrees Celsius.” degrees Celsius. 5,6 In 2021, the TTM2 trial was published. degrees Celsius for 72 hours.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

RebelEM

SEPTEMBER 26, 2022

Randomized study design Blind adjudication of transfusion reaction outcomes Follow-up was complete. The primary outcome was disease-oriented The enrolled cohort appears to be a convenience sample Sealed envelopes are a weak type of allocation and prone to error and manipulation. Hayes-Larson 2019).

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. 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? Paper: Owyang CG, et al.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

Here is the post shock ECG: Cardiology was called stat for ischemic VT, query SCAD vs thrombotic occlusion vs coronary vasospasm. For more on this topic — See discussion in the October 24, 2019 and July 31, 2018 posts in Dr. Smith's ECG Blog ). An unconscious patient probably has no pulses and so this is VF.

EKG/ECG 69

EKG/ECG Shock Outcomes 69

Dr. Smith's ECG Blog

OCTOBER 24, 2019

were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock. Outcome of our case Once the type 2 SCAD was identified, the heparin drip was stopped. JACC 2019 Sep 10;74(10):1290-1300. Lobo et al. examined SCAD presenting as STEMI (unlike Hassan et al. where more than 3/4 of cases were NSTEMI).

EKG/ECG 52

EKG/ECG Wellness Shock Ultrasounds 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

The patient went into cardiogenic shock and ultimately died of this MI. Main outcome measures Positive predictive value of an elevated cardiac troponin concentration for a diagnosis of type 1 myocardial infarction. Regional wall motion abnormality (WMA): Regional WMA: Inferobasal (this is another name for posterior), akinetic, small.

EKG/ECG 52

EKG/ECG Emergency Department Wellness Shock 52

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. Fun fact for animal lovers!-

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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. Outcomes: Primary Outcome: In-hospital mortality. 2.89, p = 0.01. times more intubations and 2.15

Sepsis 116

Sepsis Fluid Resuscitation Resuscitation Administration 116

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. He was shocked when the hospital CEO took him up on it, but a year later, volumes increased 30 percent with his emphasis on quality rather than cost-cutting. Published September 5, 2019. Published July 22, 2019.

Hospitals 113

Hospitals Radiology Radiology Administration 113

EMDocs

DECEMBER 1, 2024

The disease is generally mild, but in untreated cases, it can lead to more severe outcomes, especially in patients with underlying conditions such as glucose-6-phosphate dehydrogenase deficiency. Even though the disease often resolves spontaneously, prompt antibiotic therapy is essential for optimal outcomes. pregnant patients).

EMS 94

EMS Infectious Diseases Shock Airway Management 94

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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

EMDocs

NOVEMBER 13, 2024

Older age, recurrent episodes of SBP, hepatorenal syndrome, hepatic encephalopathy, acute kidney injury (AKI), concurrent GI bleeding, and higher MELD scores are predictors of worse outcomes. Management: Patients can rapidly progress to septic shock and multiorgan failure. 2019 Jan 14;11:13-22. 2019 May 13;2019:6963910.

Hyperthermia / Hypothermia 99

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 99

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

NOVEMBER 12, 2020

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Assessment was severe sudden cardiogenic shock. He remained hypotensive and in shock. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19).

Shock 52

Shock EKG/ECG Outcomes Hospitals 52