Sensible Medicine

JUNE 3, 2024

For the study-of-the-week, we will publish a criticism of the DanGer-Shock trial. He and colleagues sent me sharp critiques of the DanGer-Shock trial, which compared the micro-axial flow pump (brand name Impella) vs standard care in patients who had cardiogenic shock due to myocardial infarction. A brief intro to DanGer-Shock.

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Shock Hospitals Academics 75

RebelEM

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. Hydroxocobalamin Versus Methylene Blue for the Treatment of Vasoplegic Shock Associated With Cardiopulmonary Bypass. 2023 Jul 19.

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Shock Administration Academics Hospitals 71

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%

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Resuscitation Fluid Resuscitation Head Injuries Shock 145

EMDocs

NOVEMBER 19, 2024

New York, NY: McGraw-Hill Education; 2019. Cambridge: Cambridge University Press; 2019. Published 2019. Low-dose lipid emulsion for pediatric vasoplegic shock due to quetiapine and fluvoxamine overdose: a case report. Juurlink D. Antipsychotics. In: Nelson LS, Howland MA, Lewin NA, Smith SW, Goldfrank LR, Hoffman RS, eds.

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Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

ALiEM

FEBRUARY 20, 2024

2019 Oct;37(10):1989.e1-1989.e3. Epub 2019 Jul 21. Author information Timothy Harmon, MD Emergency Medicine Resident Inova Fairfax Medical Campus, George Washington University | The post ACMT Toxicology Visual Pearl: Salt, not Shock appeared first on ALiEM. Cardiovasc Toxicol. 2017 Jul;17(3):260-266. PMID: 27435408.

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Shock EKG/ECG Poisoning Burns 73

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.

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EKG/ECG Shock Emergency Department Ambulance Services 128

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.

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Ultrasounds Shock Fluid Resuscitation Resuscitation 74

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

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Shock Outcomes Sepsis Resuscitation 52

The Trauma Pro

JUNE 18, 2024

The ABC score and the shock index are two of the more common methods. The Shock Index (SI) uses the initial vital signs to perform a quick and dirty calculation by dividing the heart rate by the systolic blood pressure. Combining the ABC score with an age-adjusted Shock Index improved the accuracy only slightly. J Pediatr Surg.

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Pediatrics Blood Transfusions Resuscitation Shock 113

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.

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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.

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CDC Poisoning Pediatrics Shock 130

EMergucate

APRIL 30, 2019

The ECG below is taken from a man who has been referred by his GP after presenting symptom-free for a health check following an electric shock at work in a domestic current.

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EKG/ECG Shock 52

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.

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Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

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.

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Sepsis Fluid Resuscitation Resuscitation Administration 121

EMergucate

APRIL 30, 2019

The ECG below is taken from a man who has been referred by his GP after presenting symptom-free for a health check following an electric shock at work in a domestic current.

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EKG/ECG Shock 52

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%

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Sepsis Shock Resuscitation Outcomes 104

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).

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Shock EKG/ECG Outcomes Hospitals 52

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 January 9, 2019 post in Dr. Smith's ECG Blog ( Please scroll down to the bottom of the page to see My Comment ).

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EKG/ECG Shock Wellness 248

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. 2019 Nov;34(4):276-281. Epub 2019 Nov 29. Blood tests: FBC, U&Es, coagulation screen, electrolytes including calcium depending on the chemical involved (see below under ‘Decontamination’). Check temperature and blood glucose levels. J Med Toxicol.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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.

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Administration Sepsis EMS Shock 137

Ken Grauer, MD

FEBRUARY 28, 2023

These 2 settings are: i ) In patients with severe , often longstanding pulmonary disease ; and / or , ii ) In acutely ill patients with multi-system disease ( ie, sepsis, shock, electrolyte and/or acid-base disorders ). The September 30, 2019 post in Dr. Smith’s ECG Blog — for an example of “MAT”, but without the tachycardia.

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EKG/ECG Documentation/Coding Sepsis COPD 195

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. LAD — 100% proximal occlusion; with 70-89% mid-vessel narrowing. LCx — 50-69% stenosis of the 1st marginal branch; with 100% distal LCx occlusion. RCA — 100% proximal occlussion.

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EKG/ECG Shock Hospitals Sepsis 131

EMDocs

OCTOBER 8, 2024

POCUS: RUSH exam (Rapid Ultrasound for Shock and Hypotension) While derived to help identify unexplained hypotension, if we accept that sinus tachycardia may be an early indicator of shock, we can utilize this general approach to help reevaluate as clinically indicated. Axilla, Sacral, GU Overall Volume Status? Do they have edema?

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Shock Emergency Department Pediatrics EKG/ECG 105

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)?

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Burns Fluid Resuscitation Shock Resuscitation 80

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. One of the goals of the early treatment of septic shock is to restore end-organ perfusion.

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Sepsis Shock Resuscitation Administration 52

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Date: September 11th, 2019 Reference: Putzu et al. Date: September 11th, 2019 Reference: Putzu et al. Case: A 45-year-old female in the emergency department is being admitted to the intensive care unit (ICU) for septic shock secondary to urinary tract infection (UTI). Critical Care Medicine. Critical Care Medicine.

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Sepsis Shock Outcomes Stroke 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

AslangerE A 65-year-old gentleman presented to the emergency department after experiencing two recent ICD shocks in the preceding hours. The subsequent ECG, taken 5-10 minutes post-shock, depicted a soothing of ST deviation. This was contributed by Co-editor Emre Aslanger, an interventional cardiologist in Turkey.

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EKG/ECG Shock Emergency Department Administration 112

EMDocs

JUNE 25, 2024

National Burn Repository 2019 Update, Report of data from 2009–2018. link] (2019). American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. References American Burn Association. Cartotto R, Johnson LS, Savetamal A, Greenhalgh D, Kubasiak JC, Pham TN, Rizzo JA, Sen S, Main E. J Burn Care Res.

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Burns Fluid Resuscitation Resuscitation Poisoning 97

Emergency Medicine Journal

OCTOBER 23, 2024

Large studies have provided reassuring safety data, 1 and guidelines recognise this therapy as a short-term measure for blood pressure support, 2 particularly in septic shock. The administration of dilute solutions of noradrenaline via peripheral venous catheters (PVCs) has gained increasing acceptance in recent years.

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Sepsis Administration Shock Hospitals 52

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. Many of these patients are started on vasopressor and inopressor medications to assist in efforts to normalize blood pressure to help improve organ perfusion. In shocky patients, arterial lines are often used to monitor hemodynamic parameters and inform treatment decisions.

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Resuscitation Outcomes EMS Sepsis 125

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. McGraw-Hill Education; 2019 Madiwale T, Liebelt E.

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Shock Poisoning Pediatrics 64

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. 2019, Bauer, Gerlach et al. 2019, Evans, Rhodes et al. 2019, Evans, Rhodes et al. N Engl J Med. 2023;388(6):499-510.

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Sepsis Shock Administration Resuscitation 52

RebelEM

JANUARY 9, 2024

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. 2019; 380(5):425-436. This feels intuitive as the IV route seems like it would be stronger, faster, and fix the patient better than the oral route.

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Infectious Diseases Pediatrics EMS Administration 99

RebelEM

JUNE 26, 2023

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

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Administration Outcomes Resuscitation Radiology 145

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.

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Administration Emergency Department Outcomes Documentation/Coding 98

The Skeptics' Guide to EM

SEPTEMBER 21, 2019

Date: September 18th, 2019 Reference: Scheuermeyer et al. AEM Sept 2019 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and clinical lecturer in Calgary. Date: September 18th, 2019 Reference: Scheuermeyer et al. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM.

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Emergency Department Stroke Academics Shock 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.

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Anaphylaxis Shock Sepsis Resuscitation 52