The Trauma Pro

JUNE 18, 2024

Objective MTP activation criteria have been developed and are well-supported by the literature. 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. 2019.10.008.

Pediatrics 113

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.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

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.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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. as far west as Texas Cottonmouths/Water Moccasins live in the southeastern U.S. in wetlands, rivers, and lake areas Coral snakes inhabit the southern U.S.

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% Liberal: 14.9%

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

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 January 9, 2019 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

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. 2019 Nov;34(4):276-281. Epub 2019 Nov 29. Check temperature and blood glucose levels.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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

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.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He was admitted on oxygen and was doing fairly well with saturations of 100% on 2 L nasal cannula. 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.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

EMDocs

OCTOBER 8, 2024

Tachycardia may be present both from many medications or drugs, as well as withdrawal. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? Does the patient require blood, a procedure to address obstructive shock, or other source control? Do they have edema? Sinus Tachycardia.

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

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. In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ).

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. J Trauma Acute Care Surg 2019. 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. link] (2019). American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. J Burn Care Res.

Burns 97

Burns Fluid Resuscitation Resuscitation Poisoning 97

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.

Sepsis 52

Sepsis Shock Outcomes Stroke 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

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

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

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.

Sepsis 52

Sepsis Shock Administration 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. CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. 2019 Dec 2;102(10):34-38. vs. 18.3%).

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. There are of course much more complex neurohumoral, inflammatory type cytokiney thingies going on but as you can tell they are well over my head so I’ve skipped them for now. Circulation 139, e840–e878 (2019). – Mullens, W.,

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

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

RebelEM

APRIL 22, 2024

Adverse events in the ICU within 90 days (new shock, cerebral ischemia, myocardial infarction, or intestinal ischemia). Multi-center, international study increases external validity Baseline characteristics were well-balanced between groups. Outcomes (secondary): 90-day all-cause mortality. days (0.2 – 11.5)

Outcomes 74

Outcomes Best Practices EMS Shock 74

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

Emergency Medicine Ireland

OCTOBER 30, 2023

Well, that time has come and it’s time to run through vasopressin. Well this is where the fun beings. Nagendran 2019 in CCM. And lots of other reasonable people look at the data and say, well this is a catecholamine sparing agent and is a balanced approach to receptor manipulation and just might spare a few filters.

Shock 52

Shock Sepsis Wellness Outcomes 52

Greater Sydney Area HEMS

APRIL 26, 2023

Both the stuff of legend and go by multiple names including harness hang syndrome and orthostatic intolerance, as well as bigfoot and the abominable snowman, respectively. See I told you this sounded a lot like crush injury… Let me put it another way: ST is a state of shock that can be rapidly induced by passive hanging. That’s it?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability.

Outcomes 81

Outcomes Hospitals Operations Shock 81

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

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. Moskowits et al ( ACTS RCT) JAMA 2020: n=205 patients with septic shock. Dr. Chris Carpenter knew Rakesh well and was asked to give a brief introduction to those who did not know him.

Sepsis 40

Sepsis Shock Outcomes Research 40

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

Northwestern EM Blog

FEBRUARY 21, 2022

VitalTalk, 9 May 2019, www.vitaltalk.org/guides/transitionsgoals-of-care Expert Commentary This is a nice review of the steps of what can be a very difficult conversation from Drs. Anticipatory guidance is not just for well-child checks ! UpToDate, www.uptodate.com/contents/discussing-goals-of-care Ganta, Niharika, et al.

Dehydration 52

Dehydration Shock Hospitals Wellness 52

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. A 2019 French multi-center prospective RCT involving 370 ED patients published in Annals of Emergency Medicine similarly found no difference in antibiotic exposure between PCT-guided versus usual care groups [50]. 2019 Feb;34(2S):S187-S195.

Infectious Diseases 89

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

EMDocs

APRIL 22, 2024

However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). If RV pressure is extreme, it can exceed LV pressure causing paradoxical septal wall motion toward the LV as well. 2019 Oct-Dec;29(4):169-171. RV pressures > LV pressures.

Ultrasounds 98

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

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. J Emerg Trauma Shock. Published 2019 Dec 3. doi:10.1155/2019/5271982 Lichtenstein D, Mezière G, Biderman P, Gepner A. Ann Emerg Med. Can Respir J.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

ALiEM

JULY 17, 2023

as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4]. 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. NRMP Program Results 2019-2023 Main Residency Match. Published May 2022.

EMS 52

EMS Burns Emergency Department Shock 52

Don't Forget the Bubbles

MAY 10, 2023

A shocked friend is being ushered out of the way. And then the debrief runs through STOP : Situation – a recap of the resuscitation, including the reasoning behind decisions made Things that went well Opportunities to improve Points of action – equipment issues, or whether a case review is needed And so after the hot debrief, you pause.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Mind The Bleep

JULY 15, 2023

As well as synthesising more albumin, the liver also increases its production of LDL and VDL and lipoprotein which causes hypercholesterolaemia and hypertriglyceridaemia. If a child presents acutely unwell with nephrotic syndrome they are likely to be in hypovalaemic shock, have an infection, or both. Nephrotic Syndrome in Childhood.

Allergic Reactions 52

Allergic Reactions Shock Hospitals Wellness 52