Pediatric EM Morsels

JULY 21, 2023

We had just received a young child from EMS who was post-ictal with decreased mentation. Orso 2020] One pediatric study in this systematic review, and the intubated patients had worse outcome than non-intubated Early airway protection = lower rates of complications (in TRAUMA), but this is not always true with medical patients.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

EMDocs

MARCH 30, 2024

We’ll keep it short, while you keep that EM brain sharp. Intervertebral disks lie between vertebrae and act as shock absorbers. A 27-year-old man was brought into the emergency department via EMS after being stabbed. Published 2020 Jul 29. 2 Males experience injuries to this region at an incidence of 3:1. 2020;6(1):67.

EMS 104

EMS Fractures Emergency Department Dislocations 104

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. Ann Intensive Care.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

EMDocs

NOVEMBER 4, 2023

We’ll keep it short, while you keep that EM brain sharp. doi:10.1186/1757-1626-1-165 Hackett B, Sletten Z, Bridwell R E (July 03, 2020) Testicular Abscess and Ischemia Secondary to Epididymo-orchitis. J Emerg Trauma Shock. A 54-year-old male with a history of diabetes presents with “pain in my groin” for the past two weeks.

EMS 87

EMS Ultrasounds Emergency Department Infectious Diseases 87

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

The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC? first appeared on The Skeptics Guide to Emergency Medicine.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

RebelEM

JANUARY 18, 2024

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. appeared first on REBEL EM - Emergency Medicine Blog. to 0.97; p = 0.02 to 2.07; p = 0.91

Sepsis 130

Sepsis Hospitals Administration Outcomes 130

ACEP Now

JULY 7, 2023

However, between four and five percent of cases of VT or VF will be refractory to standard management, with nonperfusing arrhythmia persisting despite repeated shocks. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. amiodarone or lidocaine). Resuscitation. Sakai T, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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. Published 2020 Aug 19. Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. 2020;4(5):537-541.

Sepsis 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

The Skeptics' Guide to EM

AUGUST 14, 2021

Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Circulation 2020 Guest Skeptic: Missy Carter is a PA practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. J Crit Care 2020. 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.

Resuscitation 117

Resuscitation Outcomes EMS Sepsis 117

Ken Grauer, MD

JULY 15, 2023

These symptoms persisted for over an hour, which led the patient to contact EMS. Synchronized shock successfully converted the rhythm to sinus — but there was marked ST depression on the 12-lead ( Figure-2 ). Surprisingly — he was hemodynamically stable with minimal discomfort at the time his initial ECG in Figure-1 was recorded.

EKG/ECG 195

EKG/ECG Shock EMS 195

The Skeptics' Guide to EM

JUNE 6, 2020

Date: June 2nd, 2020 Reference: Permpikul et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Date: June 2nd, 2020 Reference: Permpikul et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Respir Crit Care Med 2019.

Sepsis 52

Sepsis Shock Resuscitation Administration 52

Taming the SRU

JUNE 24, 2024

Follow this algorithm in patients with unstable bradycardia with acute heart failure, change in mental status, or concern for shock, physicians should start with atropine, 1 mg and may be continued every 3 to 5 minutes if effective. Bektas, Firat, and Secgin Soyuncu. The efficacy of transcutaneous cardiac pacing in ED.”

Advances Cardiac Life Support (ACLS) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

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 132

EKG/ECG Shock Hospitals Sepsis 132

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Operations 86

Operations Radiology Radiology Fluid Resuscitation 86

RebelEM

APRIL 29, 2024

Rezaie, MD (Twitter/X: @srrezaie ) The post Don’t Forget About the IO in the Critically Ill Patient appeared first on REBEL EM - Emergency Medicine Blog. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation. Resuscitation. 2012 PMID: 21893125. 9 Zhang W et al. Medicine (Baltimore).

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

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

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

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. Macronutrients in Parenteral Nutrition: Amino Acids.

Outcomes 81

Outcomes Hospitals Operations Shock 81

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 75

EKG/ECG EMS Shock Ultrasounds 75

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

Queen of Hearts now thinks that this one looks like posterior OMI, since the STD does appear worst in V3-4: None of this seems to have been understood by the EM doctor or the cardiologist who was consulted. The notes now refer to the patient being in cardiogenic shock, on pressors. Academic Emergency Medicine 27(S1): S220; May 2020.

EKG/ECG 84

EKG/ECG Shock Documentation/Coding Academics 84

Dr. Smith's ECG Blog

JANUARY 8, 2024

Think of this diagnosis when a patient with CP and SOB again calls EMS for CP the day after acute coronary occlusion is ruled out (ie, by cath done the day before ) — especially when O2 saturation is reduced. Think of this diagnosis when a patient with CP and SOB + elevated troponin — has normal coronary arteries on cardiac cath.

EKG/ECG 72

EKG/ECG Resuscitation Hospitals EMS 72

Dr. Smith's ECG Blog

OCTOBER 28, 2022

Unfortunately, many or most physicians, including EM and cardiology, do not know this and too many also are too arrogant to learn from a paramedic. He went into cardiogenic shock and is intubated in the cardiac ICU. Great job!! You should get followup on the case. Cortland : Thank you so much for your reply!

EKG/ECG 52

EKG/ECG EMS Shock Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

Written by Pendell Meyers Family of an elderly woman with many comorbidities called EMS when she suddenly experienced shortness of breath, nausea, vomiting, and near syncope. A 12 lead ECG was obtained by EMS and is shown below: What do you think? The patient arrived to the ED in cardiogenic shock but awake. Eur Heart J.

EKG/ECG 52

EKG/ECG Shock EMS Documentation/Coding 52

RebelEM

NOVEMBER 3, 2022

Van Berkel 2017) In 2020 the NEAR study reported peri-intubation hypotension rates of 18.3% April 2020 ) RebelEM recently reviewed The EvK trial , which found a higher 7-day survival rate with ketamine but no difference in 28-day survival. April 2020 NEAR registry study represents 1/3rd the weight of this meta-analysis.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

Dr. Smith's ECG Blog

MAY 5, 2022

Submitted and written by Destiny Folk MD , peer reviewed by Meyers, Smith, Grauer, McLaren A man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. The February 11, 2020 post ( LA-RA reversal ).

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

Dr. Smith's ECG Blog

DECEMBER 10, 2022

Per EMS report, the patient had a syncopal episode at work. Seen together, these 2 ECG findings suggest possible RVH ( For review on "My Take" for the ECG diagnosis of RVH — Please see My Comment at the bottom of the page in the March 6, 2022 post and in the September 1, 2020 post of Dr. Smith's ECG Blog ).

EKG/ECG 52

EKG/ECG Operations Shock EMS 52

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). A thin wall (diameter <5mm) is suggestive of an acute etiology”. Tintinalli, J.E.

Ultrasounds 97

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Shock 97

RebelEM

MARCH 30, 2023

PMID: 35675081 What They Did: National, multicenter, randomized control, open-label parallel trial performed at 22 centers in FrancePatients enrolled from January 19, 2017 – November 23, 2020. Secondary Outcomes: Shock, ventricular tachycardia, and/or fibrillation within 48 hours after hospital admission.

Hospitals 59

Hospitals Outcomes EKG/ECG Resuscitation 59

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. Figure-2: Causes of Low Voltage on ECG ( Figure reproduced from My Comment at the bottom of the page in the November 12, 2020 post in Dr. Smith's ECG Blog ).

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

ALiEM

OCTOBER 30, 2024

Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. Our experience: It was not long ago that we instructed our staff that: ‘COWS >8, give ’em 8 (mg of buprenorphine).’ Microdosing Methods Help, 2020. They report insufflating ‘a bundle’ of tranq dope per day. J Addict Med.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

EMDocs

DECEMBER 16, 2023

We’ll keep it short, while you keep that EM brain sharp. A 34-year-old male is brought via EMS after collapsing during an outdoor adventure race. EMS reports the patient was conscious but altered, with slurred speech and confusion. The post EM@3AM: Hyperthermia appeared first on emDOCs.net - Emergency Medicine Education.

Hyperthermia / Hypothermia 87

Hyperthermia / Hypothermia EMS Stroke Seizures 87

EMDocs

FEBRUARY 12, 2024

Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. 2020 Apr 15;12:87-92. 2020 May;35(5):511-518. Epub 2019 Dec 30.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

EMDocs

JANUARY 4, 2024

In 2020, bupropion was the 18 th most-prescribed medication in the USA. Cardiogenic shock and hypotension can occur (systolic heart failure with reduced ejection fraction.) 10,12 Refractory shock or malignant arrhythmias occur in < 5% of patients. References: The Top 200 Drugs of 2020. Accessed 12/18/2022.

Seizures 84

Seizures EKG/ECG Poisoning Shock 84

RebelEM

DECEMBER 19, 2022

This procedure involves applying another set of pads attached to a second defibrillator to a patient and shocking them in hopes of terminating the rhythm. At REBEL EM, we’ve done an extensive write up that details some of the different types of DED and the electrophysiology behind it.

EMS 52

EMS CPR Shock Resuscitation 52

EMDocs

JUNE 3, 2023

What is the EM physician’s role in the stabilization of unstable pelvic injuries? 4 Patients with pelvic fractures are considered unstable when systolic blood pressure < 90mmHg and heart rate >120bpm, or in those with dyspnea, altered mental status, or skin findings of shock. Figure 2: Open book pelvic fracture.

Fractures 60

Fractures Resuscitation Operations EMS 60