EMDocs

JULY 1, 2023

We’ll keep it short, while you keep that EM brain sharp. Updated January 2021. link] The post EM@3AM: Kawasaki Disease appeared first on emDOCs.net - Emergency Medicine Education. Kawasaki disease: a comprehensive review. Arch Med Sci Atheroscler Dis. 2018; 3: e41-e45. link] Clinical Practice Guidelines: Kawasaki Disease.

EMS 92

EMS Infectious Diseases Pediatrics Research 92

EMDocs

NOVEMBER 4, 2023

We’ll keep it short, while you keep that EM brain sharp. McGraw Hill; 2021. J Emerg Trauma Shock. doi:10.1258/0956462053888853 The post EM@3AM: Testicular/Scrotal Abscesses appeared first on emDOCs.net - Emergency Medicine Education. Radiographics. 2013;33(3):721-740. doi:10.1148/rg.333125158 Scrotal Abscess.

EMS 94

EMS Ultrasounds Emergency Department Infectious Diseases 94

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.

Shock 71

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% NEJM 1994. [2] Richards JE et al.

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Pediatric EM Morsels

MARCH 17, 2023

In the US, the venomous snakes include rattlesnakes , copperheads, cottonmouths/water moccasins , and coral snakes [ CDC, 2021 ] Rattlesnakes live all across the United State s Copperheads inhabit the eastern U.S. If you are managing a snake bite from a snake that does not typically reside in the U.S.,

CDC 130

CDC Poisoning Pediatrics Shock 130

RebelEM

SEPTEMBER 27, 2023

While ACLS will recommend shocking these patients, as with everything else in medicine, clinical context is essential. Mohan 2021 ) Recall that the subsequently alkalemia will shift potassium intracellular. 2021 Sep;61(3):259-264. Epub 2021 Jun 17. As a result, it is essential to replete potassium simultaneously.

Poisoning 105

Poisoning Seizures Administration EKG/ECG 105

The Skeptics' Guide to EM

JANUARY 9, 2021

Date: January 5th, 2021 Reference: Grunau et al. 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?

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 132

Sepsis Hospitals Administration Outcomes 132

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

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

Dr. Smith's ECG Blog

APRIL 2, 2024

He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. Angiogram in 2021 was normal. Patient received 11 shocks by ICD and was in V-fib when EMS arrived. Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines.

EKG/ECG 133

EKG/ECG Shock CPR Stroke 133

The Skeptics' Guide to EM

AUGUST 14, 2021

Date: August 12th, 2021 Reference: Daya et al. Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Date: August 12th, 2021 Reference: Daya et al. Missy is also now the director […] The post SGEM#340: Andale, Andale Get An IO, IO for Adult OHCA?

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. Date: September 8th, 2021 Reference: Desch et al. The TOMAHAWK Investigators. The TOMAHAWK Investigators.

EKG/ECG 52

EKG/ECG Academics EMS CPR 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. Published on November 4, 2021. EMCrit 310 – Transvenous Pacemakers. EMCrit Blog. Available at [[link]

Advances Cardiac Life Support (ACLS) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

EB Medicine

DECEMBER 1, 2021

EMplify – December 2021 Announcements: The EB Medicine app is live and available for free in the Apple Store. Risk Factors Prehospital Care – what should EMS be looking for? Imaging CXR Echo CT MRI Aortogram Treatment BP management Heart Rate Shock Surgery – Who goes and when? Coming to Google Play soon.

EKG/ECG 52

EKG/ECG Emergency Department EMS Shock 52

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).’ 2021 Aug 1;94:103086. They report insufflating ‘a bundle’ of tranq dope per day.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. Brenner M, Bulger EM, Perina DG, Henry S, Kang CS, Rotondo MF, Chang MC, Weireter LJ, Coburn M, Winchell RJ, Stewart RM. 2021 Jul;38(7):488-494.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

APRIL 29, 2024

2021 PMID: 34273470 12 Petitpas F et al. 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. Resusc Plus. Resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

AUGUST 15, 2023

Published online April 2021. Clinically often swelling and tenderness may be considered significant if they extend beyond one major joint from the bite site (e.g., link] Antivenom administration North American Crotalinae snakebites – UpToDate. Accessed May 7, 2022. link] Highlights of prescribing information. Accessed May 7, 2022.

Poisoning 98

Poisoning CDC Administration EMS 98

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 2021 Apr 26;2021:6621368. 906 randomized to the Placebo cohort.

Sepsis 98

Sepsis Outcomes Administration EMS 98

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

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. Secondary Outcomes: Shock, ventricular tachycardia, and/or fibrillation within 48 hours after hospital admission.

Hospitals 66

Hospitals Outcomes EKG/ECG Resuscitation 66

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. POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. 2021 June 8;118:20219. Lancet Respir Med. 2014 Aug;2(8):638-46.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

RebelEM

MARCH 2, 2023

Essentially there was no difference, meaning we wouldn’t expect to find a difference in outcomes Although not patient oriented, why is there no breakdown of how many patients had cardiogenic shock, congestive heart failure, echocardiographic findings, or even troponin levels. appeared first on REBEL EM - Emergency Medicine Blog.

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 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). 2021 Apr;40(2):100852. Epub 2021 Mar 26. RV pressures > LV pressures.

Ultrasounds 98

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

ACEP Now

SEPTEMBER 13, 2023

Years before, he’d started his EM career as medical director of the ER at Memphis’ public hospital and Memphis Fire EMS. 1 “I remarked that EM was not even a specialty then, and suggested it might be an opportune time for an updated IOM report that examined the achievements and challenges of emergency care in the U.S.,”

EMS 45

EMS Research Academics Military 45

Dr. Smith's ECG Blog

OCTOBER 28, 2022

Annals of Emergency Medicine 2021. 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.

EKG/ECG 52

EKG/ECG EMS Shock Wellness 52

RebelEM

OCTOBER 31, 2022

Fujii 2022, Sevransky 2021) Contrary to the above trial, another RCT investigated patients in the ICU with sepsis and acute respiratory distress syndrome. 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

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 November 27, 2021 post ( LA-RA reversal ).

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

RebelEM

NOVEMBER 3, 2022

What They Did: Performed a search of the following databases: Pubmed, Embase, Cochrane, and ClinicalTrials.gov up to and including June 1, 2021. Rezaie, MD (Twitter: @srrezaie ) The post Etomidate Vs. Ketamine: A Systematic Review and Meta-Analysis appeared first on REBEL EM - Emergency Medicine Blog.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

EMDocs

JULY 15, 2023

We’ll keep it short, while you keep that EM brain sharp. 2021, May 18). link] The post EM@3AM: Erysipelas appeared first on emDOCs.net - Emergency Medicine Education. aureus (including MRSA), Klebsiella pneumoniae , influenzae , E. pneumoniae , S. Barton, E., & Featherstone, P. JAMA Dermatology , 155 (9), 1033.

EMS 92

EMS Infectious Diseases Shock Ultrasounds 92

EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. Septic shock is high on the differential diagnosis for this patient’s presentation. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. The patient currently resides at a skilled nursing facility.

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

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 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

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. 2021 Aug 1;133(2):374-378. 2021 Apr;47(2):365-372. Anesth Analg.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

EMDocs

JULY 17, 2023

Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients. However, surgical consultation should not be delayed while waiting for imaging in a patient who is in shock, appears toxic, or has signs of peritonitis. -In

Operations 98

Operations EMS Fluid Resuscitation Resuscitation 98

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 64

Fractures Resuscitation Operations EMS 64