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. Published May 11, 2022. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Dr. Smith's ECG Blog

JUNE 23, 2024

They shocked him twice before return of spontaneous circulation. Here is his presenting ECG: ECG 1, t = 0 What do you think? . == MY Comment , by K EN G RAUER, MD ( 6/23 /2024 ): == The beauty of Dr. Frick's presentation in today's case is its simplicity in conveying a critically important finding affecting the outcome of this patient.

EKG/ECG 111

EKG/ECG CPR EMS Hospitals 111

JournalFeed

MARCH 26, 2022

The JournalFeed podcast for the week of March 21-25, 2022. For continued access to all the JournalFeed has to offer will require you to be a member as of April 4th, 2022. Check out journalfeed.org for details.

Documentation/Coding 40

Documentation/Coding Stroke Emergency Department Resuscitation 40

The Skeptics' Guide to EM

FEBRUARY 3, 2023

September 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You are working an overnight shift at a small rural hospital. The patient is in ventricular fibrillation, and you achieve return of spontaneous circulation (ROSC) on the second shock.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Outcomes Documentation/Coding 52

PulmCCM

NOVEMBER 27, 2023

Beta-blockers for septic shock (STRESS-L trial) Septic shock deranges multiple complex signaling systems in the body. A meta-analysis of 7 randomized trials (n=503) previously suggested that co-administration of esmolol to blunt vasopressor-induced tachycardia and arrhythmias could reduce mortality in septic shock by one-third.

Sepsis 52

Sepsis Shock Administration Outcomes 52

EMDocs

JUNE 27, 2024

2022 Jul 5;328(1):57-68. 2022 Aug;58:235244. Epub 2022 Jun 11. 2022 Aug;58:235-244. Epub 2022 Jun 11. 2022 Aug 29;13:796837. Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. Sickle Cell Disease: A Review.

Pediatrics 75

Pediatrics EMS Dehydration Hospitals 75

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

Shock 52

Shock Resuscitation Outcomes Fluid Resuscitation 52

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. Damping Damping is essentially the shock absorbers in the pressurized system. Keville, M.

Shock 59

Shock Resuscitation Ultrasounds Research 59

EMDocs

FEBRUARY 12, 2024

First, there can be a poor correlation between venous and arterial gases in states of shock, hemodynamic instability, or extremes of acid-base disturbances, due to poor cardiac output/circulatory failure impairing venous and arterial flow, with associated poor gas exchange as well as hypercapnia and acidemia at the tissue level (8).

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Outcomes 52

RebelEM

APRIL 29, 2024

Given AHA guidelines recommend early epinephrine administration in cardiac arrest, obtaining access is imperative for resuscitative efforts ( 9) When evaluating over 300,000 out-of-hospital cardiac arrests, a meta-analysis found no significant change in primary outcomes when IV and IO access were compared ( 10 ). 2022 PMID: 35206981 2.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

The Skeptics' Guide to EM

FEBRUARY 25, 2023

2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Pediatric Crit Care Med.

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

EMDocs

JANUARY 16, 2024

Patients can have excellent outcomes despite prolonged resuscitation. Down time and time doing CPR is not nearly as important, and even patients with low end tidal, fixed, dilated pupils, asystole rhythm, and extended low-flow times can have favorable neurologic outcomes. doi: 10.1097/MAT.0000000000001518 Accessed September 30, 2023.

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation CPR EMS 84

PulmCCM

JUNE 19, 2023

No drug or combination improved the primary outcome (a composite outcome of hypoxemia, visit to the emergency department, hospitalization, or death). That was in NEJM Aug 18 2022. Sepsis was a main trigger, and hypothermia and shock were as common (>50%) as coma. and FT4 (0-7.8 Treatment is with IV levothyroxine.

Infectious Diseases 52

Infectious Diseases Outcomes Hyperthermia / Hypothermia Sepsis 52

ALiEM

JULY 17, 2023

Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., In 2022, unfilled PGY-1 positions totaled 219 (7.9%), and 554 (18.4%) positions were unfilled in 2023 [2,5]. Published May 2022.

EMS 52

EMS Burns Emergency Department Shock 52

RebelEM

MAY 29, 2023

septic shock). Limited, small studies on its use in septic shock do not make a clear argument for use. Early Adjunctive Methylene Blue in Patients with Septic Shock: A Randomized Controlled Trial. Background: Sepsis can induce numerous physiologic derangements. Paper: Ibarra-Estrada, M et al. Crit Care 2023. 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

Dr. No

JANUARY 3, 2022

Society reaches saturation point: the pandemic no longer shocks and stupefies; instead, it becomes an unwelcome but essentially normal part of life, in effect, just another flu like illness, dreadful, even fatal, to some, but for the vast majority, no more than a tiresome nuisance.

Operations 52

Operations Shock Outcomes 52

The Skeptics' Guide to EM

JANUARY 7, 2023

AJEM 2022 Guest Skeptics: Dr. Timlin Glaser currently a fourth-year resident in emergency medicine at Lehigh Valley Health Network and future medical toxicology fellow at the University of Arizona College of Medicine – Phoenix. Date: January 4th, 2023 Reference: Hasbrouck et al. Date: January 4th, 2023 Reference: Hasbrouck et al.

Emergency Department 40

Emergency Department Research Shock EKG/ECG 40

Mind The Bleep

AUGUST 5, 2023

Complications Short bowel syndrome (following significant resection, and more common following removal of the ileocaecal valve) Intestinal stricture Sepsis / shock DIC Intestinal perforation Mortality (1, 3) References Ginglen JG, Butki N. Updated 2022 Aug 8]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Lakhoo, K. &

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

Pediatric EM Morsels

JULY 21, 2023

Jain 2022] Now used for critically ill trauma and medical patients in >75 countries. Jain 2022] Now used for critically ill trauma and medical patients in >75 countries. Jain 2022] Glasgow Coma Scale in Children – How do you perform it correctly?

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The notes now refer to the patient being in cardiogenic shock, on pressors. hours from presentation, where he was found to have an acute thrombotic LAD occlusion which was stented with resulting TIMI 3 flow, but still the patient was in severe cardiogenic shock. Published 2022 Feb 20. 2022;Available from: [link] 7.

EKG/ECG 87

EKG/ECG Shock Documentation/Coding Academics 87

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important. == MY Comment, by K EN G RAUER, MD ( 11/4 /2022 ): == Our thanks to Drs.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Don't Forget the Bubbles

DECEMBER 11, 2023

This is shocking, but they discovered a staggering dose-response model when they compared these results with medical histories. However, the ACE score was never intended to be used individually but to highlight the links between childhood adversity and lifelong healthcare outcomes and thus provide a measure of risk.

Wellness 103

Wellness Research Outcomes Shock 103

Dr. Smith's ECG Blog

JANUARY 23, 2023

Back to the case: After the patient was roomed, he revealed that he had undergone several episodes of syncope in the last 24 hours with each event resulting in a shock during which his wife reported that he would immediately awaken. The most recent event had occurred just before being triaged.

EKG/ECG 52

EKG/ECG Shock Emergency Department Ultrasounds 52

Dr. Smith's ECG Blog

MAY 14, 2022

I am sure you already shocked it, right?" Outcome Electrophysiologic study showed an accessory pathway (WPW, antidromic AVRT) Why did adenosine not work? I've reproduced the summarizing Table from my discussion of this topic in the February 14, 2022 post in Dr. Smith's Blog in Figure-1. This is what I texted back: "VT or AVRT.

EKG/ECG 52

EKG/ECG Shock Operations EMS 52

Taming the SRU

MAY 3, 2023

During the admission, she completed a course of broad-spectrum antibiotics and as the underlying shock state improved, she was also weaned off all vasopressor support. For a complete discussion of cardiogenic shock and right ventricular failure, please see this other Air Care Series post on the subject. Accessed March 10, 2022.

Wellness 52

Wellness Hospitals Shock Outcomes 52

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. Treasure Island (FL): StatPearls Publishing; November 28, 2022. J Emerg Trauma Shock. Rojas R, Wasserberger J, Balasubramaniam S. Ann Emerg Med.

Fractures 94

Fractures COPD Hospitals Emergency Department 94

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Either approach in severe sepsis with shock seems reasonable.

Sepsis 94

Sepsis Stroke Shock 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 64

Shock Administration Academics Hospitals 64

Dr. Smith's ECG Blog

MAY 8, 2023

This was several months after the 2022 ACC Guidelines adding modified Sgarbossa criteria as a STEMI equivalent in ventricular paced rhythm). Queen of Hearts Interpretation: Would 20 minutes earlier diagnosis have made a difference in his clinical outcome? Modified Sgarbossa Criteria Refresher! Skip if you don't need this.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Taming the SRU

APRIL 13, 2023

2022 Pre-AeRATE Trial: use of HFNC for preoxygenation and apneic oxygenation showed no difference in lowest SpO2 during first intubation attempt when compared with usual care. cuffed ETT) preloaded and intubate through the stoma if PPV needed Infection (i.e. This showed no difference in Cormack-Lehane score.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Mind The Bleep

FEBRUARY 27, 2024

The children who received no bolus had significantly better outcomes and reduced mortality compared to the two bolus group. [2] saline vs balanced crystalloid solutions for initial fluid management in the treatment of septic shock which may give us more insight into this topic. [5] Boluses were given in 20-40ml/kg aliquots.

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

Dr. Smith's ECG Blog

OCTOBER 6, 2023

Thus, this ECG predicts poor myocardial perfusion and poor outcome. His included cardiogenic shock, V Tach, AV block. Small vessel occlusion is measured by "blush" on the angiogram, and codified by TIMI Myocardial Perfusion (TMP) Grading. But the ECG is telling us that the myocardium will probably not recover.

EKG/ECG 70

EKG/ECG Academics Shock Outcomes 70

Don't Forget the Bubbles

MAY 10, 2023

In May 2022, Holly and Joe, two students on the joint QMUL and DFTB PEM MSc , created video presentations on human factors. A shocked friend is being ushered out of the way. The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. They’re getting CPR.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

ACEP Now

JULY 7, 2023

2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

APRIL 8, 2022

Clin Cardiol [Internet] 2022;Available from: [link] ECG 2: 35 minutes after arrival Ongoing OMI. Her long term outcome (with very large LAD MI and EF of 30%) is unknown. Otherwise it results in a terrible outcome, as in this case, with devastating permanent loss of myocardium). Lupu L, Taha L, Banai A, et al.

EKG/ECG 52

EKG/ECG Outcomes Wellness Shock 52