EMDocs

NOVEMBER 13, 2024

Management: Patients can rapidly progress to septic shock and multiorgan failure. C (100° F), or if the ascitic fluid ANC is > 250 cells/mm 3 Mortality increases by 8-10% for every hour delay in antibiotics for patients with cirrhosis and septic shock. 2022 Mar-Apr;12(2):519-532. 2022 Oct;106(4):Online.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 105

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

The VSR is what is causing the cardiogenic shock! Mechanical complications occur acutely and significantly alter hemodynamics leading to comp ensatory mechanism which usually involve vasoconstriction and tachycardia, both hallmarks of cardiogenic shock. PIRP is strongly associated with myocardial rupture.

Shock 109

Shock EKG/ECG Hospitals Wellness 109

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

Taming the SRU

DECEMBER 17, 2024

Other contraindications include those who are unable to drink liquid (respiratory problems or impaired unconsciousness) and patients in shock, persistent vomiting, or with an ileus. 2022 Sep 11;5(5):e827. Available from: [link] Aghsaeifard Z, Heidari G, Alizadeh R. Health Sci Rep. doi: 10.1002/hsr2.827. Intravenous 0.9%

Dehydration 84

Dehydration Fluid Resuscitation Resuscitation Administration 84

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Abdominal pain may be absent in up to 60%.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. The patient was in clinical shock with a lactate of 8. This confirms inferior, posterior, lateral, and RV MI RV MI often leads to shock and (systolic) hypotension. RVMI explains part of the shock. The April 17, 2022 post ( Leads V1,V2 misplacement ).

Shock 97

Shock EKG/ECG Academics Stroke 97

EB Medicine

JANUARY 3, 2023

In this episode, Sam Ashoo, MD, interviews Ara Festekjian, MD, one of the authors of the November 2022 Pediatric Emergency Medicine Practice article on Pediatric Septic Shock in the Emergency Department Introduction: How common is sepsis in kids and what is the mortality rate in the US?

Shock 52

Shock Pediatrics Airway Management Sepsis 52

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

ALiEM

FEBRUARY 20, 2024

2022 Jun;56:394.e1-394.e4. Epub 2022 Mar 9. 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. McCabe DJ, Walsh RD, Georgakakos PK, Radke JB, Wilson BZ. Am J Emerg Med.

Shock 73

Shock EKG/ECG Poisoning Burns 73

EMDocs

NOVEMBER 19, 2024

Published 2022. Low-dose lipid emulsion for pediatric vasoplegic shock due to quetiapine and fluvoxamine overdose: a case report. Low-dose lipid emulsion for pediatric vasoplegic shock due to quetiapine and fluvoxamine overdose: a case report. J Emerg Crit Care Med Vol 6 (October 30, 2022) J Emerg Crit Care Med.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

Pediatric EM Morsels

MARCH 17, 2023

Ahmed 2008, Meyers 2022) Of course, treat any other systemic symptoms (like respiratory failure, hypotension) as you typically would. If you are managing a snake bite from a snake that does not typically reside in the U.S., please utilize other resources and local Toxicology experts for help with management protocols.

CDC 130

CDC Poisoning Pediatrics Shock 130

The Skeptics' Guide to EM

FEBRUARY 11, 2023

NEJM 2022 Guest Skeptic: Dr. Sean Moore is an emergency physician working in Kenora Ontario, where he is Chief of Staff at Lake of the Woods District Hospital, Northern Medical Director for the Ornge air medical transport program and associate medical director with CritiCall Ontario. first appeared on The Skeptics Guide to Emergency Medicine.

Shock 57

Shock CPR Hyperthermia / Hypothermia Hospitals 57

Dr. Smith's ECG Blog

JULY 9, 2024

Here is the Queen of Hearts (version 1) interpretation: Click here to sign up for Queen of Hearts Access Angiogram images before and after intervention: Another view (before and after intervention): The patient was confirmed to be in cardiogenic shock, placed on ECMO, also with impella assist device. 15, 2022 post).

EKG/ECG 116

EKG/ECG Resuscitation Shock CPR 116

Pediatric EM Morsels

MARCH 29, 2024

Pediatr Rev (2022) 43 (7): 371–383. Incidence of inborn errors of metabolism in British Columbia, 1969–1996. Pediatrics. 2000; 105:e 10. Inborn Errors of Metabolism: Becoming Ready for Rare. Samantha A. Schrier Vergano. link] The post Rebaked: Inborn Errors of Metabolism presenting in the ED appeared first on Pediatric EM Morsels.

Dehydration 297

Dehydration Pediatrics Sepsis EMS 297

PulmCCM

OCTOBER 7, 2024

Midodrine A 75-year-old woman seems to have recovered from septic shock, but each time her norepinephrine infusion is reduced from 0.05 It was reported to improve blood pressure in children with septic shock in 1979, and in the treatment of orthostatic hypotension in 1981. mcg/kg/min, her mean arterial pressure falls below 65 mm Hg.

Shock 98

Shock Outcomes 98

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

Ken Grauer, MD

OCTOBER 25, 2024

See the October 15, 2022 post ( including My Comment at the bottom of the page ) — for review and illustration of the concept of " Precordial Swirl " ( due to proximal LAD OMI ). = A DDENDUM ( 10/26/2024 ) : I excerpted what follows below from My Comment in the August 12, 2022 post in Dr. Smith's ECG Blog ). =

EKG/ECG 238

EKG/ECG Shock Hospitals 238

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Shocked x 2 without effect. Warning: if this is VT, a calcium channel blocker can result in shock and death. Today's case is insightful in many ways — especially since despite prompt electrical cardioversion, we are told that this patient "was shocked X 2 without effect". However, this is not SVT. What to do now? K returned 3.6

EKG/ECG 139

EKG/ECG Shock Academics Documentation/Coding 139

EMDocs

MARCH 4, 2025

Bacterial Meningitis Mimics: Other flu-like illnesses: COVID, influenza, toxic shock syndrome, myocarditis, endocarditis, spinal epidural abscess, pneumonia. Epub 2022 Dec 28. A 2020 Cochrane review found the pooled sensitivity was 65%. Do not rely on this to rule out bacterial meningitis. Patients require admission. Am J Emerg Med.

Infectious Diseases 85

Infectious Diseases Seizures Poisoning Sepsis 85

Don't Forget the Bubbles

MARCH 31, 2025

The primary outcome was to evaluate the impact of % FO in paediatric patients with sepsis or septic shock at any time after PICU admission. 41% of patients with septic shock had MODS. Reviewed by Dr Sadia Irshad Article 3: Updates on the management of sepsis and shock Long B, Gottlieb M. Am J Emerg Med. 2025 Apr;90:179-191.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

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. Published December 19, 2022. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

JournalFeed

DECEMBER 24, 2022

The JournalFeed podcast for the week of Dec 19-23, 2022. These are summaries from just 2 of the 5 article we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member. The authors suggest that positional maneuvers, such as the Epley maneuver, should be the primary treatment for BPPV. #1

Shock 40

Shock Hospitals 40

RebelEM

JANUARY 18, 2024

Health Sci Rep 2022. 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. Health Sci Rep 2022. Paper: Varney J et al. References: Varney J et al.

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

Emergency Medicine Cases

JANUARY 2, 2023

Based on a blend of number of listens, feedback from listeners, website visits and my personal faves, here is EM Cases Top 10 of 2022. The post Top 10 of 2022 – EM Cases Podcasts & Blogs Highlights of the Year appeared first on Emergency Medicine Cases.

EMS 52

EMS Stroke Shock 52

Don't Forget the Bubbles

FEBRUARY 5, 2025

According to the latest figures (2022), there were approximately 6,000 recorded offences where a child was a victim of violence, including physical assault, sexual abuse, and homicide. Since 2022, NFS has become a specific crime in its own right, separate from assault.

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

EMDocs

OCTOBER 9, 2023

6 However, due to the vasoconstrictive effects, hydrocortisone may be useful in refractory shock. Treasure Island (FL): StatPearls Publishing; July 26, 2022. Corticosteroids in septic shock: a systematic review and network meta-analysis. Treasure Island (FL): StatPearls Publishing; October 17, 2022. 2014;14(2):203-207.

Basic Life Support 109

Basic Life Support CPR Fractures Emergency Department 109

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. 2022 Mar 2;83(3):1-12. Epub 2022 Mar 4. 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. Br J Hosp Med (Lond).

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Taming the SRU

JANUARY 10, 2024

Physicians believe the biggest factors contributing to ED violence are a lack of adequate punitive consequences toward the attacker and the absence of adequate protective mechanisms for staff. Additionally, ED boarding is a now a larger factor than in 2018.

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

Dr. Smith's ECG Blog

JUNE 23, 2024

They shocked him twice before return of spontaneous circulation. The above said — it may prove insightful to take another look at the Wellens' Syndrome case instantly recognized by Dr. Smith in the August 12, 2022 post in Dr. Smith’s ECG Blog. His daughter immediately started CPR and another family member called EMS.

EKG/ECG 118

EKG/ECG CPR EMS Hospitals 118

EMDocs

AUGUST 15, 2023

Published April 15, 2022. Accessed May 7, 2022. StatPearls Publishing; 2022. Accessed May 17, 2022. Accessed May 7, 2022. Accessed May 7, 2022. Accessed May 7, 2022. Accessed May 7, 2022. Treatment of snakebite poisoning. Am J Hosp Pharm. 1991;48(10):2190-2196. Venomous Snakes | NIOSH | CDC.

Poisoning 98

Poisoning CDC Administration EMS 98

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. Treasure Island (FL): StatPearls Publishing; April 30, 2022.

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

EMDocs

JULY 1, 2023

UpToDate;2022. Accessed December 31, 2022. Accessed December 31, 2022. UpToDate;2022. Accessed December 31, 2022. UpToDate;2022. Accessed December 31, 2022. UpToDate;2022. Accessed December 31, 2022. In: Post TW, ed. link] Ramphul, K., Kawasaki disease: a comprehensive review.

EMS 94

EMS Infectious Diseases Pediatrics Research 94

EMDocs

JANUARY 4, 2024

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. Accessed 12/18/2022. Accessed 12/18/2022. 2022; 55:232.e3-232.e4 Cardiotoxicity: Overdose can cause prolonged QRS and QTc intervals.

Seizures 94

Seizures EKG/ECG Poisoning Shock 94

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenic shock). As per Dr. Frick — sinus tachycardia is usually not seen with acute OMI unless the patient is in cardiogenic shock. Additionally, there is borderline right axis deviation. Both were wrong.

EKG/ECG 128

EKG/ECG Ultrasounds Shock EMS 128

ALiEM

OCTOBER 30, 2024

We did not use clonidine, despite its known alpha agonist utility in opioid withdrawal, due to the undifferentiated nature of our patients receiving the pathways, not wanting to give an antihypertensive agent to patients who sometimes are experiencing shock and other critical illness. Drug Checking Quarterly Report (Q3 2022).

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

Stop and Think

MARCH 31, 2024

Our main finding was that industry paid doctors more than $12 billion dollars between 2013-2022. His list of device approvals despite dodgy evidence is shocking. The influential Journal of the American Medical Association published our data this week. The numbers surprised me. B as in billions. Let me make two points. We use devices.

Research 138

Research Shock Hospitals 138

Mind The Bleep

DECEMBER 19, 2023

Majority of DKA patients are in a fluid deficit and present acutely with shock. Signs of shock to be mindful for are tachycardia, hypotension, prolonged CRT, pallor, and a weak thready pulse. Fluid boluses are given according to local guidelines, but generally shocked patients should receive a 10ml/kg 0.9% Marcdante, R.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98