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

EMDocs

NOVEMBER 19, 2024

1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. Published 2022. J Emerg Crit Care Med Vol 6 (October 30, 2022) J Emerg Crit Care Med. Accessed October 23, 2023.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

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 RV is supplied during systole as well as diastole.

Shock 97

Shock EKG/ECG Academics Stroke 97

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

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Health Sci Rep 2022. Health Sci Rep 2022. Background: Sepsis remains one of the leading causes of morbidity and mortality. Paper: Varney J et al. More evidence is needed before this becomes mainstream practice.

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

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

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

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. 6 What Can I Do Outside of Repeated Shocks and Standard ACLS? amiodarone or lidocaine).

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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. 2022 Mar 2;83(3):1-12. Epub 2022 Mar 4. Check temperature and blood glucose levels.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 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

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

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). Instead, IR performed pulmonary thrombectomy and the patient did well. As per Dr. Frick — sinus tachycardia is usually not seen with acute OMI unless the patient is in cardiogenic shock.

EKG/ECG 128

EKG/ECG Ultrasounds Shock EMS 128

ALiEM

OCTOBER 30, 2024

The Wounds Common among patients who use xylazine, the necrotic and exudative wounds are still not fully understood [5-8], but are likely due in part to direct cytotoxic effects of the drug and its impurities, as well as possible nutritional deficiencies common in those with dependence. Drug Checking Quarterly Report (Q3 2022).

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

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 92

EMS Infectious Diseases Pediatrics Research 92

RebelEM

JUNE 8, 2023

2022 Sep 5. 2022 2022 Sep 5. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. Paper: Singer S, et al. The safety and efficacy of push dose vasopressors in critically ill adults. Am J Emerg Med. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

EMDocs

JANUARY 4, 2024

3 Bupropion blocks the reuptake of dopamine and norepinephrine, as well as antagonizes acetylcholine at nicotinic receptors. 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.

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

RebelEM

APRIL 29, 2024

2022 PMID: 35206981 2. Healthcare 2022 PMID: 35206981 Post Peer Reviewed By: Frank Lodeserto, MD & Salim R. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation. . Labs can be drawn from an IO to help with rapid diagnosis in emergencies. References: 1 Astasio-Picado Á et al.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

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. The American Journal of Emergency Medicine , vol. 2090–2093, [link] Moayedi, Siamak, et al. Circulation , vol.

Advances Cardiac Life Support (ACLS) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

Dr. Smith's ECG Blog

OCTOBER 8, 2024

A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. For more on Precordial Swirl — See the October 15, 2022 post in Dr. Smith's ECG Blog ). She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD. She could not be resuscitated.

EKG/ECG 123

EKG/ECG Documentation/Coding Resuscitation Shock 123

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

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. 2022), ideally with antibiotics administered within one hour of sepsis recognition by the treating provider (Evans, Rhodes et al. N Engl J Med.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

NOVEMBER 12, 2022

Date: November 10th, 2022 Reference: de-Madaria E et al. Date: November 10th, 2022 Reference: de-Madaria E et al. Recent evidence has challenged the routine use of aggressive large volume fluid resuscitation with the potential to increase the severity of pancreatitis as well as fluid overload. Guest Skeptic: Dr. Salim R.

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Emergency Department Shock 52

RebelEM

AUGUST 12, 2024

Epub 2022 Aug 28. 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. Epub 2022 Aug 28. The PROTECTION trial. Contemp Clin Trials. The PROTECTION trial.

Outcomes 81

Outcomes Hospitals Operations Shock 81

RebelEM

JANUARY 25, 2024

CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. 2022 Dec;106:9-38. Epub 2022 Aug 1. Published on February 28, 2022. vs. 18.3%). PMID: 24998674.

Ultrasounds 129

Ultrasounds Outcomes COPD Hospitals 129

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. 2022 Sep;24(6):579-581. Epub 2022 Jun 30. PMID: 35771485.

Ultrasounds 98

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

AED Leader

JULY 19, 2023

The importance of having an up-to-date, well-maintained system shouldn’t be underestimated. According to 2022 statistics from the American Heart Association, there are more than 356,000 out-of-hospital cardiac arrests in the United States every year and just over 10% of EMS-treated victims survive to hospital discharge.

CPR 52

CPR Shock EKG/ECG Hospitals 52

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. Background Information: Double external defibrillation (DED) is an intervention often used to treat refractory ventricular fibrillation (RVF). N Engl J Med.

EMS 52

EMS CPR Shock Resuscitation 52

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

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

ALiEM

JULY 17, 2023

Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4]. Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., 2022 Main Residency Match: Results and Data.

EMS 52

EMS Burns Emergency Department Shock 52

Dr. Smith's ECG Blog

JANUARY 8, 2024

Since that moment, she had had shortness of breath as well as pressure-like chest pain. Patient was given aspirin, sublingual nitro as well as heparin. She had been sitting doing work when she experienced "waves of chest tightness". Any kind of exertion made the shortness of breath considerably worse.

EKG/ECG 71

EKG/ECG Resuscitation Hospitals EMS 71

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 Leadership 52

Emergency Medicine Ireland

MAY 27, 2024

This is a somewhat philosophical approach that reminds us that the PA pressures themselves don’t prognosticate especially well but a failure of flow from right to left will result in cardiogenic shock and death. Well, take a step back to start with. Indeed diuresing the hypotensive patient may well be the way to go.

Poisoning 52

Poisoning Shock Wellness 52

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

Northwestern EM Blog

FEBRUARY 21, 2022

Emergency doctors know intuitively what trajectory patients are on, a chronically ill elderly patient presenting with shock requiring pressors have an extremely high mortality risk and we should be clear with families about that. Anticipatory guidance is not just for well-child checks ! 2022, Feb 21). End of Life Care in the ED.

Dehydration 52

Dehydration Shock Hospitals Wellness 52

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