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. Evaluation and Predictors of Fluid Resuscitation in Patients With Severe Sepsis and Septic Shock.

Sepsis 122

Sepsis Fluid Resuscitation Resuscitation Administration 122

Taming the SRU

JUNE 3, 2024

Knowing the capabilities of your system BEFORE disaster strikes is crucial top 10 air care cases of 2023-2024 with drs. Get a blood gas when possible to help guide your ventilation.

Shock 91

Shock Seizures Airway Management Stroke 91

The Skeptics' Guide to EM

FEBRUARY 3, 2023

Date: February 1, 2023 Reference: Wolfrum et al. Date: February 1, 2023 Reference: Wolfrum et al. You are tidying your things in anticipation of the arrival of the dayshift when a code blue is called. 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

Dr. Smith's ECG Blog

JUNE 17, 2024

A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli A 30-something with 8 hours of chest pain and an elevated troponin Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation. I refer to My Comment in the March 4, 2023 post — in which I included a Table with ECG Findings of Acute PE.

EKG/ECG 138

EKG/ECG Emergency Department Shock Ultrasounds 138

RebelEM

OCTOBER 5, 2023

While patients received respiratory support, supportive care, and antibiotics at the discretion of the medical team, the specific interventions provided outside the study were not documented, potentially leading to co-intervention bias. Lancet 2011;377:2023-30. 2023 Aug;38(11):2593-2606. Epub 2023 Apr 19.

Research 94

Research Outcomes Administration Shock 94

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) 2024 Feb 28:fetalneonatal-2023-326501. doi: 10.1136/archdischild-2023-326501. Data collected were the worst values documented within the same calendar day as the blood cultures were obtained. Of the 74.9% showed clinical improvement without antibiotics.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions. Updated 2023 Jul 17]. Updated 2023 Jul 17]. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9%

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. 2023 Jul 17. Treasure Island (FL): StatPearls Publishing; 2023 Jan– PMID: 28846317. Accessed October 21, 2023. FIGURE 2: Traumatic amputation and electrical burn of the patient’s left arm.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Don't Forget the Bubbles

OCTOBER 10, 2024

The others, such as respiratory rate, heart rate, and decompensated shock, were excluded due to the presumed difficulty for non-healthcare professionals to assess them accurately. 2023 Mar 30;110(4):432-438. 2024 Jul 10:archdischild-2023-326727. doi: 10.1136/archdischild-2023-326727. doi: 10.1136/archdischild-2023-326247.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

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

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

When Pendell and I are coding ECGs for the Queen's training, this is one category: "Definite ischemia, difficult to differentiate between posterior OMI and subendocardial ischemia." The notes now refer to the patient being in cardiogenic shock, on pressors. In my opinion, I think it looks more like subendocardial ischemia.

EKG/ECG 83

EKG/ECG Shock Documentation/Coding Academics 83

RebelEM

JANUARY 29, 2024

Clin Exp Emerg Med 2023. Clin Exp Emerg Med 2023. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE? Click here for Direct Download of the Podcast Paper: Aykan AC et al. Reduced-Dose Systemic Fibrinolysis in Massive Pulmonary Embolism: A Pilot Study. in the paper but 2.7% Am J Cardiol 2013.

Stroke 137

Stroke Outcomes Hospitals Administration 137

EMDocs

JANUARY 11, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association (AHA) and Neurocritical Care Society (NCS) released their 2023 Scientific Statement on the critical care management of post ROSC patients. 2023 Dec 1. Neurocrit Care. doi: 10.1007/s12028-023-01871-6. Epub ahead of print.

Seizures 74

Seizures Shock Infectious Diseases CPR 74

Dr. Smith's ECG Blog

MAY 8, 2023

Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. Impella (cardiac output augmentation device) placed for cardiogenic shock Unfortunately, the patient progressed to multiorgan failure with worsening cardiac output despite being maxed on pressors and a balloon pump.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

This does not mean that all patients need to be immediately shocked — but it does mean that since 90+% of such rhythms will turn out to be VT, that we need to assume VT until proven otherwise. Because of this 1st bullet — We need to always assume VT for such rhythms until we prove otherwise, and treat accordingly.

EKG/ECG 103

EKG/ECG Stroke Hospitals Documentation/Coding 103

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). Trauma: In the trauma setting, metabolic acidosis often occurs secondary to hypoperfusion from hemorrhagic shock.

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

Don't Forget the Bubbles

NOVEMBER 5, 2023

2023 Oct 20. 2023 Oct 16. 2023 Oct 16. 2023 Sep 23. 2023 Oct 31. 2023 Oct 31. 2023 Oct 30. 2023 Oct 30. 2023 Oct 27. Parental physical disease severity and severe documented physical child abuse: a prospective cohort study. 2023 Oct 27. 2023 Oct 25. 2023 Oct 25.

Pediatrics 105

Pediatrics Hospitals Infectious Diseases Outcomes 105

RebelEM

NOVEMBER 11, 2024

compared cefepime to piperacillin-tazobactam in a cohort of 250 patients with septic shock and found a signal toward higher mortality in those receiving cefepime. 4 The 2023 ACORN Trial ( covered here on REBEL EM ) randomized 2,511 patients requiring antipseudomonal coverage to receive either cefepime or piperacillin-tazobactam.

Sepsis 84

Sepsis Outcomes Administration Shock 84

PulmCCM

SEPTEMBER 13, 2024

Surprise witnesses then made shocking allegations under oath that employees of organ procurement organizations (OPO) pressured staff to obtain organs from living patients. 39:35 Dr. Cannon: “I’ve had an OPO administrator recommend I proceed with organ procurement despite legitimate concerns that the donor was still alive.”

Administration 124

Administration Operations Leadership Hospitals 124