ACEP Now

OCTOBER 10, 2023

Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. Background There have been a couple of large and influential trials published on BP management after an intracranial hemorrhage (ICH). Reference Ma LM, Hu X, Song L, et.

Outcomes 52

Outcomes Stroke Hospitals Emergency Department 52

EMDocs

JANUARY 13, 2024

Spoon Feed High-dose nitroglycerin improves outcomes in patients with sympathetic crashing acute pulmonary edema (SCAPE) without significant side effects when compared to low-dose nitroglycerin. 2023 Nov 28:emermed-2023-213285. doi: 10.1136/emermed-2023-213285. 2023 Nov 28:emermed-2023-213285. Emerg Med J.

Stroke 62

Stroke Shock Pediatrics Resuscitation 62

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]. as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4]. 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

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Liberal: 14.9%

Sepsis 100

Sepsis Shock Resuscitation Outcomes 100

The Trauma Pro

SEPTEMBER 12, 2023

This work comes from the Shock Trauma Center in Baltimore and is a follow on to a paper published in the New England Journal of Medicine earlier this year. AAST 2023 Plenary Paper 3. N Engl J Med 2023; 388:203-213. The paper demonstrates that aspirin is not inferior to LMWH when used for VTE prophylaxis of patients.

Fractures 147

Fractures Head Injuries Research Outcomes 147

Taming the SRU

SEPTEMBER 21, 2023

2023) doi:10.1016/j.annemergmed.2023.05.014. Exclusion criteria were pre-intubation hypotension, use of topical anesthesia, or missing data including primary outcome, patient weight, etomidate / ketamine dose. Primary outcome was post-intubation hypotension, defined as SBP < 100mg Hg within the first 15 minutes post-intubation.

Outcomes 90

Outcomes Emergency Department Shock 90

RebelEM

SEPTEMBER 28, 2023

The STREAM-1 trial found that for [2] patients with STEMI presenting within 3 hours of symptom onset and unable to attain PCI within 1 hour of first medical contact, a pharmaco-invasive strategy resulted in similar rates of death, shock, heart failure, or reinfarction compared to primary PCI. Primary PCI: 95.7% Primary PCI: 95.7%

EKG/ECG 135

EKG/ECG Allergic Reactions Shock Stroke 135

EMDocs

SEPTEMBER 7, 2024

Clinical features include abdominal or flank pain; ecchymosis to the flank, periumbilical region, proximal thighs, or scrotum; and hemorrhagic shock early in the disease course. Spontaneous retroperitoneal hematoma: etiology, characteristics, management, and outcome. angioembolization). J Emerg Med. 2012 Aug;43(2):e157-61. 2011.06.006.

EMS 73

EMS Fluid Resuscitation Resuscitation Radiology 73

PulmCCM

FEBRUARY 12, 2024

SCCM Guideline Update: Steroids for Community-Acquired Pneumonia, ARDS, Septic Shock Steroids are good medicine in the ICU, U.S. Recent studies, though, have shown steroids’ benefit in Covid pneumonia with ARDS, and for steroids improving outcomes in severe community-acquired pneumonia. critical care professional societies agree.

Shock 52

Shock Administration Sepsis Fractures 52

Critical Care Now

JULY 7, 2024

2023;e2320850. Military practice guidelines, along with ACEP and the American College of Surgeons, recommend REBOA for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation.

Resuscitation 52

Resuscitation Military Outcomes Hospitals 52

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. 2024 Feb 28:fetalneonatal-2023-326501. doi: 10.1136/archdischild-2023-326501. The primary outcome was the successful intubation on the second attempt. Of the 74.9%

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

PulmCCM

JUNE 5, 2023

Corticosteroids for community-acquired pneumonia have been studied with inconclusive results, and expert guidelines currently advise against their use except in patients with refractory septic shock. Patients with septic shock or influenza were excluded. standards of care. In the U.S., Patients with secondary pneumothoraces (e.g.,

Advances Cardiac Life Support (ACLS) 96

Advances Cardiac Life Support (ACLS) Documentation/Coding CPR Shock 96

Taming the SRU

JUNE 3, 2024

CESAR Trial Published in 2009 Found that even those who didn’t get ECMO, but were transported to a tertiary care center had better outcomes No matter where you go, critical care transport will be part of your life as a sending physician, receiving physician, or both. Get a blood gas when possible to help guide your ventilation.

Shock 89

Shock Seizures Airway Management Documentation/Coding 89

PulmCCM

JANUARY 29, 2024

AHA Updates its Cardiac Arrest Guidelines In December 2023, the American Heart Association published a “focused update” to its landmark guidelines for the management of cardiac arrest. three shocks with 2 minutes CPR in between) have been performed. PulmCCM is not affiliated with the American Heart Association.

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

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. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

The Skeptics' Guide to EM

FEBRUARY 3, 2023

Date: February 1, 2023 Reference: Wolfrum et al. Date: February 1, 2023 Reference: Wolfrum et al. The patient is in ventricular fibrillation, and you achieve return of spontaneous circulation (ROSC) on the second shock. Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. Circulation. Circulation.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Outcomes Documentation/Coding 52

Ken Grauer, MD

FEBRUARY 28, 2023

These 2 settings are: i ) In patients with severe , often longstanding pulmonary disease ; and / or , ii ) In acutely ill patients with multi-system disease ( ie, sepsis, shock, electrolyte and/or acid-base disorders ). MAT almost always occurs in one of 2 common predisposing settings. Additional material on MAT.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

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

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. link] Published February 12, 2023. Ann Emerg Med.

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation CPR EMS 84

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

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 ). Healthcare. Resusc Plus.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

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. Crit Care 2023. Background: Sepsis can induce numerous physiologic derangements. Paper: Ibarra-Estrada, M et al. 95% CI 15.4

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

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

JUNE 27, 2024

Intravenous fluid therapy and hospital outcomes for vaso-occlusive episodes in children, adolescents, and young adults with sickle cell disease. Epub 2023 Nov 27. 2023 Apr;98(4):620-627. Epub 2023 Feb 6. PMID: 36105295 Haimed A, Weiss R, Kwon S, Bhat R, Badawy SM. Pediatr Blood Cancer. 2024 Feb;71(2):e30781. Am J Hematol.

Pediatrics 75

Pediatrics EMS Dehydration Hospitals 75

Thinking Critical Care

MAY 18, 2023

In 1983 I was an Englishman abroad, the London anaesthetist who was appointed to be the English anaesthetist on the Shock Team only because the outstanding candidate from Oxford had preferred to take up a job doing muscle relaxant research with Kitz and Katz in the USA. 4] The research agenda at the time was broad.

Shock 40

Shock Research Sepsis Resuscitation 40

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. This should be suspected in patients with intraoperative cardiac arrest or shock. While both conditions rely on supportive care as the mainstay of treatment, plastic surgery literature suggests better outcomes with microscopic fat embolism.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

PulmCCM

DECEMBER 3, 2023

A European critical care society advised in 2023 against “sighs” resulting in pressure >35 cm H2O. Patients were excluded if they had reasons for emergency intubation: respiratory distress, severe hypoxemia, vomiting, or shock.) But not everyone gave up on sighs. A Hawthorne effect should be presumed —i.e.,

Poisoning 64

Poisoning Outcomes Hospitals Academics 64

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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. One-year outcomes following surgery for necrotising enterocolitis: a UK-wide cohort study.

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

The Skeptics' Guide to EM

JANUARY 7, 2023

Date: January 4th, 2023 Reference: Hasbrouck et al. Date: January 4th, 2023 Reference: Hasbrouck et al. This means we need to be asking the right questions that have patient-oriented outcomes and use proper high-quality methods to answer those questions.

Emergency Department 40

Emergency Department Research Shock EKG/ECG 40

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. Time = 3 hours: the next troponin returns at 60 ng/L.

EKG/ECG 87

EKG/ECG Shock Documentation/Coding Academics 87

Don't Forget the Bubbles

NOVEMBER 15, 2023

One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. She had septic shock on presentation and was resuscitated with 60ml/kg of balanced crystalloid solution and escalating vasoactive medications. Available at: [link] (Accessed: April 3, 2023).

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

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 75

Seizures Shock Infectious Diseases CPR 75

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

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

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