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 138

EKG/ECG Allergic Reactions Shock Stroke 138

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%

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

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. amiodarone or lidocaine). References Tsao CW, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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% in the paper but 2.7%

Stroke 136

Stroke Outcomes Hospitals Administration 136

RebelEM

JUNE 26, 2023

Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients with Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03 PMID: 36942533 Innerhofer P et al.

Administration 145

Administration Outcomes Resuscitation Radiology 145

Don't Forget the Bubbles

FEBRUARY 5, 2025

In trauma patients, the primary sources of bleeding are external haemorrhage (blood on the floor), chest, abdomen, pelvis, and long bones in paediatrics brain is also included (infants with open sutures can bleed a significant amount intracranially) Shock The most common cause in trauma is haemorrhage.

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

PulmCCM

NOVEMBER 17, 2023

For any given hemodynamic state, measure or estimate the P ra and CO [or stroke volume, SV] simultaneously and repeatedly after each intervention. Front Physiol 2023, 14:1230654. Crit Care 2023, 27(1):205. The trick, I believe, lies in ‘operating point guided resuscitation’ [OPGR]. What does this mean? References 1.

Operations 132

Operations Ultrasounds Resuscitation Blood Transfusions 132

Taming the SRU

JUNE 3, 2024

Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there.

Shock 91

Shock Seizures Airway Management Stroke 91

University of Maryland CC Project

JUNE 16, 2023

The first annual Mid-Atlantic Neurocritical Care Symposium will bring together experts from The University of Maryland/Shock Trauma Hospital, Johns Hopkins University, INOVA, Christiana Care, and beyond to discuss the basics of caring for critically ill neurological patients, as well as highlight recent innovations in the field.

Shock 70

Shock Hospitals Wellness Stroke 70

ACEP Now

OCTOBER 10, 2023

The CT scan reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Accessed September 17, 2023. N Engl J Med.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

Slow VT below the detection rate of the ICD lead to worsening heart failure and low stroke volume. Lowering the back up rate (LRL) of the ICD/pacer allowed for an intrinsic rhythm with physiologic AV conduction and normal AV synchrony with resultant increase in stroke volume and cardiac outpt.

EKG/ECG 119

EKG/ECG Stroke Hospitals Documentation/Coding 119

Stop and Think

MARCH 28, 2023

There are many ways to reduce costs, but, in 2023, delaying the onset of disease is not one of them. In the course of investigating this benign condition, the patient suffers a stroke from a coronary angiogram. Had this person never seen a doctor, or had no prevention efforts, she would have avoided a stroke.

Stroke 52

Stroke Wellness Shock Hospitals 52

Taming the SRU

AUGUST 30, 2023

Specific Evidence: Septic arthritis: According to the European Journal of Bone and Joint Infection’s 2023 guidelines for septic arthritis of native joints (SANJO), no blood tests have adequate sensitivity or specificity to either diagnose or exclude SANJO. 2023 Feb 2;388(5):439-452. Updated 2023 Apr 24]. 2023 Jul 10.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

ACEP Now

MAY 9, 2024

JHS’ chart review project, which identified 163 patients presenting to the ED with gluteal AFT complications in a 30-month period between 2020 and 2023, provides one of the most comprehensive and informative datasets on the breadth of AFT complications as they are currently being performed.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

ACEP Now

SEPTEMBER 13, 2023

Dr. Prescott says while significant changes have been made since the time of the report, including improved communications in the pre-hospital world, stroke care and trauma care, it’s time to take another good look at Emergency Medicine. Accessed August 21, 2023. It’s time for another push.” National Academics.

EMS 45

EMS Research Military Academics 45

Dr. Smith's ECG Blog

MARCH 15, 2023

We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion. One hundred patients who had had atrial fibrillation for a mean (±SD) of 117±201 days were randomly assigned to undergo transthoracic cardioversion with or without pretreatment with 1 mg of ibutilide.

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

Mind The Bleep

FEBRUARY 7, 2024

Lung perfusion can be decreased by pulmonary hypertension, high pulmonary vascular resistance, massive pulmonary embolus (very rare in neonates), air embolism, shock with reduced blood flow and bronchopulmonary dysplasia with pulmonary hypertension. 2023, December 20th). 2023, December 18th). References Biorender.

Wellness 52

Wellness Sepsis Stroke Shock 52

EMDocs

DECEMBER 16, 2023

Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C. C, and heat stroke occurs at a core temperature > 40°C. Temps greater than 41.5C Bendall, J.

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

Taming the SRU

APRIL 26, 2023

First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. Misdiagnosis of exertional heat stroke and improper medical treatment. Cooling Methods in Heat Stroke. April 26, 2023) Acute Hyperthermia in the Emergency Department. Resuscitation 2020. Mil Med 2011.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. Stroke Authors’ Recommendation: CTA head/neck should be acquired in patients with stroke symptoms presenting within 24 hours of symptom onset.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

PulmCCM

MARCH 13, 2025

Patients in septic shock are under extreme stress and have high levels of circulating catecholamines. Infusions of ultra-short acting beta blockers such as esmolol and landiolol have been investigated as adjunctive therapies for patients with septic shock who have persistent tachycardia after treatment of pain, agitation, arrhythmias, etc.

Shock 98

Shock Sepsis Stroke Wellness 98

Don't Forget the Bubbles

NOVEMBER 18, 2024

Neonatal hypotension can result from inadequate cardiac output, low systemic vascular resistance, or a combination of both, which are influenced by: Cardiac Output: Neonates, particularly preterm ones, may have compromised cardiac output due to myocardial immaturity, leading to reduced stroke volume and heart rate. and Roberts, N.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

EMDocs

JANUARY 6, 2025

Based on available hospital resources, the patient is treated for septic shock secondary to pneumonia and an infected wound using broad-spectrum antibiotics and IV crystalloid fluids. She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI.

Infectious Diseases 75

Infectious Diseases CDC PPE Rapid Diagnostic Testing 75