Pediatric EM Morsels

JULY 21, 2023

Academic emergency medicine 12.9 Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. Fun fact for animal lovers!- cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! Acad Emerg Med.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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 140

EKG/ECG Shock Academics Documentation/Coding 140

Sensible Medicine

AUGUST 6, 2024

If you find any shocking examples of churnalism, please either write them up for us, or send them our way. 1 I expect that this experience will be the apex of my academic career. I cringe a bit posting videos of myself but I guess I should just embrace the times in which we live.

Academics 72

Academics Shock 72

Thinking Critical Care

MARCH 18, 2024

So, while waiting for HR25 (May 2025), Katie once again worked her magic to put together a one-day webinar that packs a academic and clinical punch. Preliminary Schedule: H&R 2024 Outline: Acute Inpatient Medicine – Next Level! Date: June 15 10am-4:30pm EST (7am-1:30pm PST) Format: one-day, 6.5

Shock 63

Shock Sepsis Academics 63

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

Of academic interest — are the arrhythmias that developed. As I emphasize above — my discussion regarding rhythm problem-solving is academic, in that fast rhythms associated with hemodynamic instability in today's case needed electricity, without need to specify all details of the rhythm.

EKG/ECG 134

EKG/ECG Resuscitation Academics EMS 134

Sensible Medicine

FEBRUARY 16, 2024

I was, to put it mildly, not shocked. ” David Rind is an academic primary care physician at Beth Israel Deaconess Medical Center and Chief Medical Officer of the Institute for Clinical and Economic Review. The medical center where I was a resident had a major EP program.

Documentation/Coding 135

Documentation/Coding Academics Shock Research 135

Taming the SRU

JULY 24, 2024

National campaigns to improve sepsis care, namely the Centers for Medicare and Medicaid Services’ introduction of “Severe Sepsis and Septic Shock Early Management Bundle”, have faced many challenges in physician and provider adherence. Sepsis as a disease process has been difficult to both clearly define and quickly recognize.

Sepsis 89

Sepsis Resuscitation Emergency Department Wellness 89

Sensible Medicine

SEPTEMBER 23, 2024

Update on Sensible Medicine: Vinay, Adam and I remain shocked at the success of this newsletter. As Emerson said in his 1837 American Scholar lecture: academics should think clearly not influenced by tradition or historic views. Well more than a million views per month far exceeds are expectations.

Stroke 110

Stroke Academics Outcomes Shock 110

Taming the SRU

APRIL 17, 2024

3) Methods This study was a retrospective observational study at a single academic tertiary care facility in their medical intensive care unit (MICU). Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. References Evans L, Rhodes A, Alhazzani W, et al. Crit Care Med. 2021;49:e1063-e1143.

Sepsis 94

Sepsis Research Stroke Academics 94

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. Distinction of PMVT vs VFib is an academic one in this case ). LAD — 100% proximal occlusion; with 70-89% mid-vessel narrowing. RCA — 100% proximal occlussion.

EKG/ECG 132

EKG/ECG Shock Hospitals Sepsis 132

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

He heads curriculum and conference for the academic year and is passionate about resident […] The post SGEM#344: We Will…We Will Cath You – But should We After An OHCA Without ST Elevations? She arrives in the emergency department (ED) with decreased level of consciousness and shock.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Stop and Think

JUNE 13, 2023

It’s shocking how many have subscribed and supported this newsletter. One of my colleagues, a former academic, who is now in industry, tells me I shouldn’t have this chapter. Before I tell you about two recent (mind-boggling) studies, I want to say thank you for the support. I give the talk in seven chapters.

Outcomes 98

Outcomes Academics Shock Hospitals 98

RebelEM

JUNE 8, 2023

Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. PMID: 36108346 Clinical Question: What is the efficacy and safety of peripherally administered push dose pressors for the treatment of acute hypotension? 2006;130(4):941–6. 2015;10(3):e0119331.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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. Academic Emergency Medicine 27(S1): S220; May 2020.

EKG/ECG 84

EKG/ECG Shock Documentation/Coding Academics 84

The Skeptics' Guide to EM

DECEMBER 7, 2018

He is unsuccessfully shocked. We reviewed the Cournoyer et al cohort study as part of the #SGEMHOP series with Academic Emergency Medicine ( AEM ). You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). JAMA 2009, Hagihara et al.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

The Skeptics' Guide to EM

SEPTEMBER 21, 2019

SGEM#88 : Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol) * SGEM#133 : Just Beat It (Atrial Fibrillation) with Diltiazem or Metoprolol? Background: Atrial fibrillation is the most commonly encountered significant dysrhythmia in the emergency department (1). We have covered this topic a number of times on the SGEM.

Emergency Department 52

Emergency Department Stroke Academics Shock 52

EM SIM Cases

DECEMBER 15, 2023

Delayed (but still early) development of shock in a trauma patient has the same differential differential diagnosis as during the primary survey but the treating clinician needs to be vigilant to avoid early diagnostic closure based on lab and imaging results that have been completed.

Fractures 40

Fractures Resuscitation Academics Shock 40

PHEM Cast

APRIL 10, 2016

One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. Arriving by Emergency Medical Services Improves Time to Treatment Endpoints for Patients With Severe Sepsis or Septic Shock. Academic Emergency Medicine.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

The Skeptics' Guide to EM

DECEMBER 11, 2021

. * Fujii et al ( VITAMINS RCT) JAMA 2020: n=216 patients with septic shock. Moskowits et al ( ACTS RCT) JAMA 2020: n=205 patients with septic shock. Dr. Rakesh Engineer Rakesh died suddenly in 2019 and the Society of Academic Emergency Medicine (SAEM) reflected upon how best to honour him.

Sepsis 40

Sepsis Shock Outcomes Research 40

Don't Forget the Bubbles

MAY 6, 2024

The study included academic NICUs, which may reduce the generalisability of the results. None of these changes were associated with an increased risk of severe TIAEs or desaturation. The retrospective nature of the study cannot preclude potential selection bias. The rationale for the decision to change the intubator or equipment was unknown.

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 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 Infectious Diseases 52

Downeast Emergency Medicine

APRIL 5, 2021

Amal Mattu, MD, FAAEM, FACEP Professor and Vice Chair of Academic Affairs Department of Emergency Medicine University of Maryland School of Medicine Twitter: @amalmattu Content and original authorship by Amal Mattu, MD Edited and Posted by Jeffrey A. Holmes, MD References: Shopp, et al. Ann Noninvasive Electrocardiol 2014.[ Pubmed ]

EKG/ECG 40

EKG/ECG Shock Burns Academics 40

PulmCCM

DECEMBER 3, 2023

academic centers received an additional sigh breath every 6 minutes. Patients were excluded if they had reasons for emergency intubation: respiratory distress, severe hypoxemia, vomiting, or shock.) Could there be benefit from simulating the natural episodic physiologic sighs we all perform during spontaneous breathing?

Poisoning 64

Poisoning Hospitals Outcomes Academics 64

ACEP Now

SEPTEMBER 13, 2023

Dr. Prescott, currently retired, was Chief Academic Officer of the Association of American Medical Colleges from 2008-2021 where he says he worked with “every single school of medicine in the U.S.,” National Academics. There was no center at the NIH that looks at emergency care as a specialty.” Accessed August 21, 2023.

EMS 45

EMS Research Military Academics 45

RebelEM

MARCH 27, 2023

What They Did: Retrospective, observational cohort study in a single high-volume academic hospital The ED had a 5 bed area used for ongoing management and resuscitation of patients who clinically deteriorate while boarding or while actively undergo a workup in other sections of the ED. J Crit Care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

This pattern is essentially always accompanied by cardiogenic shock and high rates of VT/VF arrest, etc. The patient arrived to the ED in cardiogenic shock but awake. From an academic standpoint — I found several subtle ECG findings from the 2 tracings in this case to be especially interesting. Code STEMI was activated.

EKG/ECG 52

EKG/ECG Shock EMS Documentation/Coding 52

Dr. No

DECEMBER 6, 2021

In the limp language of academic writing, the authors suggest their findings ‘urge caution’ (sic) in interpretation of small differences, and that ‘bias-susceptible endpoints…should be used with care’ Translating into plain English, the masks don’t work, and the mandates should go.

Academics 52

Academics Outcomes Shock Wellness 52

Dr. Smith's ECG Blog

OCTOBER 6, 2023

This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion Nevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery: An elderly patient had onset of chest pain one hour prior. His included cardiogenic shock, V Tach, AV block. He called 911.

EKG/ECG 67

EKG/ECG Academics Shock Outcomes 67

Stop and Think

OCTOBER 2, 2024

The first ORBITA trial shocked the cardiology world when it failed to find a placebo-resistant effect of stenting substantial coronary lesions. Academic Publishing I am now up to a modest 76 peer-reviewed co-authored papers. (You might say the control arm was ablation-subtracted.) Take a look at Cardiology Trials.

Stroke 44

Stroke Academics Shock Ultrasounds 44

ALiEM

JULY 17, 2023

Match Data The unprecedented numbers of unfilled PGY-1 EM residency training positions in the NRMP Match results shocked the specialty these last two years. Many of these findings were similar to a study of the 2022 EM Match results by Murano et al.,

EMS 52

EMS Burns Emergency Department Shock 52

Taming the SRU

MAY 3, 2023

Ultimately, on the cusp of deterioration, the patient was deemed most appropriate for transfer to a medical intensive care unit (MICU) at a large academic hospital via helicopter emergency medical services (HEMS). A follow-up chest x-ray at that time revealed pneumomediastinum, and she was started on broad-spectrum antibiotics.

Wellness 52

Wellness Hospitals Shock Outcomes 52

Pediatric Emergency Playbook

MARCH 1, 2016

On arrival, he was in compensated shock, with tachycardia. Fox et al in Academic Emergency Medicine found a sensitivity of 52%; with a 95% confidence interval [CI] = 31% to 73%. A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. He decompensates and needs blood.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Dr. Smith's ECG Blog

JANUARY 5, 2020

MAT almost always occurs in one of 2 common clinical scenarios : i ) Severe pulmonary disease ( ie, COPD, long-term asthma; pulmonary hypertension ) ; or , ii ) Acutely ill patients with multisystem disease ( ie, patients with sepsis; shock; electrolyte and/or acid-base disorders ).

EKG/ECG 52

EKG/ECG COPD Wellness Sepsis 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. I limit my comments to a number of academic and semantic concepts relating to the arrhythmia in this case: What is an “SVT”?

EKG/ECG 52

EKG/ECG Wellness Administration Academics 52

Taming the SRU

AUGUST 30, 2023

A 2011 meta-analysis in the journal of Academic Emergency Medicine found ESR, CRP, and PCT were not acutely useful in the diagnosis of septic arthritis due to wildly varying sensitivities and specificities between studies. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.

Infectious Diseases 89

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

EB Medicine

JULY 8, 2019

Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Don't Forget the Bubbles

DECEMBER 11, 2023

This is shocking, but they discovered a staggering dose-response model when they compared these results with medical histories. Perhaps this is highly suggestive of a positive correlation between higher executive functioning, self-regulation, and increased academic resilience.

Wellness 104

Wellness Research Outcomes Shock 104