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 90

Shock Seizures Airway Management Stroke 90

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 94

Sepsis Fractures Documentation/Coding Administration 94

Don't Forget the Bubbles

JULY 5, 2023

The Kilifi algorithm includes five clinical situations that are common sickle cell presentations – clinical jaundice, severe anaemia, bone and joint infections, and stroke. Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Taming the SRU

JANUARY 26, 2024

Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2 10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

PulmCCM

NOVEMBER 17, 2023

shows blood administration with a direct linear relationship between Pra and CO/VR; only Pmsf is varied here. For any given hemodynamic state, measure or estimate the P ra and CO [or stroke volume, SV] simultaneously and repeatedly after each intervention. OP is operating point. See text for details. What does this mean?

Operations 132

Operations Ultrasounds Resuscitation Blood Transfusions 132

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Abdominal pain may be absent in up to 60%.

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Case: A 45-year-old female in the emergency department is being admitted to the intensive care unit (ICU) for septic shock secondary to urinary tract infection (UTI). The existing evidence to support vitamin C use in patients with septic shock is weak and has been summarized in a systematic review meta-analysis.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

PulmCCM

JULY 10, 2023

In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours). However, the practice has not been supported by randomized trials.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

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.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Downeast Emergency Medicine

APRIL 26, 2021

2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. MI or stroke). When looking at the subgroups with severe shock, there was an 18.5%

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

EB Medicine

JANUARY 10, 2020

MACE= Major Adverse Cardiovascular Event: including re-infarction, stroke, dysrhythmia, heart failure, cardiogenic shock, and death. PCI) in STEMI Early administration of aspirin decreases mortality and complications of MI (all types). (19), Part 2 : Why do we care? Patterns to know… Troponin. Part 2 : Why do we care? *

Emergency Department 40

Emergency Department Shock EKG/ECG Sepsis 40

PulmCCM

DECEMBER 11, 2024

An excellent review article titled “Sepsis and Septic Shock” was published 4 December 2024 in the New England Journal of Medicine. It’s a wonderful contribution to the literature and well worth reading. But it feels like something important was missed, or misplaced.

Sepsis 45

Sepsis Research Shock Wellness 45

PulmCCM

JANUARY 4, 2022

For example, should a fluid challenge fail to raise stroke volume [SV], a state of physiological preload intolerance exists and additional volume is arguably harmful ; further attempts to increase tissue perfusion might then be best achieved with vasoactives. For what are intravenous fluids diagnostic? ED50] and in 90% [i.e.,

Wellness 40

Wellness Outcomes Sepsis Stroke 40

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Taming the SRU

MAY 3, 2023

During the admission, she completed a course of broad-spectrum antibiotics and as the underlying shock state improved, she was also weaned off all vasopressor support. However, inhalational administration of epoprostenol requires certain equipment, namely a drug delivery device such as an Aerogen nebulizer (5).

Wellness 52

Wellness Hospitals Shock Outcomes 52

EB Medicine

SEPTEMBER 1, 2018

Unfortunately, this myokymia may not respond to antivenom administration and myokymia of the chest well and torso can necessitate intubation in extreme cases. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Nachi: In terms of respiratory effects of envenomations – they aren’t common.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Pediatric Emergency Playbook

JANUARY 1, 2017

CRIES is a 10-point scale, using a physiologic basis similar to APGAR: Crying; Requires increased oxygen administration (distress and breath-holding); Increased vital signs; Expression; and Sleeplessness ( Krechel 1995 ). Once the pain is controlled, less frequent administration of medications, with frequent reassessments, are indicated.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

EB Medicine

MAY 3, 2019

Jeff: And while it seems crass to even mention the financial impact, the number is shocking - suicide has an estimated economic burden of $5.4 Since commonly prescribed antidepressants take up to 6-8 weeks to have a clinical effect, the administration of psychotropic medications is not routinely initiated in the ED.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

RebelEM

JUNE 12, 2024

Background and Physiology Shock secondary to beta-blocker (BB) or calcium-channel blocker (CCB) toxicity bears a tremendous degree of morbidity and mortality. 1 Recall that cardiac output is a function of both stroke volume and heart rate. 1 Recall that cardiac output is a function of both stroke volume and heart rate.

Poisoning 97

Poisoning Stroke Shock Administration 97

Taming the SRU

OCTOBER 25, 2023

100U (30-60 min prior), 0.25-0.375/100U 100U (30-60 min prior), 0.25-0.375/100U

Blood Transfusions 97

Blood Transfusions Hospitals Stroke Anaphylaxis 97

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding 63

Documentation/Coding Seizures Psychiatric Wellness 63

EB Medicine

AUGUST 1, 2018

Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 Also, be aware that there are various formulations of cannabis that allow for different routes of administration. Basically, any way you can imagine, it seems like a route of administration has been explored.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

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 87

Stroke Radiology Radiology Emergency Department 87