Emergency Live

AUGUST 20, 2024

Lightning is a serious danger and can cause severe damage such as burns and cardiac arrest Lightning, a spectacular manifestation of nature, is a powerful electric shock that occurs during thunderstorms. Although fascinating, they pose a serious danger to people’s safety.

Burns 52

Burns Shock 52

Greater Sydney Area HEMS

DECEMBER 3, 2023

Join for the second part of Dr Brian Burns’ episode, as we continue to discuss mimics of shock in our trauma population. See some show notes below for more resources. Thanks for listening!

Burns 52

Burns Shock Ultrasounds 52

Don't Forget the Bubbles

OCTOBER 7, 2024

Up to 5% of burns occur secondary to electrical injuries, and this rises to 27% in developing countries. Significant injuries can occur even in the absence of extensive burns or other signs of external injury. Was the patient thrown from the source (suggestive of DC shock and may result in further blunt force trauma)?

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

RebelEM

FEBRUARY 19, 2024

Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. of patients not requiring CVC insertion. CHEST 2024. PMID: 37611862 Evans L et al.

Administration 135

Administration Sepsis EMS Shock 135

Taming the SRU

AUGUST 11, 2024

This was felt to be a necessary change in response to decreasing ITE scores and first-time board pass rates The written exam will still be required and is not changing The new certifying exam will be offered in-person in Raleigh, North Carolina with 9 sessions per year There will be two case types: clinical care cases and objective structured clinical (..)

Sepsis 88

Sepsis Burns Shock Operations 88

Taming the SRU

FEBRUARY 7, 2024

Tillotson and Hinckley Simulation Communication on arrival to a scene is key, both between you and your flight nurse before you enter the ambulance and with the EMS crew Reassessing the potential reasons for shock in a trauma is important to pick up causes that are not initially on your mind initially (blood products for hemorrhage, controlling a significant (..)

Administration 97

Administration PPE Ultrasounds Poisoning 97

ACEP Now

MARCH 14, 2024

Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. FIGURE 1: Electrical burns of the patient’s bilateral feet. FIGURE 2: Traumatic amputation and electrical burn of the patient’s left arm. He was intubated by EMS due to the extent of his injuries.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% I will continue to reach for pressors early in resuscitation of the septic shock patient.

Sepsis 67

Sepsis Shock Resuscitation Fluid Resuscitation 67

Taming the SRU

DECEMBER 17, 2024

Other conditions that lead to intravascular fluid depletion include but are not limited to starvation/dehydration, vomiting, diarrhea, burns/trauma, hyperglycemia, and hemorrhage. Oral intake is the most preferred method for receiving fluids.

Dehydration 82

Dehydration Fluid Resuscitation Administration Resuscitation 82

Taming the SRU

SEPTEMBER 15, 2023

ETT onto a fiberoptic scope.

CPR 88

CPR Burns Airway Management Wellness 88

Taming the SRU

JUNE 24, 2024

Follow this algorithm in patients with unstable bradycardia with acute heart failure, change in mental status, or concern for shock, physicians should start with atropine, 1 mg and may be continued every 3 to 5 minutes if effective. Skin burns and irritation can also result from the pacing pads and cause pain.

Advances Cardiac Life Support (ACLS) 88

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 88

EMergucate

APRIL 15, 2014

Possible airway and ventilation compromise Concerns: Burns – … Continue reading → Critically unwell patient with 1. Altered GCS 2. Tissue hypoxia 4.

Burns 40

Burns Shock EMS 40

Dr. Smith's ECG Blog

DECEMBER 3, 2024

This was written by one of our fine residents, who will soon be an EMS fellow: Michael Perlmutter Case A mid-50s male came to the ED with a burning sensation that was acutely worse while at home. I put this through the Queen of Hearts and was shocked that she did not see it. He came to the ED at the urging of his wife.

EKG/ECG 93

EKG/ECG Burns Wellness Shock 93

RebelEM

APRIL 29, 2024

Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

JUNE 7, 2023

Moulds and Wright Epidemiology: no active surveillance system and difficult to know incidence from poison control ED visits ~ 50,000, >400 deaths Can occur from car exhaust, burning stoves, paint thinner, fires Most often seen in young children, highest morbidity/mortality in elderly Upticking morbidity and mortality with natural disasters Pathophysiology: (..)

Poisoning 75

Poisoning EKG/ECG Pediatrics Burns 75

EB Medicine

NOVEMBER 1, 2018

Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. You’re probably familiar with this concept when you see high voltages arcing through the air without direct contact with the actual electrical source, leading to diffuse burns. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Ziqitza HealthCare Ltd

JUNE 13, 2024

However, if severe instances are not addressed, they can lead to shock or kidney failure. Burns For burns, place the injured area under running cool water for at least 10 minutes. This should be done in case of minor burns for instant relief. In case of major burns, call emergency medical services immediately.

Stroke 52

Stroke Burns Ambulance Services Seizures 52

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Pediatric Emergency Playbook

AUGUST 1, 2020

Temperature (core) Presentation Management Miliaria Crystallina Normal Salt-colored tiny papules, easily burst; not pruritic Modify environment; light clothing; hydration Miliaria Rubra Normal Discrimiate, red papules, not assocaited with follicles; pruritic Above plus cool compresses; calamine lotion; symptomatic tx for pruritis Miliaria (..)

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Stroke Best Practices Burns 52

Pediatric Emergency Playbook

DECEMBER 1, 2015

Case 1: Toddler with an oral commissure burn An electrical burn to the angle of the mouth cauterizes superficial bleeding vessels, and hours later the wound becomes covered with a white layer of fibrin, surrounded by erythema. Most patients do well, and the burn heals by secondary intention. Take Home Points 1. J Pediatr Surg.

Burns 40

Burns Emergency Department EKG/ECG Shock 40

Emergency Medicine Ireland

JUNE 10, 2024

We’re going to cover a bit of an environmental/tox topic today and look at carbon monoxide poisoning from Oh’s manual chapter 83 on burns. Patients are going to be pretty sick often from multiple pathologies but COHb on its own is enough to produce severe neurological injury, shock and even cardiac injury is also quite prevalent.

Poisoning 52

Poisoning EMS Burns Shock 52

SheMD

MAY 28, 2023

I was excited, scared and still a little bit in shock that I was really there. Once we become attendings, many of us forget what our core values even are and we are hypnotized to follow in the overworked and burned out physicians who came before us. I remember sitting in the classroom on my first day of medical school.

OB/GYN 52

OB/GYN Burns Shock 52

Pediatric Emergency Playbook

NOVEMBER 1, 2015

Etomidate is perfectly acceptable, but ketamine is actually a superior drug to etomidate in the rapid sequence intubation of children in septic shock. On the other side of the spectrum, permissive hypotension is not described in children, as hypotension is a late and dangerous sign of shock. Relax, it’s a myth.

Shock 40

Shock Sepsis Airway Management Pediatrics 40

Downeast Emergency Medicine

APRIL 5, 2021

Findings from 12-lead electrocardiography that predict circulatory shock from pulmonary embolism: systematic review and meta-analysis. Electrocardiographic abnormalities in patients with acute pulmonary embolism complicated by cardiogenic shock. Holmes, MD References: Shopp, et al. Acad Emerge Med 2015. [ Pdf ] Dibgy, et al.

EKG/ECG 40

EKG/ECG Shock Burns Academics 40

Northwestern EM Blog

DECEMBER 27, 2021

Marc Sala, summarize the current literature on the peripheral infusion of vasopressors, which is becoming more and more commonplace as the evidence evolves to support earlier initiation of pressors and more judicious use of crystalloid for many forms of shock.

Dislocations 52

Dislocations Emergency Department Burns Shock 52

Rural Doctors Net

AUGUST 30, 2013

The visual confrontation of a man in pain with an obvious amputation and airway burns will induce a catecholamine surge in all but the psychopathic. He may need large amounts of fluid down the track as part of his burns management – we’ll calculate this a bit later. Airway compromised by burns. Keep him warm and covered.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

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. Murano T, Weizberg M, Burns B, Hopson LR. Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., Ann Emerg Med. PMID: 37436344.

EMS 52

EMS Burns Emergency Department Shock 52

Don't Forget the Bubbles

OCTOBER 16, 2024

Don’t forget the essentials: Eat Hydrate +/- caffeinate Exercise Unwind Sleep It’s not rocket science, but it’s shocking how many of us forget! Are there distinctive sub-specialty referral pathways for your area e.g. liver, burns, surgery, neurosurgery etc. What puts a pep in your step? What are the local referral systems in place?

Teamwork 52

Teamwork Documentation/Coding Leadership Burns 52

AED Leader

OCTOBER 11, 2023

If you are hosting a meal at your home, consider brushing up on your CPR, the Heimlich Maneuver, and the steps to take for cuts and burns. Some portable defibrillators can connect to WiFi at a receiving hospital and send the patient’s heart rhythm and a record of the shocks given.

CPR 52

CPR Burns Hospitals Shock 52

AED Leader

OCTOBER 11, 2023

If you are hosting a meal at your home, consider brushing up on your CPR, the Heimlich Maneuver, and the steps to take for cuts and burns. Some portable defibrillators can connect to WiFi at a receiving hospital and send the patient’s heart rhythm and a record of the shocks given.

CPR 52

CPR Burns Hospitals Shock 52

Pediatric Emergency Playbook

OCTOBER 1, 2015

He is in compensated shock. Increased demand may be temporary, such as in burns, s/p cardiac surgery, or ay prolonged recovery. The Huber needle is not a resuscitative line. Obtain proper access to give fluids -- do not rely on the port-a-cath. Vascular devices are notoriously troublesome.

Pediatrics 40

Pediatrics Fractures Resuscitation Burns 40

PEMBlog

JUNE 5, 2024

You should also consider the possibility of quote unquote spinal shock. than it is spinal shock. And hypotension, bradycardia, or temperature instability can result from hemorrhagic and or spinal shock. This is due to the loss of sympathetic output and vasodilatation. Resuscitate with volume and blood.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

PEMBlog

OCTOBER 2, 2024

It’s a burning sensation in the chest or epigastrium, and that is the classic symptom in this age group. Typically manifests as fullness, bloating, nausea, or burning in the stomach, especially after eating. or somebody who appears pale, dehydrated, in severe pain, or worse, even in shock.

Pediatrics 52

Pediatrics Emergency Department Ultrasounds Wellness 52

Pediatric Emergency Playbook

JANUARY 1, 2017

Pediatric burns should be assessed carefully and treated aggressively. Minor burns can be treated topically and with oral medications. Minor burns can be treated topically and with oral medications. Major burns require IN, IM, or IV analgesics with morphine. Unexplained tachycardia may be the early signs of shock.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Taming the SRU

AUGUST 30, 2023

However, PCT can be elevated in severe trauma, such as burns or surgery [5,25]. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Notably, PCT is not elevated in noninfectious inflammatory conditions including most rheumatological diseases, gout, SLE, and IBD. Intensive Care Med.

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

EMDocs

JULY 15, 2023

She has had pruritus and swelling to the site accompanied by a painful burning sensation and a couple “painful knots” on her right inguinal region. She denies any prior history of deep vein thrombosis (DVT, IV drug use, or any history of vascular surgeries to the lower extremities. pneumoniae , S.

EMS 66

EMS Infectious Diseases Shock Ultrasounds 66

EB Medicine

DECEMBER 4, 2019

Nachi: AEDs are also required and have been since 2001 and amazingly when a shock was delivered in flight, 40% survived to hospital discharge with a good outcome. Fun fact: planes also take off heavy - with tons of fuel that will be burned prior to landing. Jeff: Just as on the ground, shockable rhythms do well with good BLS care.

Dehydration 40

Dehydration EMS Wellness Burns 40