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Episode 21- Updates and Controversies in the Early Management of Sepsis and Septic Shock

EB Medicine

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2.

Sepsis 40
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Diagnostics and Therapeutics: Managing Pneumothorax

Taming the SRU

It can be further divided into two types: primary--those that occur in generally healthy individuals without underlying lung disease, and secondary--those that occur in individuals with underlying lung disease such as COPD [1]. Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. J Emerg Trauma Shock.

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POCUS findings of hemodynamically unstable PE with cardiac arrest

EMDocs

RV chamber size alone is not enough information to rule-in a PE as RV cavity enlargement can be visualized in other conditions such as pulmonary hypertension, RV infarct, COPD and cardiac arrest from multiple causes. 10,11 Vid 1. SubX4 Asystole RV > LV. SubX2 Asystole RV > LV. RV pressures > LV pressures. 2022 Aug 27;14(8):e28481.

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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. If you can use Doppler, then you can diagnose it.

EKG/ECG 40
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A woman in her 20s with syncope

Dr. Smith's ECG Blog

Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. This patient’s pericardial effusion may likely be subacute given the size and echogenicity of the effusion (new blood is anechoic and this looks more isoechoic).

EKG/ECG 40
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ABG Versus VBG in the Emergency Department

EMDocs

Louis); Marina Boushra, MD (EM-CCM, Cleveland Clinic Foundation); Brit Long, MD (@long_brit) Case Emergency Medical Services brings in a 62-year-old male with COPD in acute on chronic hypoxemic respiratory failure (usually on 3 L nasal cannula, now on non-rebreather at 15 L/min). is more likely to portend death (13, 14).

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REBEL Core Cast 122.0 – Neutropenic Fever

RebelEM

Give appropriate fluids, vasopressors, and antibiotics.