Taming the SRU

JUNE 3, 2024

Get a blood gas when possible to help guide your ventilation. glenn, haffner, and jackson In Flight Emergencies: As a responding physician to an in-flight emergency, you may recommend diverting the plane, however, the captain (lead pilot) will make the final decision.

Shock 91

Shock Seizures Airway Management Stroke 91

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. Provide detailed documentation of the initial assessment, treatment provided, and the patient’s response to interventions. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Check temperature and blood glucose levels.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Dr. Smith's ECG Blog

JUNE 17, 2024

A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli A 30-something with 8 hours of chest pain and an elevated troponin Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation. KEY Point: The respiratory rate that is written on the chart does not count!

EKG/ECG 139

EKG/ECG Emergency Department Shock Ultrasounds 139

RebelEM

JUNE 8, 2023

Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. 2006;130(4):941–6. PMID: 17035422 Holler JG, et al. 2015;10(3):e0119331.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

She was in shock with thready pulses. The rate is not fast enough to be causing shock, so if it is VT, the priority is still to treat hyperK and secondarily to cardiovert. They thought it was VT, but did not shock. On arrival, the patient was in shock, was intubated, and had an immediate cardiac ultrasound.

Shock 40

Shock EKG/ECG Resuscitation Ultrasounds 40

EB Medicine

OCTOBER 1, 2018

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. That’s where we’re at.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

AED Leader

JUNE 11, 2024

Quick Shock Delivery and Fast Charging In a life-threatening situation, quick response time is vital. Philips defibrillators are designed to deliver a shock quickly, minimizing the time between chest compressions and defibrillation. This rapid shock delivery feature can significantly improve the chances of a successful resuscitation.

CPR 52

CPR Shock Resuscitation Operations 52

Don't Forget the Bubbles

JULY 26, 2023

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Smith : LAD OMI with RBBB/LAFB is not only subtle on the ECG, but most of these patients are extremely ill: most I have seen are post-ROSC, in cardiogenic shock, or arrested shortly after. Initial negative troponin is not uncommon even in the most dangerous OMI cases, when the time from occlusion to troponin is within the first few hours.

EKG/ECG 121

EKG/ECG EMS Documentation/Coding Shock 121

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. In both tracings — an exceedingly fast PMVT is documented. LAD — 100% proximal occlusion; with 70-89% mid-vessel narrowing. RCA — 100% proximal occlussion.

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

Sensible Medicine

MAY 22, 2023

See screenshot: The endpoint was the proportion of patients whose chart had a documented goals of care care discussion. In a university hospital system known for its strength in palliative care, only a third of seriously ill patients in the intervention arm have a documented goals of care discussion. The absolute risk difference of 4.1%

Documentation/Coding 60

Documentation/Coding Hospitals Shock Outcomes 60

AED Leader

APRIL 24, 2024

Their AEDs are designed to be user-friendly, reliable, and effective in delivering life-saving shocks to restore a normal heart rhythm. Escalating Energy : This feature allows the AED to automatically increase the energy level of subsequent shocks if the initial shock is unsuccessful, increasing the chances of restoring a normal heart rhythm.

CPR 52

CPR Shock Pediatrics Documentation/Coding 52

RebelEM

OCTOBER 5, 2023

While patients received respiratory support, supportive care, and antibiotics at the discretion of the medical team, the specific interventions provided outside the study were not documented, potentially leading to co-intervention bias. More than 75% of patients did not complete the treatment course.

Research 94

Research Outcomes Administration Shock 94

AED Leader

AUGUST 22, 2024

By delivering an electric shock to restore normal heart rhythm in cases of ventricular fibrillation or other arrhythmias, AEDs play a vital role in increasing survival rates following sudden cardiac arrests. If it detects such a problem, it delivers an electric shock to restore normal heart function.

CPR 52

CPR Shock Operations Outcomes 52

EMDocs

JANUARY 11, 2024

Individualize the choice of using inotropes, vasopressors, or fluids to treat post-CA hypotension and to target the likely cause(s) contributing to the shock and hemodynamic state (100%, 23/23). In patients with enteral intolerance or shock, start with trophic EN (rates of 10–20 mL/h) and adjust according to tolerance (91%, 19/21).

Seizures 97

Seizures Shock Infectious Diseases CPR 97

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Data collected were the worst values documented within the same calendar day as the blood cultures were obtained. Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days.

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 81

Outcomes Hospitals Operations Shock 81

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47

Stroke 136

Stroke Outcomes Hospitals Administration 136

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. This segues relatively nicely into a section of the document on palliative care. Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. To start with there are apparently 5 types of cardiorenal syndrome.

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We should use lactate to detect occult shock. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later. Am J Cardiol.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

JournalFeed

MARCH 26, 2022

Epi vs. NorEpi Spoon feed: Continuous epinephrine infusion for post-resuscitation shock in out of hospital cardiac arrest (OHCA) was associated with both higher all-cause and cardiovascular specific mortality when compared to norepinephrine. Check out journalfeed.org for details.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

Medical Law

JULY 19, 2024

Unlike vehicles, bicycles have less stability and shock absorption, making them more susceptible to road imperfections. This documentation is vital for any subsequent legal proceedings and helps establish a clear record of the event. Moreover, these issues often go unrepaired for extended periods, exacerbating the risk.

Documentation/Coding 52

Documentation/Coding Shock Wellness 52

Dr. Smith's ECG Blog

AUGUST 9, 2024

He had no previously documented medical problems except polysubstance use. below) Other examples of AIVR: Young man with Gunshot wound to right chest with hemorrhagic shock, but bullet path not near heart. He reported a history of “Wolf-Parkinson-White” and “heart attack” but said neither had been treated. Leave it alone. Bigger et al.

EKG/ECG 107

EKG/ECG EMS Emergency Department Wellness 107

EMDocs

FEBRUARY 9, 2024

A 200J shock is reasonable – though a higher dose may be needed for larger patients. The literature base for the use of lidocaine for torsade storm is documented primarily by case studies in drug-induced TdP. Assess your patient and if there is any sign of instability, use electricity.

EKG/ECG 96

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 96

AED Leader

JUNE 25, 2024

Keep Track of Maintenance and Servicing Proper documentation of maintenance and servicing activities is crucial for record-keeping and compliance purposes. Expired pads or batteries may not deliver the shocks or power required in a life-saving situation.

Operations 52

Operations Best Practices Documentation/Coding Shock 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

This does not mean that all patients need to be immediately shocked — but it does mean that since 90+% of such rhythms will turn out to be VT, that we need to assume VT until proven otherwise. Because of this 1st bullet — We need to always assume VT for such rhythms until we prove otherwise, and treat accordingly.

EKG/ECG 119

EKG/ECG Stroke Hospitals Documentation/Coding 119

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. Documentation with coronary arteriography within 12 1/2 hours of the onset of symptoms in two cases (three episodes). FIGURE 2: Traumatic amputation and electrical burn of the patient’s left arm.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Mind The Bleep

FEBRUARY 27, 2024

saline vs balanced crystalloid solutions for initial fluid management in the treatment of septic shock which may give us more insight into this topic. [5] They concluded that some evidence in the literature shows a shorter length of hospital stay associated with prescribing balanced isotonic fluids (Plasma-lyte) over non-balanced (0.9%

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

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! Don’t be afraid to ask the simple questions: Where do I document? Top tip: verbally communicating your plan followed by clear documentation can help avoid confusion!

Documentation/Coding 52

Documentation/Coding Teamwork Leadership Burns 52

Downeast Emergency Medicine

APRIL 26, 2021

Trauma patients between the ages of 18-90 years had to have either had one documented episode of hypotension (defined as a systolic BP <90 mmHg) or tachycardia (>100 beats/minute) to be included in the study. When looking at the subgroups with severe shock, there was an 18.5% MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. There may have very well been a policy where only RTs can make changes to a ventilator after an order was placed to ensure accurate documentation.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

RebelEM

MARCH 2, 2023

Essentially there was no difference, meaning we wouldn’t expect to find a difference in outcomes Although not patient oriented, why is there no breakdown of how many patients had cardiogenic shock, congestive heart failure, echocardiographic findings, or even troponin levels. Low O2 protocol: 3.1% aOR 0.96, 95% CI 0.86 Low O2 protocol: 10.6%

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52

Don't Forget the Bubbles

OCTOBER 10, 2024

The others, such as respiratory rate, heart rate, and decompensated shock, were excluded due to the presumed difficulty for non-healthcare professionals to assess them accurately. Inclusion criteria required documented acute streptococcal pharyngitis, as per positive throat swab culture or rapid antigen testing, in patients 1-18 years of age.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Perhaps, not insignificantly, they were accustomed to receiving systematized government-supplied medical and trauma care, with "shock rooms" receiving an influx of victims, as contrasted to those later who opposed "socialized medicine." Committee on Shock. EMS in America: The Foundation Documents. Sakran, J.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Emergency Medicine Ireland

AUGUST 1, 2022

The next job is to document clearance from the blood. There are some nuances once you get into the weeds (and beyond the scope of an ICU exam) about addition of aminoglycosides (not routinely recommended) or addition of rifampicin (generally only in the context of prosthetic joints or hardware). once on the bug juice repeat the cultures.

Sepsis 40

Sepsis Shock Documentation/Coding 40

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Documents improvements in BVMs previously investigated and found deficient in FIO2. Classic pre-EMS document describing rescue care by rural volunteer squads. Committee on Shock. **Critical exam of poor FIO2 delivery, valve-jamming, rebreathing, reservoir designs. CARDEN, E., & FRIEDMAN, D. Abdo Khoury, M. Hugonnot, S.,

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

PulmCCM

OCTOBER 16, 2023

Numerous specific recommendations are available here: search the document for “dressings” or “Catheter Site Dressing Regimens” Other Methods to Prevent CLABSI Catheters impregnated with antibiotics (minocycline–rifampin) or chlorhexidine reduce catheter colonization and CVC-related bloodstream infections.

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52