AED Leader

NOVEMBER 25, 2024

Effective January 1, 2017, the state’s Health and Safety Code 19300 mandates that certain high-occupancy buildings must install Automated External Defibrillators (AEDs). Specifically, the law targets high-occupancy structures such as theaters, schools, hospitals, shopping malls, and office spaces.

CPR 52

CPR Documentation/Coding Shock Hospitals 52

The Skeptics' Guide to EM

FEBRUARY 3, 2023

Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. September 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You are working an overnight shift at a small rural hospital. Circulation. Circulation.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Documentation/Coding CPR 52

Taming the SRU

JUNE 3, 2024

Myth: Some patients are “too sick to transport” Myth Part B: The receiving hospital gets to decide if a patient is too sick to transport. What drives the concern? Relative to inactions, actions receive more attention, elicit stronger emotional reactions, trigger higher regret, and are often perceived as more consequential.

Shock 91

Shock Seizures Airway Management Stroke 91

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A Rising Troponin That afternoon, he complained of increased shortness of breath and was noted to have oxygen saturations in the 70s, prompting a mini code to be called. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. What is it? 3–8 Shi et al.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

Don't Forget the Bubbles

MAY 10, 2023

Then you hear the words coming out of the speaker, “ Paediatric code black. Paediatric code black ”. You’ve heard the phrase code black before – it’s a traumatic cardiac arrest. A shocked friend is being ushered out of the way. You know a paediatric code black means paediatric traumatic cardiac arrest. It’s mayhem.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

RebelEM

JUNE 8, 2023

The relationship between ICU hypotension and in-hospital mortality and morbidity in septic patients. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. Intensive Care Med. 2018;44(6):857–67. PMID: 29872882 Jones AE, et al. 2006;130(4):941–6. PMID: 17035422 Holler JG, et al.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. First aid done pre-hospital. 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%

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

Dr. Smith's ECG Blog

JUNE 17, 2024

Given his exertional chest pain and elevated troponin, the patient was admitted to the hospital for "NSTEMI" with a plan for left heart catheterization the next day. During my decades of working with residents when hospital Attending — by far, the most commonly overlooked vital sign was respiratory rate.

EKG/ECG 139

EKG/ECG Emergency Department Shock Ultrasounds 139

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. The patient was extubated on Day-3 of the hospital stay. The patient improved, and on Day-11 of the hospital stay — he was off inotropes and on a small dose of a ß-blocker.

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

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. 5148 excluded 800 enrolled and randomized in the trial. in the hydrocortisone group vs. 11.9%

Research 94

Research Outcomes Administration Shock 94

RebelEM

AUGUST 12, 2024

Hospitals should be cautious in deciding to put their efforts towards them when the data from this trial has actually shown that it works in a diversified patient population such as that which exists in the United States.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Sensible Medicine

MAY 22, 2023

A true crisis in humanity goes unnoticed in nearly every US hospital. See screenshot: The endpoint was the proportion of patients whose chart had a documented goals of care care discussion. The setting of the trial was 3 hospitals in one healthcare system. Frail patients made more frail with each chemo infusion.

Documentation/Coding 62

Documentation/Coding Hospitals Shock Outcomes 62

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. For those listening, my hospital probably looks a little bit like yours. Roughly half of in-hospital mortality is associated with septic in some fashion. At our hospital in northern Manhattan they like to breath around 18.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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

Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED? ETT onto a fiberoptic scope. ETT onto a fiberoptic scope.

CPR 90

CPR Burns Airway Management Wellness 90

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) 807 patients between the ages of 7 days to 17 years, from the ED, ward and PICU, were included across ten hospitals in Switzerland. Data collected were the worst values documented within the same calendar day as the blood cultures were obtained. Of the 74.9%

Sepsis 75

Sepsis Pediatrics Outcomes Documentation/Coding 75

EMDocs

JANUARY 11, 2024

Methods This scientific statement was led by the AHA and NCS and focused on the acute and critical care management of adult cardiac arrest survivors of in-hospital and out-of-hospital cardiac arrest. This post covers the key components, with each section starting with the key takeaway followed by the scientific statements.

Seizures 98

Seizures Shock Infectious Diseases CPR 98

ACEP Now

JUNE 14, 2024

The ED Accreditation program is designed to recognize hospitals that adhere to policies and practice standards that meet key criteria and provide the best patient care possible. Open applications will be coming soon, but you can find out more and get on the interest list today at acep.org/EDap.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 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

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

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

Mind The Bleep

FEBRUARY 27, 2024

This is hospital dependent and you should be told about which fluid to prescribe at your induction (or I’m sure the nurses will tell you!) 3] The type of IV fluid you use will vary depending on which hospital you are working in and what is available. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. How much fluid?

Fluid Resuscitation 96

Fluid Resuscitation Hospitals Dehydration Research 96

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. I'm also aware a number of cases ( including one at my former hospital ) — where the patient was awake and alert in sustained VT for several days!

EKG/ECG 119

EKG/ECG Stroke Hospitals Documentation/Coding 119

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

ACEP Now

AUGUST 15, 2023

The AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members advises against it. I was recently hospitalized for a fever of unknown origin at a well-respected teaching hospital. I continue to go to this hospital for my medical care. Even the best physicians at the best hospitals can make mistakes.

Hospitals 52

Hospitals Documentation/Coding Fractures Dislocations 52

Downeast Emergency Medicine

APRIL 26, 2021

Four level-1 US trauma centers participated in the study where the inclusion criteria were trauma patients who were within 2 hours of their injury and were transported to the trauma center from either the field or another hospital. 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

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58). What do you see?

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

EMDocs

FEBRUARY 9, 2024

Authors: Adam Roussas, MD, MBA, MSE // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); and Brit Long, MD ( @long_brit ) Case A 40-year-old female presents to the emergency department for palpitations and lightheadedness.

EKG/ECG 97

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 97

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. Dr. Koo is faculty and an emergency physician at MedStar Washington Hospital Center in Washington, D.C., Mary’s Hospital in Leonardtown, Maryland. Click to enlarge.) Emerg Med Pract. Am J Cardiol.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Don't Forget the Bubbles

OCTOBER 10, 2024

This time the team from Bristol Royal Children’s Hospital ED tell us what is new in the world of paediatric literature… Led by Dr John Coveney a Paediatric Emergency Medicine Trainee in Bristol who has revived The Journal Club at Bristol Royal Children’s Hospital ED on a monthly basis. 2023 Mar 30;110(4):432-438.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

RebelEM

MARCH 27, 2023

2 Finally the settings initiated early in a patient’s care are often carried forward unchanged into their hospital and ICU stay. 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. Unfortunately, its not clear whether the documentation came from RTs or ED providers.

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

Dr. Smith's ECG Blog

JUNE 11, 2021

The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. But by this time the patient went into cardiogenic shock and passed away. The paramedics found the patient with ROSC and a GCS 7, and an ECG showing LBBB with possible lateral ST elevation. Vitals were HR 58 BP 167/70 R20 sat 96%.

EKG/ECG 52

EKG/ECG Documentation/Coding CPR Shock 52

PulmCCM

OCTOBER 16, 2023

hospitals, between roughly one and four central line-associated bloodstream infections (CLABSI) occur per 1,000 days with a central line in place (catheter-days). Central line infections result in excess mortality, hospital stays, and cost (although the magnitude of all three are debated). How Often Do Central Lines Become Infected?

CDC 52

CDC Hospitals Ultrasounds 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. Code STEMI was activated. in-hospital mortality was 18.8% This one of the highest risk OMI patterns possible to see on an ECG. for AMI with new RBBB alone).

EKG/ECG 52

EKG/ECG Shock EMS Documentation/Coding 52