Pediatric Septic Shock
EB Medicine
JANUARY 3, 2023
2) 2023 E/M coding guidelines are in effect. 2) 2023 E/M coding guidelines are in effect. Announcements: 1) The interactive Clinical Pathways have launched and they are available for free!
Young man with Gunshot wound to right chest with hemorrhagic shock, but bullet path not near heart
Dr. Smith's ECG Blog
MARCH 7, 2024
A young man presented with a gunshot wound to the right chest, with hemo-pneumothorax and hemorrhagic shock. I’ve attached an article and an abstract (that article is in Japanese unfortunately … ) that do document that you CAN however on occasion find AIVR in otherwise healthy children — and I suppose that IS what we have here.
Shock 
109
109 Join 5,000+
Insiders
Sign Up for our Newsletter
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Trending Sources
ECG Blog #366 — Diltiazem didn't work.
Ken Grauer, MD
FEBRUARY 28, 2023
Figure-2: I've color-coded P waves from Figure-1 according to P wave morphology ( See text ). NOTE: For clarity — I've color-coded P waves in the long lead II rhythm strip according to morphology. MAT almost always occurs in one of 2 common predisposing settings.
EKG/ECG 195
195 
Issue #3: The Latest in Critical Care, 6/5/23
PulmCCM
JUNE 5, 2023
Corticosteroids for community-acquired pneumonia have been studied with inconclusive results, and expert guidelines currently advise against their use except in patients with refractory septic shock. Patients with septic shock or influenza were excluded. standards of care. Patients with secondary pneumothoraces (e.g.,
The Latest in Critical Care, 1/29/24 (Issue #27)
PulmCCM
JANUARY 29, 2024
Read the document for all the details (it’s not long). three shocks with 2 minutes CPR in between) have been performed. In accordance with the fraught ethical and emotional factors surrounding organ donation, this section is the tersest, least explicated section of the document. Cooling patients to targets below 37.5°C
Seizures 115
115 
Extreme shock and cardiac arrest in COVID patient
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?
Shock 52
52 
5 Features of Philips Defibrillators You Need to Know About
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
52 
Acute chest pain, right bundle branch block, no STEMI criteria, and negative initial troponin.
Dr. Smith's ECG Blog
SEPTEMBER 12, 2024
The paramedic called the EM physician ahead of arrival and discussed the case and ECGs, and both agreed upon activating "Code STEMI" (even though of course it is not STEMI by definition), so that the acute LAD occlusion could be treated as fast as possible. So the cath lab was activated.
EKG/ECG 111
111 
Travel-Related Illnesses in Children
Pediatric EM Morsels
FEBRUARY 2, 2024
In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk.
Grand Rounds Recap 8.16.23
Taming the SRU
SEPTEMBER 1, 2023
Shewakramani Sepsis is associated with 20-40% mortality Screening tools for detecting patient at risk for sepsis in the ED SIRS Criteria (more sensitive tool) Temp <36C (96.8F) or >38C (100.4F) HR >90 RR >20 WBC <4k or >12k (or >10% bands) qSOFA Score GCS <15 RR >22 SBP <100mmHg Overall, SIRS Criteria remains (..)
Sepsis 95
95 
Grand Rounds Recap 5.22.24
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
91 
What is an AED defibrillator
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
52 
Cardiac Science AEDs: How They Revolutionize Cardiac Arrest Response
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
52 
A 50-something with Regular Wide Complex Tachycardia: What to do if electrical cardioversion does not work?
Dr. Smith's ECG Blog
SEPTEMBER 19, 2023
Shocked x 2 without effect. Warning: if this is VT, a calcium channel blocker can result in shock and death. Today's case is insightful in many ways — especially since despite prompt electrical cardioversion, we are told that this patient "was shocked X 2 without effect". However, this is not SVT. What to do now? K returned 3.6
EKG/ECG 132
132 
The Latest in Critical Care, 7/31/23 (Issue #10)
PulmCCM
JULY 31, 2023
is to restrict caloric delivery in patients with this degree of shock. To make that leap, I for one would need to see improved outcomes with caloric restriction in patients with less-severe shock. Computers writing progress notes holds huge potential for reducing the 50% of working hours time doctors spend documenting.
Shock 98
98 
Severe shock, obtunded, and a diagnostic prehospital ECG. Also: How did this happen?
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 52
52 
Bradycardia Basics
EM Guide Wire
SEPTEMBER 9, 2020
0.5 – 1 mg q5min, max dose 3 mg peds = 0.02 Epinephrine bolus 20-40 mcg IV (EMCRIT recommended dose using push dose epi) peds 0.01 Dosing formula on MedCalc using serum level & amount ingested (mg ingested x 0.8
Some Surrogate Endpoints Are Fine
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%
How terrible can it be to fail to recognize OMI? To whom is OMI Obvious or Not Obvious?
Dr. Smith's ECG Blog
OCTOBER 8, 2024
She was worked as a full code, and ROSC was achieved. A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. About 45 minutes after the second EKG, the patient was found in cardiac arrest. She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD.
EKG/ECG 101
101 
ABG Versus VBG in the Emergency Department
EMDocs
FEBRUARY 12, 2024
ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). Trauma: In the trauma setting, metabolic acidosis often occurs secondary to hypoperfusion from hemorrhagic shock.
Learning about human factors in the emergency department
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.
What Are Some Tips for Students Studying Abroad?
Pediatric Education
OCTOBER 27, 2024
These can also be used to store documents and prescription medications. It is a culture shock. Coming home – People often don’t realize that there can be a culture shock of coming back to your home country. Documents – Have a copy of your important documents. beach activities).
How Bad Road Maintenance Can Cause Bicycle Accidents
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.
Grand Rounds Recap 7.24.24
Taming the SRU
JULY 31, 2024
morbidity and mortality - faculty case follow-up - R4 Capstone - high-risk, low prevalence diseases in pediatrics morbidity and mortality WITH dr. moulds Syncope Complete heart block is a rare but important cause of syncope P waves outnumbering QRS complexes should clue to you to high grade heart block Triage EKGs are often obtained to screen for cardiac (..)
EKG/ECG 52
52 
Epi vs. NorEpi | EVT for BAO | High-dose IN Fentanyl | Post-thrombectomy tPA | Stress of the Stress Test
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
40 
20-something with huge verapamil overdose and cardiogenic shock
Dr. Smith's ECG Blog
MAY 26, 2023
A 20-something presented after a huge verapamil overdose in cardiogenic shock. He was admitted to the ICU and was unstable, in shock, overnight. Today's patient is a young male who presented in cardiogenic shock following a massive verapamil overdose. How Are the P Waves Color-Coded? The initial K was 3.0
Shock 83
83 
The Latest in Critical Care, 3/4/24 (Issue #32)
PulmCCM
MARCH 4, 2024
About half of participants had had documented prior Covid infection. They kept a “septic shock” category for those requiring vasopressors or with lactate >5 mmol/L. standard deviation). The term “severe sepsis” was advised to be eliminated as a redundancy, since all sepsis is severe and life-threatening.
Sepsis 52
52 
The 80th Bubble wrap x DFTB MSc in PEM
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 76
76 
SGEM#391: Is it Time for a Cool Change (Hypothermia After In-Hospital Cardiac Arrest)?
The Skeptics' Guide to EM
FEBRUARY 3, 2023
You are tidying your things in anticipation of the arrival of the dayshift when a code blue is called. The patient is in ventricular fibrillation, and you achieve return of spontaneous circulation (ROSC) on the second shock. The nurses started CPR immediately and place pads before you even arrived. The patient is still unconscious.
You’re Now A Paediatric Registrar: Step Up, Survive & Thrive
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!
Teamwork 52
52 
Chemical Burns
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
52 
The Latest in Critical Care, 10/30/23 (Issue #18)
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
52 
Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?
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 133
133 
Expert Tips for Maintaining and Servicing Your Philips AED
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
52 
See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens
Dr. Smith's ECG Blog
NOVEMBER 3, 2023
When Pendell and I are coding ECGs for the Queen's training, this is one category: "Definite ischemia, difficult to differentiate between posterior OMI and subendocardial ischemia." The notes now refer to the patient being in cardiogenic shock, on pressors. In my opinion, I think it looks more like subendocardial ischemia.
EKG/ECG 81
81 
Case Report: a High-Voltage Victim
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
52 
What are treatment options for this rhythm, when all else fails?
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 107
107 
AHA/NCS Statement on Critical Care Management of Post ROSC Patients
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 75
75 
Tasty Morsels of Critical Care 072 | Cardiorenal syndrome
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
96 
A Doctor’s Reflections on Being a Patient and Patient Advocate
ACEP Now
AUGUST 15, 2023
The AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members advises against it. This was shocking to me. AMA code of medical ethics’ opinion on physicians treating family members. As a physician, how should one relate to the medical system when you are not the one providing care? What history was related?
Hospitals 52
52 
Post #3 Back-to-Sleep series
Sensible Medicine
AUGUST 14, 2024
In his work, Dr. Goldwater describes a kind of toxic-shock (cytokine) reaction in the body that results from the combination of a cold virus plus being infected with a common bacterium—each pathogen relatively harmless on its own but deadly together.
CDC 69
69 
An elderly woman with acute vomiting, presyncope, and hypotension, and a wide QRS complex
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. This one of the highest risk OMI patterns possible to see on an ECG. in-hospital mortality was 18.8% for AMI with new RBBB alone).
EKG/ECG 52
52 
The 85th Bubble Wrap Bristol Royal Children’s ED Journal Club x DFTB
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.
LBBB: Using the (Smith) Modified Sgarbossa Criteria would have saved this man's life
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
52 
Let's personalize your content