ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

RebelEM

JANUARY 25, 2024

In many emergency departments (ED), US machines are readily available and can be used to rapidly assess and monitor patients with acute dyspnea at the bedside. What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021.

Ultrasounds 127

Ultrasounds Outcomes COPD Hospitals 127

RebelEM

DECEMBER 17, 2024

A large observational study of > 2000 patients found an association with fever at presentation and ICU survival for patients with severe sepsis or septic shock ( Sunden-Culberg 2017 ). Importantly, all of the patients in this study had septic shock requiring vasopressors and mechanical ventilation. PMID: 26436473 Schortgen F et al.

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Sepsis Shock EMS Emergency Department 72

Taming the SRU

OCTOBER 31, 2024

Development of a New Screening Tool for Pediatric Septic Shock. Ann Emerg Med 2024; Big Picture Current screening tools for pediatric septic shock and sepsis are highly specific but lack sensitivity. Score ranges from 0-4 points Quick Pediatric Septic Shock Screening Score (qPS4). of patients. Sensitivity of 89.7%

Sepsis 71

Sepsis Shock Pediatrics Administration 71

RebelEM

JUNE 8, 2023

Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Taming the SRU

SEPTEMBER 21, 2023

Exclusion criteria were pre-intubation hypotension, use of topical anesthesia, or missing data including primary outcome, patient weight, etomidate / ketamine dose. Primary outcome was post-intubation hypotension, defined as SBP < 100mg Hg within the first 15 minutes post-intubation.

Outcomes 91

Outcomes Emergency Department Shock 91

RebelEM

DECEMBER 4, 2024

Ann Emerg Med 2015; 65(5): 532-9. PMID: 25701296 The SGEM: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol) ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers. Ann Emerg Med 2011; 57(1): 32-3. Managing reent-onset atrial fibrillation in the emergency department.

Emergency Department 86

Emergency Department Stroke EMS Shock 86

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. He writes an […] The post SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock first appeared on The Skeptics Guide to Emergency Medicine. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Assessment was severe sudden cardiogenic shock. He remained hypotensive and in shock. The physicians found him to be in s hock, with very poor O2 saturations. What is it? There is STE in V2-V6.

Shock 52

Shock EKG/ECG Outcomes 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. Reviewed by: Isabella Davenport Article 2: Does it improve outcomes if you replace the nail in nail bed repair? The assessors scored both groups 5.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

Taming the SRU

JANUARY 10, 2024

89% agree that violence in the emergency department has harmed patient care. Phenobarbital has been proven to be equivalent to benzodiazepines with regard to clinical, pharmacologic and utilization outcomes. None of the physicians in the study believe that the rate of violence has decreased at all.

EKG/ECG 92

EKG/ECG Shock Fractures Dislocations 92

ACEP Now

JUNE 6, 2023

When considering an optimized environment for compassionate patient communication, the chaotic emergency department (ED) probably gives some clinicians pause. Example: “ I can imagine this comes as a shock” or “ I can hear how upset you are.” Example: “Would it be okay for me to share some of my concerns?”

Emergency Department 98

Emergency Department Hospitals Best Practices Shock 98

EMDocs

AUGUST 24, 2023

Study design Multicenter prospective observational cohort study across seven urban emergency departments. 18.6%) Takeaways: Drawing blood cultures 30-120 min and 30-240 min after antibiotics has significant decrements in the rate of culture positivity in patients with septic shock. Difference of 12% (95% CI 5.4

Administration 69

Administration Sepsis Shock Outcomes 69

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Guest Skeptic: Dr. Max Hockstein trained as an Emergency Medicine physician at University of Texas Southwestern and is finishing his Intensive Care fellowship at Emory. Case: It’s another day in your emergency department (ED).

Sepsis 52

Sepsis Shock Resuscitation Administration 52

RebelEM

OCTOBER 5, 2023

Secondary Outcome By day 90, mortality was 9.3% Strengths: The investigators framed a research question centered on patient outcomes, ensuring the study’s relevance and practicality. Control: Normal Saline via continuous infusion according to the same regimen used in the hydrocortisone group. in the placebo group (p = 0.006).

Research 94

Research Outcomes Administration Shock 94

RebelEM

APRIL 29, 2024

Given AHA guidelines recommend early epinephrine administration in cardiac arrest, obtaining access is imperative for resuscitative efforts ( 9) When evaluating over 300,000 out-of-hospital cardiac arrests, a meta-analysis found no significant change in primary outcomes when IV and IO access were compared ( 10 ). Crit Care Med. Resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Guest Skeptics: Dr. Erin Willard is a PGY-3 Emergency Medicine Resident, Department of Emergency Medicine, University of Arkansas for Medical Sciences. Critical Care Medicine.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

EB Medicine

SEPTEMBER 1, 2018

Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

The Skeptics' Guide to EM

AUGUST 14, 2021

Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Circulation 2020 Guest Skeptic: Missy Carter is a PA practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Annals of emergency medicine, 82(1), 3746.

EMS 72

EMS Sepsis Shock Fluid Resuscitation 72

EB Medicine

MARCH 1, 2019

This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: Emergency Department Diagnosis and Management. Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

RebelEM

NOVEMBER 20, 2023

Military practice guidelines recommend REBOA for profound shock (SBP <90mmHg) 1 and ACEP along with the American College of surgeons recommend REBOA for traumatic life-threatening hemorrhage below the diaphragm in patients with hemorrhagic shock who are unresponsive or transiently responsive to resuscitation.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

EM Literature of Note

MARCH 2, 2023

First, and not least, the Annals of Emergency Medicine Podcast , the Ryan and Rory Show, recapping the articles from each month’s issue, available for free on your choice of streaming platforms: Apple Podcasts Google Podcasts Soundcloud Then, there’s always something to learn from ACEP Now!

Emergency Department 52

Emergency Department Resuscitation Shock EMS 52

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

The Skeptics' Guide to EM

JANUARY 15, 2022

Intensive Care Med 2021 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a professor of Emergency Medical Services at Tacoma Community College’s paramedic program. Both agents are considered hemodynamically stable, but any induction agent may precipitate shock in the critically ill.

Sepsis 42

Sepsis Shock Emergency Department Outcomes 42

Taming the SRU

SEPTEMBER 1, 2023

for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 94

Sepsis Fractures Documentation/Coding Administration 94

PHEM Cast

APRIL 10, 2016

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Am J Emerg Med. Severe Sepsis in Pre-Hospital Emergency Care. Academic Emergency Medicine. Emergency Medicine Journal. Prehosp Emerg Care.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

EB Medicine

MAY 3, 2019

This month, we’re moving into uncharted territories for the podcast… we’re talking psychiatry Nachi: Specifically, we’ll be discussing Depressed and Suicidal Patients in the emergency department. The strongest predictor for suicide-related outcomes is history of prior suicidal ideation or suicide attempt.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

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

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause.

Emergency Department 40

Emergency Department Sepsis Operations Ultrasounds 40

Taming the SRU

JANUARY 26, 2024

Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2 10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

Critical Care Now

JULY 7, 2024

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. Reading Time: 3 minutes Jansen JO, Hudson J, Cochran C, et al. 2023;e2320850.

Resuscitation 52

Resuscitation Military Outcomes Hospitals 52

EMDocs

JANUARY 16, 2024

Louis) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Brit Long, MD (@long_brit) Case You are working in the trauma/critical care pod of your emergency department (ED). You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Ann Emerg Med. link] Published April 13, 2023.

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation CPR EMS 84

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. 7-9 The PE model then aims to sell acquired businesses for a profit within three to six years.

Hospitals 113

Hospitals Radiology Radiology Administration 113

The Skeptics' Guide to EM

APRIL 28, 2018

Case: A 72-year-old gentleman presents to your emergency department. He has been generally unwell for around one week, with a worsening cough, shortness of breath […] The post SGEM#216: Pump It Up – Corticosteroids for Patients with Pneumonia Admitted to Hospital first appeared on The Skeptics Guide to Emergency Medicine.

Hospitals 40

Hospitals Emergency Department Outcomes Shock 40