RebelEM

JANUARY 18, 2024

PMID: 35387313 Clinical Question: Do prehospital antibiotics impact 28 day mortality, length of stay in the hospital and ICU length of stay for patients triggering sepsis compared to usual care (No prehospital antibiotics)? appeared first on REBEL EM - Emergency Medicine Blog. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26

Sepsis 130

Sepsis Hospitals Administration Outcomes 130

EMDocs

OCTOBER 19, 2024

We’ll keep it short, while you keep that EM brain sharp. Care Variations and Outcomes for Children Hospitalized With Bacterial Tracheostomy-Associated Respiratory Infections. Hospital Pediatrics. link] The post EM@3AM: Bacterial Tracheitis appeared first on emDOCs.net - Emergency Medicine Education. Rev Infect Dis.

EMS 106

EMS Pediatrics Sepsis Airway Management 106

Pediatric EM Morsels

JUNE 2, 2023

Admission to hospital depending on severity of symptoms and need for further hydration Moral of the Morsel Diseases, just like our patients, are unique and varied! link] The post Food Protein Induced Enterocolitis Syndrome (FPIES) appeared first on Pediatric EM Morsels. Allergy Asthma Clin Immunol 18, 54 (2022).

Dehydration 193

Dehydration Shock Pediatrics Emergency Department 193

EMDocs

NOVEMBER 19, 2024

He was extubated on hospital day 2 and was able to be discharged to psychiatry on hospital day 5. Low-dose lipid emulsion for pediatric vasoplegic shock due to quetiapine and fluvoxamine overdose: a case report. His roommate found an empty pill bottle on the floor next to him. The patient gradually improved. 2022;15:3915-3929.

Poisoning 108

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 108

Pediatric EM Morsels

NOVEMBER 3, 2023

This allowed US hospitals to stock the drug to ensure quick treatment of suspected severe cases, rather than having to ship it from the CDC under the prior expanded-access protocol (Thomas 2023). For non-complicated malaria use oral Co ART em. falciparum parasitemia , and no other defined cause of AMS (WHO 2023). vivax or P.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

Pediatric EM Morsels

MARCH 29, 2024

link] The post Rebaked: Inborn Errors of Metabolism presenting in the ED appeared first on Pediatric EM Morsels. Then please put IEM on your differential for critically ill newborns and infants Kids should be Sweet! Inborn Errors of Metabolism: Becoming Ready for Rare. Samantha A. Schrier Vergano. Pediatr Rev (2022) 43 (7): 371–383.

Dehydration 297

Dehydration Pediatrics Sepsis EMS 297

RebelEM

NOVEMBER 6, 2023

Background Information: Vasoplegic shock is defined as hypotension with normal or increased cardiac output and can commonly occur in post-cardiac surgery patients having received cardiopulmonary bypass. Hydroxocobalamin Versus Methylene Blue for the Treatment of Vasoplegic Shock Associated With Cardiopulmonary Bypass. 2023 Jul 19.

Shock 71

Shock Administration Academics Hospitals 71

EMDocs

JULY 1, 2023

We’ll keep it short, while you keep that EM brain sharp. Patients should be admitted to the hospital and cardiology consulted early in their course. Kawasaki disease: two case reports from the Aga Khan Hospital, Dar es Salaam-Tanzania. The Royal Children’s Hospital Melbourne. cm, mucous membrane involvement (e.g.

EMS 84

EMS Infectious Diseases Pediatrics Research 84

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

RebelEM

FEBRUARY 15, 2024

PMID: 38019968 Clinical Question: In patients with suspected acute poisoning and GCS <9, is a conservative airway strategy of withholding intubation associated with a reduction in death, ICU LOS, and hospital LOS compared with routine practice of intubation?

Poisoning 139

Poisoning Airway Management Seizures Shock 139

Pediatric EM Morsels

JULY 21, 2023

We had just received a young child from EMS who was post-ictal with decreased mentation. Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. The post Glasgow Coma Scale in Children appeared first on Pediatric EM Morsels. Less than 8, intubate!

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

ACEP Now

JANUARY 4, 2025

Clarke had begun an emergency medicine residency at what was then known as LA CountyUSC Hospital, Los Angeles. The specialty, he said, spoke to his interest in surgery and EMS in a way that family medicine did not. Firsthand Account An ambulance bay at the LA County-USC Hospital in 1978. Click to enlarge.) Click to enlarge.)

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

EMDocs

DECEMBER 6, 2024

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality. Manoguerra, A. Erdman, A.

Poisoning 94

Poisoning Fluid Resuscitation Seizures Resuscitation 94

RebelEM

SEPTEMBER 28, 2023

In non-PCI-capable hospitals this goal is not always achievable due to delays in transfer. Thrombolysis in Myocardial Infarction Flow Grade 3 at Last Angiography was ≈87% in both groups Composite of Death, Shock, Heart Failure, or Reinfarction: Pharmaco-Invasive Treatment: 12.8% Primary PCI: 95.7% Primary PCI: 95.7% Primary PCI: 78.4%

EKG/ECG 137

EKG/ECG Allergic Reactions Shock Stroke 137

ACEP Now

JULY 7, 2023

Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S. 6 What Can I Do Outside of Repeated Shocks and Standard ACLS?

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Liberal: 14.9%

Sepsis 99

Sepsis Shock Resuscitation Outcomes 99

RebelEM

NOVEMBER 30, 2023

Current SSC guidelines recommend fluid resuscitation with at least 30mL/kg IV crystalloid in patients with sepsis induced hypoperfusion or septic shock within the first three hours of resuscitation, regardless of comorbidities. Outcomes: Primary Outcome: In-hospital mortality. The study was conducted according to PRISMA guidelines.

Sepsis 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

Dr. Smith's ECG Blog

JUNE 23, 2024

His daughter immediately started CPR and another family member called EMS. When EMS arrived the patient was in ventricular fibrillation. They shocked him twice before return of spontaneous circulation. He was intubated in the field and sedated upon arrival at the hospital. He was admitted to cardiology.

EKG/ECG 120

EKG/ECG CPR EMS Hospitals 120

The Skeptics' Guide to EM

JANUARY 9, 2021

Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% Today we look at the CENSER trial. vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 86

Sepsis Shock Resuscitation Fluid Resuscitation 86

Dr. Smith's ECG Blog

JULY 25, 2024

EMS arrived and found him in Ventricular Fibrillation (VF). For clarity in Figure-1 — I've reproduced today's ECG — obtained following successful resuscitation of out-of-hospital cardiac arrest. This patient was witnessed by bystanders to collapse. They started CPR. He was defibrillated into VT.

Resuscitation 126

Resuscitation EKG/ECG CPR Shock 126

Dr. Smith's ECG Blog

APRIL 2, 2024

He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. Then the patient's electronic record from an outside hospital appeared. Patient received 11 shocks by ICD and was in V-fib when EMS arrived. Here is the initial ED ECG. What do you think?

EKG/ECG 134

EKG/ECG Shock CPR Stroke 134

RebelEM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Article: How-Berlemont C, Lamhaut L, Diehl J, et al. JAMA Cardiol. 1.15; P= 0.32

Hospitals 59

Hospitals Outcomes EKG/ECG Resuscitation 59

Taming the SRU

MARCH 10, 2024

There are also many costs to hypoglycemia, both in terms of financial burdens on hospitals/caretakers/patients, and in terms of morbidity and mortality. critical AS, ASD, HCM) Arrhythmogenic right ventricular cardiomyopathy Pulmonary embolism Thoracic aortic dissection Transient occult shock Sepsis Hemorrhagic shock (ex.

EKG/ECG 97

EKG/ECG Shock Wellness EMS 97

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. Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Date: August 12th, 2021 Reference: Daya et al.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

RebelEM

APRIL 29, 2024

Many clinicians don’t consider IO placement while others consider it a last resort or only a pre-hospital procedure. Intravenous vs.intraosseous vascular access during out-of-hospital cardiac arrest – protocol for a randomized clinical trial. PMID: 33350794 10 Meilandt C. Resusc Plus. 2023 PMID: 37502742 11 Schwalbach KT et al.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. 2009;338:b2085.

Hyperthermia / Hypothermia 104

Hyperthermia / Hypothermia Resuscitation CPR EMS 104

RebelEM

AUGUST 14, 2023

in both groups Mean APACHE II score was 12 in both groups Almost half of the patients had septic shock at enrollment Mean time from sepsis identification to randomization was 1.4 001) Hospital mortality: Placebo 22.8% More on this Topic: First10EM: Finally, a cure for sepsis: Herbs REBEL EM: Sepsis 3.0 vs. XBJ 14.2%

Sepsis 97

Sepsis Outcomes Administration EMS 97

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

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. 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. What do you think?

EKG/ECG 140

EKG/ECG Emergency Department Shock Ultrasounds 140

RebelEM

JANUARY 29, 2024

appeared first on REBEL EM - Emergency Medicine Blog. 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 133

Stroke Outcomes Hospitals Administration 133

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

This was written by Magnus Nossen, from Norway, with comments and additions by Smith A 50 something smoker with no previous medical hx contacted EMS due to acute onset chest pain. Upon EMS arrival the patient appeared acutely ill and complained of chest pain. An ECG was recorded immediately and is shown below. Is there OMI?

EKG/ECG 134

EKG/ECG Resuscitation Academics EMS 134

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. 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.

EKG/ECG 132

EKG/ECG Shock Hospitals Sepsis 132

EMDocs

NOVEMBER 1, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

Operations 86

Operations Radiology Radiology Fluid Resuscitation 86

RebelEM

JANUARY 9, 2024

You decide she is stable to be discharged home on levofloxacin (See REBEL EM for antibiotic coverage in CAP ) but consider giving her a first dose intravenously. Except for patients with poor gut absorption or those with critical infectious processes such as septic shock or necrotizing fasciitis, this belief appears to be unfounded.

Infectious Diseases 95

Infectious Diseases Pediatrics EMS Administration 95

RebelEM

OCTOBER 5, 2023

About 25% of the excluded patients had septic shock, but the classification of hypotension as septic shock was at the discretion of the treating team. Dexamethasone and length of hospital stay in patients with community-acquired pneumonia: a randomised, double-blind, placebo-controlled trial. in the placebo group (p = 0.006).

Research 94

Research Outcomes Administration Shock 94

RebelEM

APRIL 22, 2024

Adverse events in the ICU within 90 days (new shock, cerebral ischemia, myocardial infarction, or intestinal ischemia). Absolute number of days alive and out of hospital in 90 days. appeared first on REBEL EM - Emergency Medicine Blog. Outcomes (secondary): 90-day all-cause mortality. days (0.2 – 11.5)

Outcomes 74

Outcomes Best Practices EMS Shock 74