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

EM SIM Cases

SEPTEMBER 19, 2024

WHY IT MATTERS Patients in hemorrhagic shock require blood products expeditiously as well as identification and definitive management of the source of bleeding. This case provides an opportunity to practice identification and treatment of multiple sources of blood loss in hemorrhagic shock.

Shock 52

Shock Emergency Nursing Operations Administration 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. These procedures require an experienced operator. A joint statement released by the American College of Surgeons/American College of Emergency Physicians recommends that zone 1 REBOA should only be performed if the anticipated time to start the operation is less than 15 minutes. c) Or, do both?

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

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. J Spec Oper Med.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

RebelEM

APRIL 29, 2024

One may speculate that the US-guided CVC placement would have a higher first-pass success rate with fewer complications, however, this may potentially add time to the procedure depending on the operator and institution’s use of ultrasound during emergencies and maintaining sterile technique with the US probe.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

AED Leader

SEPTEMBER 27, 2024

The defibrillator sends an electric shock to stop this chaos, letting the heart’s natural pacemaker take back control. Giving a shock in time might just save a life. ” This portable lifesaver guided us with voice prompts as we attached it and administered a shock.

Shock 52

Shock Operations CPR Outcomes 52

RebelEM

AUGUST 12, 2024

2020 Mar 14; PMID: 32183395 Post Peer Reviewed By : Salim Rezaie, MD (Twitter/X: @Srrezaie ) The post The PROTECTION Trial – A Randomized Trial of Intravenous Amino Acids for Kidney Protection appeared first on REBEL EM - Emergency Medicine Blog.

Outcomes 81

Outcomes Hospitals Operations Shock 81

RebelEM

JUNE 8, 2023

Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. Rezaie, MD (Twitter: @srrezaie ) The post The Safety and Efficacy of Push Dose Vasopressors in Critically Ill Adults appeared first on REBEL EM - Emergency Medicine Blog. Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. Am J Emerg Med.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Critical Care Now

JULY 7, 2024

Military practice guidelines, along with ACEP and 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. Check out the full post on REBEL EM

Resuscitation 52

Resuscitation Military Outcomes Hospitals 52

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." Advocacy for Trauma Care and EMS Development. Development of EM Residencies.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

AED Leader

JUNE 11, 2023

Studies have shown a greater likelihood of survival when a bystander used an AED (67%) rather than waiting for emergency medical services to shock the patient (43%). Following these instructions is critical to the safe and effective functioning of your defibrillator.

Best Practices 52

Best Practices Shock Pediatrics CPR 52

RebelEM

JANUARY 25, 2024

Point-of-care ultrasound (PoCUS) is inherently operator-dependent, which may have led to inconsistencies in the quality and findings of the ultrasound exams across different operators. POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. Lancet Respir Med. 2014 Aug;2(8):638-46.

Ultrasounds 125

Ultrasounds Outcomes COPD Hospitals 125

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Taming the SRU

JULY 31, 2024

However, believers in this superstition will perceive crazier shifts if the word is uttered so you probably shouldn’t say it, or use cautiously Full moons have no impact on ED, EMS, or HEMS volumes or acuity. Nice people are not more likely to get cancer.

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

ACEP Now

SEPTEMBER 13, 2023

Years before, he’d started his EM career as medical director of the ER at Memphis’ public hospital and Memphis Fire EMS. 1 “I remarked that EM was not even a specialty then, and suggested it might be an opportune time for an updated IOM report that examined the achievements and challenges of emergency care in the U.S.,”

EMS 45

EMS Research Military Academics 45

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. More pertinent and relevant takeaway messages have to do with staffing and operations. Prior studies have used annual census or shift level crowding.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Dr. Smith's ECG Blog

DECEMBER 10, 2022

Per EMS report, the patient had a syncopal episode at work. While I could not rule out the possibility of a large acute ongoing infarction — I thought it more likely that there was some unusual process operative, including RVH and/or some type of cardiomyopathy. CLICK HERE — for more on my approach to the Tall R in Lead V1 ).

EKG/ECG 52

EKG/ECG Operations Shock EMS 52

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Review of the Wellcome Library movies on YouTube (1945) [ links below in references ] is instructive as to resuscitative methods of the 1930s and 1940s: Manual methods; gas bag or bellows operated by hand or machine; an anesthesia gas machine; or iron lung. Evaluation: Manually Operated Resuscitators (1971) Emergency Care Research Institute.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

Dr. Smith's ECG Blog

MAY 14, 2022

I am sure you already shocked it, right?" See this post: Idiopathic Ventricular Tachycardias for the EM Physician. As Dr. Smith said in his initial comment, "I am sure you already shocked this rhythm, right?" Or, of course, you can always use electrical cardioversion. This is what I texted back: "VT or AVRT. Antidromic WPW).

EKG/ECG 52

EKG/ECG Shock Operations EMS 52

Pediatric Emergency Playbook

FEBRUARY 1, 2016

REBOA If you have access to resuscitative endovascular balloon occlusion of the aorta or REBOA, this may be an option to temporize the child to get him to the relative control of the operating room. They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. Brenner et al. J Pediatr Surg. J Pediatr Surg.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

An elderly lady in cardiogenic shock (BP 60/40) with no veins , I was lucky to get a 24-gauge PIV into the back of her wrist. Intraosseous Infusion. Not as often resorted to promptly, as it should be. It was all she had. GPS, Mobile Data Terminals, and Cell Phones. Readers must verify validity to their own practice.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. She felt nauseous and lightheaded with no neurologic deficits.

Ultrasounds 40

Ultrasounds EKG/ECG EMS Radiology 40

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. Jeff: And don’t forget to get the crash details from the EMS crew before they depart! In those with severe injury, you may note refractory hypotension secondary to cardiogenic shock.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

RebelEM

NOVEMBER 3, 2022

The environment, operator-related factors, and equipment are different in a pre-hospital vs. ED setting. 2/3rds of the population were trauma patients, and more patients in the ketamine arm had shock, hypoxemia, extremes of size, and anatomic challenges, potentially biasing the results to favor etomidate.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

EB Medicine

JULY 8, 2019

Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

JUNE 6, 2019

Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. You can also use the shock index, which as a reminder is simply the HR/SBP. The greatest value of a lactate level is to detect occult shock and sepsis. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

ALiEM

OCTOBER 30, 2024

Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. Our experience: It was not long ago that we instructed our staff that: ‘COWS >8, give ’em 8 (mg of buprenorphine).’ Your patient ultimately is diagnosed with a spinal epidural abscess requiring operative care.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. Septic shock is high on the differential diagnosis for this patient’s presentation. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. The patient currently resides at a skilled nursing facility.

Sepsis 83

Sepsis Fluid Resuscitation Shock Resuscitation 83

EMDocs

JULY 17, 2023

7 While post-operative adhesive disease is also a risk factor, it is far less commonly implicated in LBO compared to SBO. Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients.

Operations 95

Operations EMS Fluid Resuscitation Resuscitation 95

RebelEM

DECEMBER 19, 2022

This procedure involves applying another set of pads attached to a second defibrillator to a patient and shocking them in hopes of terminating the rhythm. At REBEL EM, we’ve done an extensive write up that details some of the different types of DED and the electrophysiology behind it.

EMS 52

EMS CPR Shock Resuscitation 52

EMDocs

JUNE 3, 2023

What is the EM physician’s role in the stabilization of unstable pelvic injuries? 4 Patients with pelvic fractures are considered unstable when systolic blood pressure < 90mmHg and heart rate >120bpm, or in those with dyspnea, altered mental status, or skin findings of shock. Figure 2: Open book pelvic fracture.

Fractures 60

Fractures Resuscitation Operations EMS 60

EB Medicine

DECEMBER 4, 2019

The authors note that the air is actually comparable to that of an operating room. Physicians reportedly respond 44% of the time, followed by nurses at 20% and EMS providers at about 4%. Nachi: And we alluded to this earlier - Physicians advise diversion more frequently at 9% of the time followed by EMS providers and nurses.

Dehydration 40

Dehydration EMS Wellness Burns 40

EB Medicine

AUGUST 1, 2018

Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 million, and cocaine at 1.9 Counsel them on drug abuse also.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EB Medicine

JANUARY 2, 2019

I know this is a HOTLY debated topic among EM Docs. Jeff: Perhaps most importantly, no history or physical alone can rule in or out an ectopic pregnancy, for that you’ll need testing and imaging or operative findings. Jeff: Oh it certainly is. Nachi: And that’s a perfect segue into our next section - diagnostic studies.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

EMDocs

NOVEMBER 13, 2023

Authors: Mary Hamblen, DO (EM Resident Physician, TX); Justin Hacnik, MD (EM Resident Physician, TX); Katherine Spencer, MD (EM Resident Physician, TX); J.D. However, IgE-mediated or not, anaphylactic shock is possible in either case. 32 Table 2 : Memphis Criteria.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

Pediatric EM Morsels

MARCH 7, 2025

2022.01.069 The post TXA (Tranexamic Acid) in Pediatrics appeared first on Pediatric EM Morsels. of IV form TXA [O’Neill 2020] Inexpensive ! Effectiveness and safety of tranexamic acid in pediatric trauma: A systematic review and meta-analysis. Am J Emerg Med. 2022;55:103-110. doi:10.1016/j.ajem.2022.01.069

Pediatrics 231

Pediatrics Blood Transfusions Anaphylaxis Military 231