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

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 137

Poisoning Airway Management Seizures Shock 137

Emergency Medicine Journal

OCTOBER 26, 2023

Objective Over 300 000 cases of out-of-hospital cardiac arrests (OHCAs) occur each year in the USA and Europe. Inclusion criteria were non-traumatic cardiac arrests treated with at least one external electric shock with an automated external defibrillator from the basic life support team and resuscitated by a physician-staffed ALS team.

Resuscitation 75

Resuscitation Basic Life Support Hospitals CPR 75

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Either approach in severe sepsis with shock seems reasonable.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

The Skeptics' Guide to EM

DECEMBER 14, 2024

Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. Clinical Question: How accurately can a new clinical decision rule (The Phoenix Sepsis Score) diagnose pediatric sepsis and septic shock in hospitalized children within the first 24 hours? Reference: Sanchez-Pinto, L.N.,

Sepsis 85

Sepsis Pediatrics Shock Hospitals 85

Sensible Medicine

DECEMBER 16, 2024

JMM The CHAGASICS Trial: A Disturbing Failure of Peer Review at a Leading Cardiology Journal By Anis Rassi Jr, MD, PhD, FAHA, FACP, FACP, Scientific Director, Anis Rassi Hospital, Goiânia, Brazil I submitted a letter to the editor regarding the CHAGASICS trial, which was recently published in JAMA Cardiology (October 2024).

Shock 98

Shock Hospitals Outcomes Research 98

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. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

University of Maryland Department of Emergency Med

JULY 1, 2023

Shock index (heart rate/systolic blood pressure) has been used to predict trauma outcomes. This study from American Journal of Emergency Medici. Click to view the rest

Hospitals 71

Hospitals Shock Outcomes 71

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 135

EKG/ECG Allergic Reactions Shock Stroke 135

The Skeptics' Guide to EM

FEBRUARY 11, 2023

NEJM 2022 Guest Skeptic: Dr. Sean Moore is an emergency physician working in Kenora Ontario, where he is Chief of Staff at Lake of the Woods District Hospital, Northern Medical Director for the Ornge air medical transport program and associate medical director with CritiCall Ontario. first appeared on The Skeptics Guide to Emergency Medicine.

Shock 55

Shock CPR Hyperthermia / Hypothermia Hospitals 55

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 95

Sepsis Shock Resuscitation Outcomes 95

Stop and Think

AUGUST 28, 2024

Doctors and hospitals make money. Trial after trial after trial finds that fixing stable coronary artery disease does not improve outcomes over basic medications and lifestyle changes. The trial found no difference in outcomes. of patients had a primary outcome (death or heart attack). RITA-2 shocks me.

Outcomes 120

Outcomes Shock Hospitals Wellness 120

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 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 130

Stroke Outcomes Hospitals Administration 130

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% vs 48.4% (OR 3.4, 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 78

Sepsis Shock Resuscitation Fluid Resuscitation 78

RebelEM

JANUARY 25, 2024

What They Did: Design: Randomized, controlled, blinded-outcome trial Sites: Three emergency departments in Denmark Duration: October 9, 2019 to May 26, 2021. Outcomes: Primary Outcome: Reduction of dyspnea measured on a verbal dyspnea scale (VDS) from 0 to 10 recorded at enrollment, then at 2, 4, and 5 hours after arrival.

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

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.

Hospitals 57

Hospitals Outcomes EKG/ECG Resuscitation 57

Sensible Medicine

AUGUST 7, 2023

It is shocking. The brave investigators in London decided to study the idea that medical therapy of heart failure has become so outstanding, that adding revascularization (fixing the obstructions with stents) might not improve outcomes. Their primary outcome was death or hospitalization for heart failure. Look at that.

Shock 98

Shock Outcomes Hospitals Wellness 98

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% vs. pSOFA 43.9%

Sepsis 72

Sepsis Shock Pediatrics Administration 72

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. veterans’ hospitals did not show a mortality reduction from low-dose methylprednisolone. standards of care. In the U.S.,

Advances Cardiac Life Support (ACLS) 96

Advances Cardiac Life Support (ACLS) Documentation/Coding CPR Shock 96

PulmCCM

JANUARY 29, 2024

automated external cooling system) for all arrest patients (with any presenting rhythm, occurring in- or out-of-hospital) maintained for at least 24 hours; longer periods of fever prevention (which AHA now calls “temperature control”) for persistently comatose patients are also considered reasonable.

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

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 Outcomes 52

Sensible Medicine

OCTOBER 21, 2024

It was a small study at one hospital. CAST shocked the world of cardiology because suppression of rhythm disturbances after MI had been an accepted practice. I was shocked at how many people said that they read Sensible Medicine. The story begins in Nottingham UK in 1980. But its lessons are large. First the background.

Evidence-Based Practice 105

Evidence-Based Practice Shock Fractures Outcomes 105

RebelEM

AUGUST 12, 2024

What They Did: Double-blind, randomized, placebo controlled trial that ran from October 2019 through January 2024 Multinational study conducted at 22 centers in three European countries 3512 patients were enrolled and before surgery eligible patients were randomly assigned to one of the following two groups Amino Acid Group: 10% Isopuramin at a dose (..)

Outcomes 81

Outcomes Hospitals Operations Shock 81

RebelEM

DECEMBER 17, 2024

What The Evidence Says: Antipyretics are commonly given to patients with fever suspected to be caused by an infection in both at home and in the hospital setting. It may also be that it is easier to recognize patients with sepsis if they have a fever and early recognition and treatment of sepsis has shown improved outcomes.

Sepsis 68

Sepsis Shock EMS Emergency Department 68

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 Secondary Outcome Results: ICU mortality: placebo 20.0% 001) Hospital mortality: Placebo 22.8% The primary outcome was patient oriented.

Sepsis 96

Sepsis Outcomes Administration EMS 96

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

The Skeptics' Guide to EM

FEBRUARY 25, 2023

2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Case: A 6-month-old boy presents to […] The post SGEM#394: Say Bye Bye Bicarb for Pediatric In-Hospital Cardiac Arrest first appeared on The Skeptics Guide to Emergency Medicine.

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

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 97

Administration Emergency Department Outcomes Documentation/Coding 97

Ken Grauer, MD

FEBRUARY 28, 2023

These 2 settings are: i ) In patients with severe , often longstanding pulmonary disease ; and / or , ii ) In acutely ill patients with multi-system disease ( ie, sepsis, shock, electrolyte and/or acid-base disorders ). MAT almost always occurs in one of 2 common predisposing settings.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

Dr. Smith's ECG Blog

JUNE 23, 2024

They shocked him twice before return of spontaneous circulation. He was intubated in the field and sedated upon arrival at the hospital. At his family's request, he was transferred to a hospital closer to his home to continue care. His daughter immediately started CPR and another family member called EMS.

EKG/ECG 121

EKG/ECG CPR EMS Hospitals 121

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

RebelEM

APRIL 22, 2024

Intervention: Target PaO2 = 60 mm Hg Control: Target PaO2 = 90 mm Hg Outcome (primary): Absolute number of days without life support in 90 days defined as the absence of mechanical ventilation, circulatory support, or kidney replacement. Outcomes (secondary): 90-day all-cause mortality. CI) Secondary Outcomes 90-day Mortality 34.7%

Outcomes 74

Outcomes Best Practices EMS Shock 74

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 96

EKG/ECG Shock Wellness EMS 96

Stop and Think

JUNE 13, 2023

It’s shocking how many have subscribed and supported this newsletter. In PARAGON-HF, the new drug reduced a composite primary outcome of heart failure events and death from cardiovascular causes but the reduction failed to meet statistical significance. This will be the first of a two-part series regarding two curious studies.

Outcomes 98

Outcomes Academics Shock Hospitals 98

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

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

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. One of the goals of the early treatment of septic shock is to restore end-organ perfusion. Date: June 2nd, 2020 Reference: Permpikul et al.

Sepsis 52

Sepsis Shock Resuscitation Administration 52