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! It may sound silly (“FPIES”), but it can be serious!

Dehydration 193

Dehydration Shock Pediatrics Emergency Department 193

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

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. The initial K was 3.0 mEq/L and ionized calcium was 5.5 What is going on here?

Shock 98

Shock EKG/ECG Documentation/Coding Resuscitation 98

Greater Sydney Area HEMS

APRIL 15, 2023

It is a rare but confronting situation where a pre-hospital and retrieval medicine team are presented with a sick newborn. As a pre-hospital and retrieval service, it’s rare for us to even be around in the first few minutes of a baby’s life, but as our colleagues described, not impossible. Place a sats probe on the right hand.

Hospitals 85

Hospitals Resuscitation Hyperthermia / Hypothermia Teamwork 85

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The hospital is the Paediatric Major Trauma Centre for the South-West. International Consensus Criteria for Pediatric Sepsis and Septic Shock. doi:10.1001/jama.2024.0179

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

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. Abdominal pain may be absent in up to 60%.

EMS 97

EMS Sepsis Shock Fluid Resuscitation 97

Mount Sinai EM

APRIL 7, 2023

TB is caused by the acid-fast bacillus Mycobacterium Tuberculosis and spreads via aerosolized respiratory secretions.

Shock 130

Shock Hospitals 130

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 57

Shock CPR Hyperthermia / Hypothermia Hospitals 57

ACEP Now

JANUARY 4, 2025

1 Just one year prior, Dr. Clarke had begun an emergency medicine residency at what was then known as LA CountyUSC Hospital, Los Angeles. Firsthand Account An ambulance bay at the LA County-USC Hospital in 1978. Clarke was then hired as assistant director in the emergency department (ED) at Pomona Valley Hospital, Pomona, Calif.

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

ETM Course

JUNE 28, 2015

Just over a year ago London HEMS performed the first pre-hospital regtrograde endovascular balloon occlusion of the aorta (REBOA). Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Shock 2014; 41(2): 130–7 12. 2011 Dec;71(6):1869-72 (full article free text) 2. Avaro et al.

Hospitals 52

Hospitals Resuscitation Shock Military 52

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

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

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

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. Potassium and magnesium were replenished, and the QTc interval improved to 440 within two hours. Hum Exp Toxicol.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

Pediatric Emergency Playbook

JUNE 1, 2016

Do we recognize shock early enough? World wide, shock is a leading cause of morbidity and mortality in children, mostly for failure to recognize or to treat adequately. So, what is shock? Simply put, shock is the inadequate delivery of oxygen to your tissues. How do we prioritize our interventions? Pericardial Effusion?

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

The Trauma Pro

APRIL 26, 2024

In the last post in the series, I’ll discuss a paper in press that compares the efficacy and hospital charges of the two techniques. A multi-center trial published in 2015 showed an astounding 32% mortality rate for patients with shock from pelvic fracture.

Fractures 147

Fractures Head Injuries Radiology Radiology 147

Greater Sydney Area HEMS

FEBRUARY 20, 2024

Obtaining access in shocked trauma patients can be notoriously difficult due to circulatory collapse. Those who are shocked, shut down with limited or no other options for peripheral access require central access. Right Brachiocephalic Vein Origin Access for the Resuscitation of Shocked Adult Trauma Patients. Green et al.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

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 92

Sepsis Shock Resuscitation Fluid Resuscitation 92

Emergency Medicine Education

OCTOBER 19, 2022

They concluded that “early norepinephrine infusion was not associated with 24-hour or in-hospital mortality among patients with blunt trauma and hemorrhagic shock.” ” Link to article

Shock 40

Shock Hospitals 40

Pediatric EM Morsels

MARCH 29, 2024

Then please put IEM on your differential for critically ill newborns and infants Kids should be Sweet!

Dehydration 297

Dehydration Pediatrics Sepsis EMS 297

JournalFeed

DECEMBER 24, 2022

1 Shock Methods Spoon Feed For the treatment of refractory ventricular fibrillation (VF) in out-of-hospital cardiac arrest, survival to hospital discharge was more common among patients who received double sequential external defibrillation (DSED) and vector-change (VC) defibrillation than those who received standard defibrillation.

Shock 40

Shock Hospitals 40

EMDocs

MARCH 4, 2025

Bacterial Meningitis Mimics: Other flu-like illnesses: COVID, influenza, toxic shock syndrome, myocarditis, endocarditis, spinal epidural abscess, pneumonia. HSV meningitis needs hospital admission. A 2020 Cochrane review found the pooled sensitivity was 65%. Do not rely on this to rule out bacterial meningitis. What about steroids?

Infectious Diseases 82

Infectious Diseases Seizures Poisoning Sepsis 82

University of Maryland CC Project

MAY 30, 2023

Petr Ostadal, MD, PhD, Head of the Acute Cardiology Unit and Deputy Head of the Department of Cardiology at Na Homolce Hospital, Prague, Czech Republic and Associate Professor of Medicine at the 2nd Faculty of Medicine, Charles University in Prague presents results of his trial with a lecture entitled, "Extracorporeal Membrane Oxygenation in the Therapy (..)

Shock 40

Shock Hospitals 40

Greater Sydney Area HEMS

NOVEMBER 26, 2023

Join us as Sydney HEMS Senior Staff Specialist Dr Brian Burns discusses the recognition, aetiology and treatment of different types of shock in our pre-hospital trauma patients.

Burns 69

Burns Shock Hospitals 69

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. Referring to Figure-1 — this 53-year old woman who presented in extremis with cardiogenic shock and an initial pH = 6.9, This was sent by a reader. and K was normal. Here was the ECG: There is sinus tachycardia.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

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

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 CPR 52

University of Maryland CC Project

JUNE 16, 2023

The first annual Mid-Atlantic Neurocritical Care Symposium will bring together experts from The University of Maryland/Shock Trauma Hospital, Johns Hopkins University, INOVA, Christiana Care, and beyond to discuss the basics of caring for critically ill neurological patients, as well as highlight recent innovations in the field.

Shock 70

Shock Hospitals Wellness Stroke 70

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

Stop and Think

MARCH 31, 2024

As I walk through the hospital these days, having looked at the actual evidence for what we do, my brain struggles to resolve the tension between the popularity of treatments vs the dubious evidence. His list of device approvals despite dodgy evidence is shocking. The other one failed to meet its lax noninferiority primary endpoint.

Research 138

Research Shock Hospitals 138

Dr. Smith's ECG Blog

JULY 25, 2024

For clarity in Figure-1 — I've reproduced today's ECG — obtained following successful resuscitation of out-of-hospital cardiac arrest. == MY Comment , by K EN G RAUER, MD ( 7/5 /2024 ): == Clinical ECG interpretation is a 2-Step process. Figure-1: The initial ECG in today's case. —

Resuscitation 124

Resuscitation EKG/ECG CPR Shock 124

University of Maryland Department of Emergency Med

DECEMBER 8, 2022

This paper outlines a training course by Hartford Hospital for general surgery and emergency medicine residents. Their goal was to assess pre-a. Click to view the rest

Resuscitation 40

Resuscitation Shock Hospitals 40

Taming the SRU

JANUARY 10, 2024

There are 38 states where it currently is a felony of some level to assault a healthcare worker BUT there is currently no federal law that protects hospital employees from assault or intimidation. Current bills in progress: US H.R.2663 2663 & S.1176 1176 focuses on violence prevention (introduced for the 3rd time 4/18/23); US H.R.2584

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

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

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 132

EKG/ECG Shock CPR Stroke 132

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

EMDocs

JANUARY 8, 2024

Emergent coronary angiography is not recommended over a delayed or selective strategy in patients with ROSC after cardiac arrest in the absence of ST-segment elevation, shock, electrical instability, signs of significant myocardial damage, and ongoing ischemia (Level 3: no benefit). o C recommended (Level 1: strong). COR 2a, LOE B-NR.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98