Sensible Medicine

JUNE 3, 2024

For the study-of-the-week, we will publish a criticism of the DanGer-Shock trial. Dr. Guillermo Aldama is an interventional cardiologist in a university hospital in Northwestern Spain. A brief intro to DanGer-Shock. DanGer-Shock, therefore, was a major trial. But DanGer-Shock was positive. years/47.5%).

Shock 74

Shock Hospitals Academics 74

EMDocs

NOVEMBER 13, 2024

Paracentesis performed within 12 hours was associated with lower in-hospital mortality and shorter length of stay when compared to paracentesis performed within 12-72 hours (13% compared to 27%). Management: Patients can rapidly progress to septic shock and multiorgan failure. increase in mortality. Am J Gastroenterol.

Hyperthermia / Hypothermia 103

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 103

Taming the SRU

DECEMBER 17, 2024

compared the effects of these two among the acute gastroenteritis children and reported that the use of ORT was associated with shorter hospital stay and increased patient satisfaction. demonstrated that use of ORT was characterized by shorter stays at the hospital. AtherlyJohn et al. A systematic review by Freedman et al.

Dehydration 84

Dehydration Fluid Resuscitation Administration Resuscitation 84

EMDocs

DECEMBER 1, 2024

Treatment significantly shortens the duration of illness, and early initiation of therapy can prevent severe complications and reduce the length of hospitalization. Ischemic Hepatitis and Septic Shock Secondary to Murine Typhus Infection in Pregnancy. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll.

EMS 101

EMS Infectious Diseases Shock Airway Management 101

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

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

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

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

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

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). Higher Rates of Misdiagnosis in Pediatric Patients versus Adults Hospitalized with Imported Malaria. June 28, 2023. J Travel Med.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

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 101

Sepsis Shock Pediatrics Hospitals 101

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

The Trauma Pro

JANUARY 3, 2024

They postulated that, since hemorrhagic shock can cause hyperfibrinolysis (HF) and early administration of agents like TXA seem to work better when given early, wouldn’t it be nice to have a more objective way of identifying it as early as possible? The study was prospective and observational and involved two Level I trauma centers.

Shock 113

Shock Operations Administration Hospitals 113

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Figure B At this point, with the ECG changing from diffuse ST depression to widespread ST elevation and the patient presenting in cardiogenic shock, left main coronary artery (LMCA) occlusion is the likely diagnosis. Complete LMCA occlusion is associated with clinical shock and/or cardiac arrest. This is an ominous sign.

EKG/ECG 130

EKG/ECG Shock Emergency Department Ambulance Services 130

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

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 94

EMS Sepsis Shock Fluid Resuscitation 94

Sensible Medicine

JUNE 24, 2024

One of the most common uses of LV assist devices is cardiogenic shock due to an acute MI. Doctors and hospitals are paid extra to use the expensive device. As I covered in April , the DANGER-Shock trial produced positive results. DANGER-Shock, like many trials, had caveats. More than DANGER-Shock). But not enough.

Shock 105

Shock Hospitals 105

Pediatric EM Morsels

JULY 21, 2023

Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. Fun fact for animal lovers!- cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! 2008 Apr;39(4):1347-8. doi: 10.1161/STROKEAHA.107.498345.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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

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 56

Shock CPR Hyperthermia / Hypothermia Hospitals 56

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

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

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 97

Shock Hospitals Outcomes Research 97

Ken Grauer, MD

OCTOBER 25, 2024

The remaining 13/26 patients developed these changes within 24 hours after hospital admission. Unfortunately — this patient died within 12 hours of obtaining this tracing from cardiogenic shock. Panel A: The initial ECG on admission to the hospital; — Panel B: The repeat ECG done 23 hours after A. .

EKG/ECG 236

EKG/ECG Shock Hospitals 236

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

Sensible Medicine

APRIL 15, 2024

A common cause of cardiogenic shock occurs when a blocked coronary artery (myocardial infarction or MI) causes the heart to fail. Cardiogenic shock from MI has a death rate of about 50%. This is why the DanGer-Shock trial had to be done in Denmark, a place where doctors are perhaps a little less sure of themselves. It did not.

Shock 90

Shock Sepsis Hospitals 90

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

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

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 108

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 108

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

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

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

Emergency Medicine Journal

SEPTEMBER 25, 2024

Most burn injuries can be treated in local hospitals but 6.5% The scope of the present practice review is the immediate management of the adult patient with severe burns, including inhalation injury and burn shock. There are approximately 180 000 deaths per year from thermal burn injury worldwide. require specialist burn care.

Burns 98

Burns Fluid Resuscitation Airway Management Resuscitation 98