The Skeptics' Guide to EM

FEBRUARY 11, 2023

This has included things like therapeutic hypothermia ( SGEM#54 , SGEM#82 , SGEM#183 and SGEM#275 ), supraglottic devices ( SGEM#247 ), crowd sourcing CPR ( SGEM#143 and SGEM#306 ), epinephrine ( SGEM#238 ) and IO vs IV (SGEM#231 and SGEM#340). . first appeared on The Skeptics Guide to Emergency Medicine.

Shock 56

Shock CPR Hyperthermia / Hypothermia Hospitals 56

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

Don't Forget the Bubbles

FEBRUARY 5, 2025

In trauma patients, the primary sources of bleeding are external haemorrhage (blood on the floor), chest, abdomen, pelvis, and long bones in paediatrics brain is also included (infants with open sutures can bleed a significant amount intracranially) Shock The most common cause in trauma is haemorrhage.

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

PulmCCM

JANUARY 29, 2024

Patients presenting with hypothermia should not be warmed too quickly (allowing their temperature to increase by <0.5°C/hour). three shocks with 2 minutes CPR in between) have been performed. There should be an active approach to fever prevention (e.g., °C/hour). ECMO used as CPR is referred to as ECPR.)

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

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

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. Exposure Expose the patient in a systematic manner while keeping remaining body areas covered e.g. 1 limb at a time, to reduce the risk of hypothermia. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9%

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Sensible Medicine

JUNE 5, 2023

The conclusion therefore read that therapeutic hypothermia “did not confer a significant benefit in survival with a good functional outcome at 1 year.” We are shocked at the response this newsletter has achieved. That 8% better survival in absolute terms did not reach statistical significance. Stay tuned—and think.

Stroke 98

Stroke Hyperthermia / Hypothermia Outcomes Shock 98

EMergucate

JUNE 7, 2017

A 49 year old man with confusion, hypothermia and shock requiring urgent resuscitation has blood results which showSevere HAGMA uncompensated, … Continue reading →

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Shock Resuscitation EMS 40

Dr. Smith's ECG Blog

DECEMBER 20, 2010

She was shocked into sinus rhythm. Before initiating therapeutic hypothermia, a head CT was done and showed fatal subarachnoid hemorrhage. This is the ECG of a 50 yo old woman who collapsed, was found to have a pulse, but then found to be in ventricular tachycardia. She presented to the ED comatose.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock EKG/ECG 52

EMergucate

MARCH 18, 2014

shock – hypotensive, tachycardic, hypothermia 2. Critically unwell patient with 1. life threatening acidaemia and lactic acidosis He requires immediate … Continue reading →

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Shock EMS 40

EMergucate

JUNE 11, 2017

A 49 year old man with confusion, hypothermia and shock requiring urgent resuscitation has blood results which show The same … Continue reading →

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Shock EMS 40

EMergucate

JUNE 14, 2017

A 49 year old man with confusion, hypothermia and shock requiring urgent resuscitation has blood results which show The patient … Continue reading →

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Shock EMS 40

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

ACEP Now

APRIL 3, 2024

Early work on TTM in 2002 showed benefit to cooling to 33 degrees Celsius, which subsequently influenced international resuscitation guidelines to recommend mild hypothermia at 32 degrees to 34 degrees Celsius in 2005. Adding nuance, this study also showed that the highest-severity arrests did not benefit from hypothermia.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

Taming the SRU

JULY 19, 2023

Fundamentals of ECMO - leadership curriculum - ultrasound GR - macgyver techniques fundamentals of ecmo WITH dr. bonomo ECPR from the ED: The ideal patients: Young patients with refractory VF/VT arrest ≤ 30 min since arrest onset Poisonings with cardiogenic shock Severe hypothermia with arrest Massive PE with arrest Key points: Good CPR/advanced ACLS (..)

Ultrasounds 84

Ultrasounds Leadership Hyperthermia / Hypothermia Poisoning 84

Dr. Smith's ECG Blog

JULY 14, 2010

She arrived comatose and in cardiogenic shock and the following ECG was recorded. She underwent therapeutic hypothermia, and emerged from coma. Before EMS arrived, she had "seizure activity" and became unresponsive. She was defibrillated successfully from ventricular fibrillation and developed a perfusing rhythm. She was intubated.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Seizures EKG/ECG EMS 52

Pediatric Emergency Playbook

AUGUST 1, 2020

Hyperthermia. The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations. J Athl Train. 2013 Jul-Aug; 48(4): 546–553. DeFranco MJ et al. Environmental issues for team physicians. Am J Sports Med. 2008 Nov;36(11):2226-37. Ishimine P. Jardine DS.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Stroke Burns Pediatrics 52

EMDocs

JUNE 25, 2024

Severely burned patients have impaired thermoregulation and are at risk of hypothermia. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. No role for prophylactic antibiotics in burn and inhalation injuries. May increase the risk of fungal infections and resistant organism. link] (2019).

Burns 97

Burns Fluid Resuscitation Resuscitation Poisoning 97

Mind The Bleep

DECEMBER 19, 2023

Majority of DKA patients are in a fluid deficit and present acutely with shock. Signs of shock to be mindful for are tachycardia, hypotension, prolonged CRT, pallor, and a weak thready pulse. Fluid boluses are given according to local guidelines, but generally shocked patients should receive a 10ml/kg 0.9%

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

Taming the SRU

APRIL 13, 2023

Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

EM Guide Wire

SEPTEMBER 9, 2020

Dosing formula on MedCalc using serum level & amount ingested (mg ingested x 0.8 x 2) Pacing: Transcutaneous Pacing: [link] – Peds example, smoooooth voice [link] – adult example [link] – how to set up the box Transvenous Pacing: [link] – Set up [link] – Procedure [link] – trouble shooting

Documentation/Coding 52

Documentation/Coding Hyperthermia / Hypothermia Sepsis Shock 52

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Greater Sydney Area HEMS

APRIL 15, 2023

Don’t forget that every ambulance has a maternity kit with bunny rugs, surgical gown, umbilical cord clamps, nappy, tiny warm hat… Consider reducing the risk of hypothermia by working inside the ambulance, and warming the vehicle, particularly in winter. This is likely to be difficult in a shocked baby.

Hospitals 85

Hospitals Resuscitation Hyperthermia / Hypothermia Teamwork 85

The Skeptics' Guide to EM

JANUARY 9, 2021

CPR is currently in progress with a single shock having been delivered. This has included things like therapeutic hypothermia ( SGEM#54 , SGEM#82 , SGEM#183 and SGEM#275 ), supraglottic devices ( SGEM#247 ), crowd sourcing CPR ( SGEM#143 and SGEM#306 ), and epinephrine ( SGEM#238 ).

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

EMergucate

MARCH 15, 2016

44 year old critically unwell man with low GCS and severe hypothermia Severe high anion gap metabolic acidosis with additional … Continue reading →

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Shock EMS 40

Don't Forget the Bubbles

JUNE 26, 2023

But, they may present postnatally with cyanosis/hypoxaemia due to insufficient pulmonary blood flow, cardiogenic shock due to insufficient systemic blood flow, or both. The JET is treated by deepening sedation (to minimise exogenous and endogenous catecholamines), optimizing electrolytes and active mild hypothermia.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

Greater Sydney Area HEMS

APRIL 26, 2023

In contrast, shock (leading to syncope and rarely cardiac arrest) from ST can occur well before mechanisms of crush injury come into play, with low-flow states described as early as within 6 minutes (2). . Nope they’re different. – Vagally-mediated bradycardia/hypotension , precipitating syncope and ultimately circulatory collapse.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

EMDocs

FEBRUARY 9, 2024

A 200J shock is reasonable – though a higher dose may be needed for larger patients. Common causes include hypokalemia, hypocalcemia, hypomagnesemia, and hypothermia 3. Assess your patient and if there is any sign of instability, use electricity. Identify and discontinue all QT-prolonging medications.

EKG/ECG 96

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 96

Taming the SRU

MAY 1, 2023

Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures. EMS was bagging him on arrival Primary notable for Compromised Airway Protection, bilateral Breath sounds, strong pulses,GCS 3 CT images of Head, Chest, Abdomen, Pelvis, and Spine No acute findings pH of 6.75

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Thinking Critical Care

MAY 18, 2023

In 1983 I was an Englishman abroad, the London anaesthetist who was appointed to be the English anaesthetist on the Shock Team only because the outstanding candidate from Oxford had preferred to take up a job doing muscle relaxant research with Kitz and Katz in the USA. 4] The research agenda at the time was broad.

Shock 40

Shock Research Resuscitation Sepsis 40

EMergucate

SEPTEMBER 5, 2018

A 68 year old female present with altered mental state, shock and hypothermiaHer blood test shows severe life threatening high … Continue reading →

Shock 40

Shock Hyperthermia / Hypothermia Sepsis Resuscitation 40

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. Traditionally thought to result from the dilutional effects of massive transfusion, acidaemia or hypothermia, trauma-induced coagulopathy is now known to be triggered at the time of injury, long before these factors have developed or any medical intervention has taken place.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

MARCH 30, 2023

Secondary Outcomes: Shock, ventricular tachycardia, and/or fibrillation within 48 hours after hospital admission. For More on This Topic, Checkout: MIRACLE2 Risk Score for Early Prediction of Neurologic Outcome in Out-of-Hospital Cardiac Arrest TTM2: Hypothermia vs Normothermia for Out-of-Hospital Cardiac Arrest References: Geri, G.,

Hospitals 62

Hospitals Outcomes EKG/ECG Resuscitation 62

Pediatric Emergency Playbook

MARCH 1, 2016

On arrival, he was in compensated shock, with tachycardia. The Trauma Death Spiral Lethal triad of hypothermia, acidosis, and coagulopathy. Do everything you can to support perfusion and avoid the death spiral of hypothermia, coagulopathy, and acidosis. He decompensates and needs blood. That patient will needs clot-stablizer.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Mind The Bleep

FEBRUARY 9, 2024

The ICU team are aware that this patient may require therapeutic hypothermia, continuous cardiac monitoring and may deteriorate to the point of arrest. Circulation Is there evidence of shock – think hypoperfusion; confusion, chest pain, rising lactate, low BP.What is the most likely cause of this? Is it reversible?

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

Don't Forget the Bubbles

JANUARY 10, 2024

These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Were the study groups similar at the start of the trial? Groups were well matched at baseline.

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

Dr. Smith's ECG Blog

MAY 5, 2022

ST elevation in aVL with reciprocal ST depression in the inferior leads Shock, bradycardia, ST Elevation in V1 and V2. Physician also reads it as normal) Severe shock, obtunded, and a diagnostic prehospital ECG. Another Shark Fin. With a twist. Do you recognize this ECG yet? Right Bundle Branch Block with ST Elevation in V1?

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52