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

Don't Forget the Bubbles

OCTOBER 2, 2024

This referral procedure is only possible with a well-structured system and may not be feasible in all settings. Original clinical studies Prevention of NICU Admission Hypothermia in Moderate- and Late-Preterm Infants. Trends in HIE and Use of Hypothermia in California: Opportunities for Improvement. Pecenka C, et al. Pediatrics.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Urgent Care 52

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

EM Guide Wire

SEPTEMBER 9, 2020

Epinephrine bolus 20-40 mcg IV (EMCRIT recommended dose using push dose epi) peds 0.01 Dosing formula on MedCalc using serum level & amount ingested (mg ingested x 0.8

Documentation/Coding 52

Documentation/Coding Hyperthermia / Hypothermia Sepsis Shock 52

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9%

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC? CPR is currently in progress with a single shock having been delivered.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

Greater Sydney Area HEMS

APRIL 26, 2023

Both the stuff of legend and go by multiple names including harness hang syndrome and orthostatic intolerance, as well as bigfoot and the abominable snowman, respectively. – Concurrent traumatic injuries , along with hypothermia, hypoglycaemia, pain and fear can all stimulate maladaptive compensation, potentiating the above mechanisms.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

EMDocs

JUNE 25, 2024

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. Severely burned patients have impaired thermoregulation and are at risk of hypothermia. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. link] (2019).

Burns 73

Burns Fluid Resuscitation Resuscitation Poisoning 73

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 Emergency Department Seizures 52

Greater Sydney Area HEMS

APRIL 15, 2023

Consider skin-to-skin on Mum’s chest to keep an otherwise well baby warm. 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.

Hospitals 85

Hospitals Resuscitation Hyperthermia / Hypothermia Teamwork 85

PEMBlog

JANUARY 17, 2024

Well when a break in the skin occurs, normal skin, flora, and bacteria can enter the subcutaneous tissue, where they do not belong, and they can also invade the lymphatic system. You can also see petechiae and hemorrhage, as well as superficial bulla, vesicles, or even echemosis. Full blown sepsis and toxic shock syndrome.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

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. Resistance provided by this pathway will have a marked bearing on how well-balanced the circulation is – it is the primary determinant of PVR.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

EMDocs

FEBRUARY 9, 2024

She is well appearing, and while being placed on the monitor becomes anxious stating the symptoms are recurring. A 200J shock is reasonable – though a higher dose may be needed for larger patients. Common causes include hypokalemia, hypocalcemia, hypomagnesemia, and hypothermia 3. Adapted from Dr. Smith’s EKG Blog.

EKG/ECG 71

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 71

Mind The Bleep

FEBRUARY 9, 2024

She is moderately frail with a few well-managed comorbidities, and states that she would not want to live if she was not able to do her gardening or hold her grandchildren. The ICU team are aware that this patient may require therapeutic hypothermia, continuous cardiac monitoring and may deteriorate to the point of arrest.

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 52

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. His immunizations are current and has received all pneumococcal vaccinations. C or 100.4

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

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. Groups were well matched at baseline. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

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. Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. He decompensates and needs blood.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. You will be running the show today, and you want to use your preparation time well. But unfortunately for Ranulf, as Tarquin stood, he slipped on a blob of spilt quince jelly. Lurching awkwardly sideways, Tarquin fell towards his best friend, the knife lunging deep into the left side of his chest.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Rural Doctors Net

AUGUST 30, 2013

I’d raise here the concept of his ‘anticipated clinical course’ – he’s going to OT and has airway injury that will likely progress – so you might as well intubate on these grounds alone. Sure he’s got a traumatic amputation – your tourniquet has arrested the bleeding, but there may well be more blood loss.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

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. 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. Read more

EMS 52

EMS CPR Shock Resuscitation 52

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Drug toxicity , especially diphenhydramine , which has sodium channel blocking effects, and also anticholinergic effects which may result in sinus tachycardia, hyperthermia, delirium, and dry skin. How well does the computer interpretation perform? Hyperkalemia 2. Other drugs with sodium channel blockade: Tricyclic antidepressants.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

EB Medicine

AUGUST 1, 2018

Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 Nachi: Among metabolic abnormalities, patients can present with hyperthermia, hypoglycemia, hypokalemia, hyponatremia, and metabolic acidosis. Jeff: And the etiology of CHS is not well understood.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40