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. Patients with septic shock or influenza were excluded. standards of care. In the U.S., Some states’ screening rates are 1%.

Advances Cardiac Life Support (ACLS) 96

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

Taming the SRU

SEPTEMBER 1, 2023

to divert the plane). for detecting major injuries Abnormal CXR Rapid deceleration mechanism Presence of a distracting injury Chest wall tenderness Sternal/thoracic spine/scapular tenderness There are limited decision-making rules for thoracic spine imaging Yet a study (Inaba et al., 2015) reported a sensitivity of 98.9%

Sepsis 88

Sepsis Administration Documentation/Coding Fractures 88

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. Whilst waiting for an operation, they need to be managed medically. Soon after the operation, the baby is noted to have junctional ectopic tachycardia (JET).

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

AED Leader

JULY 1, 2024

Its user-friendly design ensures trained professionals and laypersons can confidently operate it during an emergency. It features ADAPTIV biphasic waveform technology, which adjusts energy levels based on the patient’s needs, ensuring effective and safe defibrillation shocks.

Pediatrics 52

Pediatrics CPR Operations Resuscitation 52

EMDocs

JULY 17, 2023

7 While post-operative adhesive disease is also a risk factor, it is far less commonly implicated in LBO compared to SBO. Measures to optimize the patient for surgical intervention and treat shock, including antibiotics and fluid resuscitation, are associated with improved outcomes in these patients. World J Gastroenterol.

Operations 77

Operations EMS Fluid Resuscitation Resuscitation 77

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. Damping Damping is essentially the shock absorbers in the pressurized system. Keville, M.

Shock 59

Shock Resuscitation Ultrasounds Research 59

RebelEM

APRIL 29, 2024

One may speculate that the US-guided CVC placement would have a higher first-pass success rate with fewer complications, however, this may potentially add time to the procedure depending on the operator and institution’s use of ultrasound during emergencies and maintaining sterile technique with the US probe.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

Intensive Blog

FEBRUARY 7, 2023

Despite thromboaspiration, she had recurrent VF arrests with worsening cardiogenic shock (CS), so an Impella CP (Abiomed, Danvers, MA) was inserted through the right femoral artery for left ventricular (LV) support. Management of left ventricular distension during peripheral extracorporeal membrane oxygenation for cardiogenic shock.

Shock 52

Shock Hospitals Operations Outcomes 52

Dr. No

JANUARY 3, 2022

Society reaches saturation point: the pandemic no longer shocks and stupefies; instead, it becomes an unwelcome but essentially normal part of life, in effect, just another flu like illness, dreadful, even fatal, to some, but for the vast majority, no more than a tiresome nuisance.

Operations 52

Operations Shock Outcomes 52

ACEP Now

MARCH 14, 2024

18 The finger is inserted through the stoma alongside the endotracheal tube and, while 90 percent success rate has been reported with this method in controlling bleeding, the pressure must be maintained until the patient is transferred to the operating room. Operative technique for trachea-innominate artery fistula repair. J Vasc Surg.

Operations 52

Operations Pediatrics Airway Management Radiology 52

Don't Forget the Bubbles

MAY 10, 2023

A shocked friend is being ushered out of the way. Then the patient is rapidly moved to the operating theatre. The effects of aviation-style non-technical skills training on technical performance and outcome in the operating theatre. A teenager lies on the resus trolley. They’re getting CPR. They have been stabbed.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

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 64

Shock Administration Academics Hospitals 64

Dr. Smith's ECG Blog

MAY 14, 2022

I am sure you already shocked it, right?" Outcome Electrophysiologic study showed an accessory pathway (WPW, antidromic AVRT) Why did adenosine not work? As Dr. Smith said in his initial comment, "I am sure you already shocked this rhythm, right?" Or, of course, you can always use electrical cardioversion. Antidromic WPW).

EKG/ECG 52

EKG/ECG Shock Operations EMS 52

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 89

Resuscitation Outcomes Operations Hospitals 89

ACEP Now

JULY 7, 2023

2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. In those with severe injury, you may note refractory hypotension secondary to cardiogenic shock. of cases and contributed to the death of 45.2% of those patients. for pericardial effusion.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

PHEM Cast

APRIL 18, 2016

Hauwald, 2002 A co-operative patient does not require immobilization unless their conscious level deteriorates. The periscope video of the SKEPTIC trial presentation is accessible here: [link] The Royal Flying Doctors Service (RFDS) use infusion of ketamine to manage agitated mental health patient without need for intubation.

Fractures 40

Fractures Administration Operations Shock 40

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 74

Outcomes Hospitals Operations Shock 74

Don't Forget the Bubbles

JULY 26, 2023

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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. Background Information: Double external defibrillation (DED) is an intervention often used to treat refractory ventricular fibrillation (RVF).

EMS 52

EMS Shock CPR Resuscitation 52

EB Medicine

JULY 8, 2019

Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. These patients often require emergent operative intervention.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. They stratified patients according to the ratio of FFP: PRBC received (1:1, 1:2, 1:3 and 1:3+) and performed logistic regression analyses for various outcomes.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Don't Forget the Bubbles

MARCH 4, 2024

This was a secondary outcome embedded in the Travel Fever study – a multi-centre, retrospective diagnostic accuracy study for imported malaria. International Consensus Criteria for Pediatric Sepsis and Septic Shock. The aim of this paper was to update and evaluate the criteria for sepsis and septic shock in children.

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

RebelEM

JANUARY 25, 2023

Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 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 95

Administration Emergency Department Outcomes Documentation/Coding 95

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 113

Ultrasounds Outcomes COPD Hospitals 113

PHEM Cast

SEPTEMBER 6, 2017

trauma 2004) showed that end-tidal CO2 may be of value in predicting outcome from major trauma (19). Qvigstad et al showed in again in Resuscitation in 2013, confirming inter-individual variation in effectiveness of CPR using ETCO2 as a surrogate for CO Trauma Deakin et al. (J. 2013;118(1):192-201. doi:10.1097/ALN.0b013e318278c8b6

CPR 52

CPR Resuscitation Wellness Operations 52

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. 7-9 The PE model then aims to sell acquired businesses for a profit within three to six years.

Hospitals 52

Hospitals Radiology Radiology Administration 52

EMDocs

JUNE 3, 2023

4 Patients with pelvic fractures are considered unstable when systolic blood pressure < 90mmHg and heart rate >120bpm, or in those with dyspnea, altered mental status, or skin findings of shock. 12 Patients with pelvic fractures and concerning straddle mechanisms should be thoroughly evaluated for genitourinary injuries.

Fractures 54

Fractures Resuscitation Operations EMS 54

RebelEM

MARCH 27, 2023

Ventilator-associated lung injury and inflammation can occur even during short-term mismanagement can worsen patient outcomes. 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. This is a critical error that leads to poorer outcomes for patients in need of critical care.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

EB Medicine

JUNE 6, 2019

Nachi: And remember that hypothermic patients who are septic have worse outcomes than those who are hyperthermic and septic. Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. In one study, a SI > 0.7 Jeff: As for the lactate.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

PulmCCM

JANUARY 4, 2022

” -Fran Lebowitz Background Quite recently, the BaSICS investigators evaluated the infusion rate of a fluid bolus on patient outcome. The primary outcome was identification of the optimal volume for assessing fluid responsiveness. If I get to the dry cleaners without having a huge fight, that’s challenging enough.”

Wellness 40

Wellness Outcomes Sepsis Stroke 40

EB Medicine

DECEMBER 4, 2019

The authors note that the air is actually comparable to that of an operating room. Nachi: AEDs are also required and have been since 2001 and amazingly when a shock was delivered in flight, 40% survived to hospital discharge with a good outcome. Nachi: Then why are people always getting sick after flying…?

Dehydration 40

Dehydration Wellness EMS Burns 40

RebelEM

NOVEMBER 3, 2022

Outcomes: Primary Outcome: Incidence of post-induction hypotension Secondary Outcome : First-pass success rate of endotracheal intubation Primary Results: 84 articles were identified for potential inclusion. Articles removed were duplicates, contained irrelevant outcomes, or had a significant risk for bias.

Outcomes 52

Outcomes Emergency Department Sepsis Hospitals 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 Jeff: It’s also worth noting that cannabis is known to cause adverse outcomes on babies such as low birth weight and more frequent perinatal ICU placement. million, and cocaine at 1.9 Counsel them on drug abuse also.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Rural Doctors Net

AUGUST 30, 2013

Smart retrieval services have a presence in the Emergency Operations Centre and will be ‘on standby’ as the initial ambulance call comes through – a much more proactive approach than the usual sequence of calls from first responder-ambulance-local hospital-doctor-retrieval service.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021.

Infectious Diseases 81

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 81