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. The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i].

Ultrasounds 98

Ultrasounds Shock Research Emergency Department 98

PulmCCM

NOVEMBER 17, 2023

Kenny MD [ @heart_lung ] In part 1 , right atrial pressure [P ra ] and cardiac output/venous return [CO/VR] were considered as two hemodynamic measures bound at the operating point [OP] of the circulatory system. OP is operating point. Shows what happens when Ppc, Pmsf, Rcardiac and Rvr all vary [grey operating points].

Operations 132

Operations Ultrasounds Resuscitation Blood Transfusions 132

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Perhaps, not insignificantly, they were accustomed to receiving systematized government-supplied medical and trauma care, with "shock rooms" receiving an influx of victims, as contrasted to those later who opposed "socialized medicine." EM makes a strong push into bedside use of ultrasound sonography. EDNA->ENA.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

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. Jeff: Interestingly, the system I work in has prehospital physicians, who do carry US, but I can’t think of a major trauma where ultrasound changed any of the decisions we made.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. You can also use the shock index, which as a reminder is simply the HR/SBP. Jeff: Indeed.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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

Sensible Medicine

JUNE 17, 2024

PFA destroys myocardium with electricity (shocks). Every “application” is actually a shock. PFA is especially concerning because the shocks in the left atrium create intense microbubbles. What’s more, the lack of esophageal damage has encouraged PFA operators to deliver more (not less) ablation.

Shock 126

Shock Stroke Operations Ultrasounds 126

Pediatric Emergency Playbook

MARCH 1, 2016

On arrival, he was in compensated shock, with tachycardia. Often children even with high-grade splenic and liver lacerations can be managed non-operatively. Unfortunately, a negative FAST cannot help with detecting or grading the laceration for non-operative management. He decompensates and needs blood.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

RebelEM

JANUARY 25, 2024

Background: Point-of-care ultrasound (PoCUS) is a valuable clinical tool in the assessment of acute dyspnea. Impact of serial cardiopulmonary point-of-care ultrasound exams in patients with acute dyspnoea: a randomized, controlled trial. PoCUS evaluations included lung ultrasound (LUS) and focused cardiac ultrasound (FoCUS).

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

Don't Forget the Bubbles

MARCH 4, 2024

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. Check out DFTB’s module on SIRS, Sepsis and Shock Module – Don’t Forget the Bubbles (dontforgetthebubbles.com) Why does it matter?

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

RebelEM

JANUARY 25, 2023

2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Pediatric Emergency Playbook

JANUARY 1, 2017

Neonatal observational scales have been validated in the intensive care and post-operative settings; ED-specific quantitative scales are lacking. CRIES ( Table 1 ) was validated for post-operative patients; to adapt its use for the ED, the most conservative approach is to substitute “preoperative baseline” with normal range for age.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

ACEP Now

SEPTEMBER 3, 2024

While secrecy surrounds the operations of many PE-owned groups, Envision serves as a case study. He was shocked when the hospital CEO took him up on it, but a year later, volumes increased 30 percent with his emphasis on quality rather than cost-cutting. Her primary interests are in ultrasound, machine learning, and health justice.

Hospitals 69

Hospitals Radiology Radiology Administration 69

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. How to intubate?

Burns 52

Burns Hospitals Wellness Ambulance Services 52

EB Medicine

AUGUST 1, 2018

It was peer-reviewed by Joseph Habboushe, assistant professor at NYU and Nadia Maria Shaukat, director of the emergency and critical care ultrasound at Coney Island Hospital in Brooklyn, New York. Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 million, and cocaine at 1.9

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Taming the SRU

AUGUST 30, 2023

Notably, lung ultrasound for the diagnosis of bacterial CAP demonstrated exceptional stand-alone diagnostic accuracy in 33 studies including 4,901 adults and children in the emergency department, with a pooled sensitivity of 92% and specificity of 90%. Intensive Care Med. 2021 Nov;47(11):1181-1247. doi: 10.1007/s00134-021-06506-y.

Infectious Diseases 86

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 86

EB Medicine

JANUARY 2, 2019

Jeff: Perhaps most importantly, no history or physical alone can rule in or out an ectopic pregnancy, for that you’ll need testing and imaging or operative findings. So to get us all on the same page, the discriminatory zone is the b-HCG at which an IUP is expected to be seen on ultrasound. Jeff: Up first is the urine pregnancy test.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

While Point of Care Ultrasound has made limited entry in prehospital care, largely with physician-led services and some Advanced Paramedics; it has largely been as a proof of concept rather than everyday care. An elderly lady in cardiogenic shock (BP 60/40) with no veins , I was lucky to get a 24-gauge PIV into the back of her wrist.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. What are the most up-to-date guidelines for managing this patient?

Sepsis 65

Sepsis Fluid Resuscitation Resuscitation Shock 65

Pediatric Emergency Playbook

JUNE 1, 2017

The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’. Fontan Operation and the Single Ventricle. Cardiovasculr Ultrasound. That may very well be true, but any virus can be invasive with myocardial involvement.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Don't Forget the Bubbles

JULY 5, 2023

Afro-Caribbean patients should be screened for sickle cell before anaesthesia for possible pre-operative transfusion. Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. What could be the differential diagnosis? coli and Staphylococcus aureus.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

NOVEMBER 13, 2023

26 With regards to penetrating neck injuries, particularly those in which the platysma is violated, CTA of the neck has allowed a shift away from mandatory operative exploration of Zone 2 neck wounds (those in the mid-neck). However, IgE-mediated or not, anaphylactic shock is possible in either case. 32 Table 2 : Memphis Criteria.

Stroke 87

Stroke Radiology Radiology Emergency Department 87