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. These cases illustrate some of the common issues associated with each shunt type, but what does the evidence say about outcomes? What is the best option for repair?

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

AED Leader

JULY 5, 2024

The HeartStart OnSite AED boasts a quick start-up time and delivers a shock within eight seconds if it detects a shockable rhythm. The HeartStart OnSite AED has a long-life lithium battery that can deliver up to 200 shocks or provide approximately four hours of continuous monitoring.

CPR 52

CPR Resuscitation Shock Pediatrics 52

ACEP Now

JUNE 6, 2023

Example: “ I can imagine this comes as a shock” or “ I can hear how upset you are.” Often, the outcome of an ED visit is not what the patient wants, but this skill prepares the patient for the reality. For some chest pain I had last night.” References Phillips KA, Ospina NS. Physicians interrupting patients. 2017;318(1):93–94.

Emergency Department 98

Emergency Department Hospitals Best Practices Shock 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 CPR Shock Resuscitation 52

PHEM Cast

APRIL 10, 2016

And from our buddies at HEFT EM CAST: [link] A bit more detail covering some of the research in an easy to understand way. This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. 2009;13(5):R167. 2014 Oct 28;:1–9.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

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.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We could use it to track treatment , and see if we can clear the lactate; decreased lactate levels are associated with a better outcome in adults. Clinical Chemistry.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

One-liner… Understanding how to manage maintenance fluids in critically unwell children best is a basic but important way to improve outcomes. She had septic shock on presentation and was resuscitated with 60ml/kg of balanced crystalloid solution and escalating vasoactive medications. Ann Intensive Care.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

The Skeptics' Guide to EM

JANUARY 7, 2023

We just said there is so much research being published every day. As Professor Altman said in the BMJ back in 1994; “we need less research, better research and research done for the right reasons.” As Professor Feynman said…It’s ok to say: “I don’t know”.

Emergency Department 40

Emergency Department Research Shock EKG/ECG 40

Mind The Bleep

FEBRUARY 27, 2024

The children who received no bolus had significantly better outcomes and reduced mortality compared to the two bolus group. [2] saline), however more research is needed in this area. [4] Boluses were given in 20-40ml/kg aliquots.

Fluid Resuscitation 96

Fluid Resuscitation Dehydration Hospitals Research 96

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.

Emergency Department 52

Emergency Department Outcomes Sepsis Operations 52

The Skeptics' Guide to EM

FEBRUARY 10, 2018

Exclusions: Oxygen saturations <92% on room air; silent chest; shock or sepsis; previous PICU admission with wheeze; prematurity; other cardiac or respiratory disease; likely alternative diagnosis for the wheeze; or steroid treatment within the preceding 14 days. Intervention: Three-day course of oral prednisolone (1mg/kg once daily).

Emergency Department 40

Emergency Department Pediatrics Sepsis Hospitals 40

ACEP Now

APRIL 3, 2024

1,2 However, the European TTM1 trial in 2013 showed similar outcomes for those cooled to 33 degrees Celsius compared to 36 degrees Celsius, leading to a 2015 AHA class I recommendation of “cooling between 32 degrees Celsius-36 degrees Celsius.” degrees Celsius. 5,6 In 2021, the TTM2 trial was published. degrees Celsius for 72 hours.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 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

RebelEM

MAY 29, 2023

septic shock). Most of the research on the use of MB has been in patients with vasoplegia following cardiopulmonary bypass. Limited, small studies on its use in septic shock do not make a clear argument for use. Early Adjunctive Methylene Blue in Patients with Septic Shock: A Randomized Controlled Trial. Crit Care 2023.

Shock 145

Shock Fluid Resuscitation Sepsis Resuscitation 145

RebelEM

SEPTEMBER 14, 2023

Background: Cardiogenic shock develops in up to 10% of patients with acute myocardial infarction (AMI) and carries a 30 day mortality rate around 50%. Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8% to 1.03) Poor Neurologic Outcome (CPC 3 or 4): 24.8%

Shock 136

Shock Outcomes Resuscitation Stroke 136

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

Pediatric EM Morsels

JULY 21, 2023

Motor Fingernail bed pressure with a pencil first If flexion outcome, then apply painful stimulus to neck or head (trapezius or supraorbital notch) to look for localization Spinal reflex can result in a falsely elevated score if lower extremity pain induced Verbal Orientated- Able to answer all questions. Fun fact for animal lovers!-

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

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. What They Did: Researchers performed a systematic review and meta-analysis. 2.89, p = 0.01.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

PulmCCM

APRIL 10, 2025

Among 166 patients with “sepsis” who were randomized to aspirin 200 mg or placebo at five ICUs in Brazil, those receiving aspirin had no improvement in organ failure scores or other outcomes. Most Clinicians Ignore New “Steroids-For-All” Septic Shock Guideline In 2024, the major U.S. hours after symptom onset.

CDC 40

CDC Stroke Sepsis Radiology 40

Sensible Medicine

SEPTEMBER 18, 2023

They then looked at a primary outcome of death. Earlier surgery may improve outcomes in these high-risk patients. Differences in baseline characteristics between the 2 groups likely largely explain the differences in their outcomes as discussed above, and propensity matching was not performed. vs 18.2% ; P =.036).

Operations 133

Operations Academics Shock Outcomes 133

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 93

Sepsis Fluid Resuscitation Resuscitation Shock 93

Don't Forget the Bubbles

MARCH 31, 2025

The Bridge is a Postgraduate Doctor in Training (PGDiT)- led paediatric research forum in Yorkshire and Humber, UK, with the aim of bridging the gap in research access among PGDiT. This was a secondary analysis of the Management and Outcome of Fever in Children in Europe (MOFICHE) study. Whats it about? Am J Emerg Med.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

The Trauma Pro

SEPTEMBER 12, 2023

The authors are given very little print space to fully describe their research idea, their methods, and their results’ significance. Even then, it needs to be taken in context with past, similar research before trickling down to patient care. But mercifully, this does not happen often. The first abstract is fascinating.

Fractures 113

Fractures Head Injuries Research Outcomes 113

RebelEM

AUGUST 14, 2023

in both groups Mean APACHE II score was 12 in both groups Almost half of the patients had septic shock at enrollment Mean time from sepsis identification to randomization was 1.4 Secondary Outcome Results: ICU mortality: placebo 20.0% Investigators asked a patient-centered research question. vs. XBJ 14.2% vs. XBJ 17.0%

Sepsis 98

Sepsis Outcomes Administration EMS 98

Sensible Medicine

DECEMBER 16, 2024

With that in mind, the reported outcomes, such as the reduction in heart failure hospitalizations at three years, and even the questionable reduction in total mortality in the first years of follow-up, are likely to be the result of statistical noise. This drastic reduction in power was not properly acknowledged in the manuscript.

Shock 98

Shock Hospitals Outcomes Research 98

Emergency Medicine Journal

OCTOBER 26, 2023

Despite decades of investment and research, survival remains disappointingly low. 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

AENJ: Current Issue

MAY 8, 2024

This column on translating research into practice is crafted to offer advanced practice registered nurses an analysis of current research topics that hold practical relevance for emergency care settings.

Emergency Department 40

Emergency Department Outcomes Sepsis Research 40

RebelEM

OCTOBER 5, 2023

Secondary Outcome By day 90, mortality was 9.3% Strengths: The investigators framed a research question centered on patient outcomes, ensuring the study’s relevance and practicality. Control: Normal Saline via continuous infusion according to the same regimen used in the hydrocortisone group. to −0.8).

Research 94

Research Outcomes Administration Shock 94

Don't Forget the Bubbles

DECEMBER 11, 2023

Neglect Emotional Physical A subsequent study, ‘ The Philadelphia ACE Study ’, in 2015, identified that community factors were routinely neglected from research and so added in five community domains. This is shocking, but they discovered a staggering dose-response model when they compared these results with medical histories.

Wellness 104

Wellness Research Outcomes Shock 104

Don't Forget the Bubbles

APRIL 7, 2025

Early recognition of these signs is crucial, as timely hormone replacement can significantly improve outcomes. Early identification and treatment can significantly improve long-term outcomes, preventing complications such as severe short stature, metabolic disturbances, and delayed puberty. Why are we worried about hypopituitarism?

Dehydration 72

Dehydration Pediatrics Administration Seizures 72

Dr. Smith's ECG Blog

AUGUST 9, 2024

Opioids associate with worse outcomes in myocardial infarction , probably because they eliminate the pain signal that informs the clinician of the urgency of revascularization. below) Other examples of AIVR: Young man with Gunshot wound to right chest with hemorrhagic shock, but bullet path not near heart. Do not treat AIVR.

EKG/ECG 107

EKG/ECG EMS Emergency Department Wellness 107

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

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.,

Advances Cardiac Life Support (ACLS) 96

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

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. The Effect of Vitamin C on Clinical Outcome in Critically Ill Patients: A Systematic Review with Meta-Analysis of Randomized Controlled Trials. Critical Care Medicine. Critical Care Medicine.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. Optimal management of septic patients has been a source of intense research, stemming from the landmark study by Rivers in 2001. Jeff : Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40