EMDocs

JANUARY 13, 2024

Spoon Feed High-dose nitroglycerin improves outcomes in patients with sympathetic crashing acute pulmonary edema (SCAPE) without significant side effects when compared to low-dose nitroglycerin. sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock. Crit Care Med.

Stroke 88

Stroke Shock Pediatrics Resuscitation 88

Sensible Medicine

AUGUST 26, 2024

In population studies, AF associates with worse outcomes. Strokes and heart failure are the main complications of AF. And even when drugs suppress AF, trials failed to show that doing so reduces stroke or heart failure. In CABANA, ablation reduced AF episodes on monitors, but hard outcomes did not differ significantly.

Stroke 100

Stroke Outcomes Shock Research 100

RebelEM

SEPTEMBER 28, 2023

The STREAM-1 trial found that for [2] patients with STEMI presenting within 3 hours of symptom onset and unable to attain PCI within 1 hour of first medical contact, a pharmaco-invasive strategy resulted in similar rates of death, shock, heart failure, or reinfarction compared to primary PCI. Primary PCI: 95.7% Primary PCI: 95.7%

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Liberal: 14.9%

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

Sensible Medicine

JUNE 5, 2023

Did the new treatment reduce the bad outcome so much so that the difference meets a statistical threshold? Two examples explain the challenge of using statistics to judge science In large studies, a tiny difference in outcomes—one that is not “clinically” significant can easily reach statististical significance.

Stroke 98

Stroke Hyperthermia / Hypothermia Outcomes Shock 98

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

Stroke 136

Stroke Outcomes Hospitals Administration 136

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. The patient was in clinical shock with a lactate of 8. This confirms inferior, posterior, lateral, and RV MI RV MI often leads to shock and (systolic) hypotension. RVMI explains part of the shock. His prehospital ECG was diagnostic of inferior posterior OMI.

Shock 97

Shock EKG/ECG Academics Stroke 97

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

ACEP Now

OCTOBER 10, 2023

The CT scan reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. Both INTERACT-2 and ATACH-2 showed no statistical difference in their primary outcome between intensively lowering the BP and a less-intensive strategy. Reference Ma LM, Hu X, Song L, et.

Outcomes 52

Outcomes Stroke Emergency Department Hospitals 52

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 143

Administration Outcomes Resuscitation Radiology 143

Dr. Smith's ECG Blog

APRIL 2, 2024

He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. No wall motion abnormality Decreased left ventricular systolic performance, severe Left ventricular enlargement, marked Dilated cardiomyopathy severe Est. stroke volume 52 cc at HR 70 = 3.64

EKG/ECG 133

EKG/ECG Shock CPR Stroke 133

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. patients with more discrepant readings had NIBP checked more frequently) Some patients were on multiple vasopressors, but for an unclear reason the authors decided to only evaluate the dose of norepinephrine MAP discrepancy is not a patient oriented outcome (i.e.

Resuscitation 123

Resuscitation Outcomes EMS Sepsis 123

Sensible Medicine

SEPTEMBER 23, 2024

They also found that the largest difference between truncated and nontruncated trials occurred when the truncated trials had fewer than 500 outcome events. The rate of the composite primary outcome of CV death, MI, unstable angina, stroke or transient attack was 4.29% with asa vs 4.48% with placebo.

Stroke 109

Stroke Academics Outcomes Shock 109

Taming the SRU

JUNE 3, 2024

Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there. Benefits of transport are evidenced based.

Shock 91

Shock Seizures Airway Management Stroke 91

Taming the SRU

JANUARY 26, 2024

Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2 10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

RebelEM

JUNE 8, 2023

They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. Assessed clinical practice, outcome, length of stay, safety, and efficacy of both phenylephrine and epinephrine peripherally administered through a push dose.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Taming the SRU

APRIL 17, 2024

The primary outcome was defined as agreement of less than 10 % of the mean arterial pressure (MAP) between simultaneously recorded IABP and NIBP measurements. Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. References Evans L, Rhodes A, Alhazzani W, et al. Crit Care Med.

Sepsis 94

Sepsis Research Stroke Academics 94

Don't Forget the Bubbles

FEBRUARY 5, 2025

There is significant evidence in adults and developing in the paediatric population that TXA results in better outcomes if given early in patients with mild to moderate traumatic brain injury (TBI) and does not cause harm. Disability – Altered mentation, seizure, stroke symptoms, severe headache, neurological deficit, visual symptoms.

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

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

PulmCCM

JULY 10, 2023

In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours). A sequel to that trial, BLING III, is underway. access, etc.,

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Ziqitza HealthCare Ltd

JUNE 13, 2024

Knowledge of life-saving skills can significantly impact patient outcomes, potentially saving lives and avoiding future health complications. Difficulty speaking Sudden speech difficulties, weakness, or numbness could be an emergency medical warning sign of a stroke. These also require emergency medical intervention at the earliest.

Stroke 52

Stroke Burns Ambulance Services Seizures 52

Stop and Think

JANUARY 9, 2022

When someone presents in shock because of AV block and a low heart rate, you place a pacemaker. Our intervention aims to reduce the odds of that bad outcome. The benefit of preventive therapy, therefore, can only be considered as a reduced probability of that outcome. When someone falls and breaks a hip, the decision is easy.

Stroke 52

Stroke Outcomes Shock 52

AED Leader

DECEMBER 6, 2024

This article explores Stryker’s impactful role in revolutionizing cardiac emergency preparedness worldwide, from pioneering technologies and addressing healthcare disparities to aligning with major organizations like the American Heart Association in pursuit of improved outcomes.

Basic Life Support 52

Basic Life Support Resuscitation Outcomes Hospitals 52

JournalFeed

MARCH 26, 2022

Epi vs. NorEpi Spoon feed: Continuous epinephrine infusion for post-resuscitation shock in out of hospital cardiac arrest (OHCA) was associated with both higher all-cause and cardiovascular specific mortality when compared to norepinephrine. Check out journalfeed.org for details.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. 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 should use lactate to detect occult shock.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

ACEP Now

NOVEMBER 7, 2023

Double sequential external defibrillation (DSED) is a technique in which rapid sequential shocks are placed from two defibrillators, with defibrillation pads in two planes, such as anterior-lateral and anterior-posterior. The primary outcome was survival to hospital discharge. Hershey Medical Center and associate editor of ACEP Now.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. This should be suspected in patients with intraoperative cardiac arrest or shock. While both conditions rely on supportive care as the mainstay of treatment, plastic surgery literature suggests better outcomes with microscopic fat embolism.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

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

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Taming the SRU

APRIL 13, 2023

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. Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

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

Taming the SRU

MAY 3, 2023

During the admission, she completed a course of broad-spectrum antibiotics and as the underlying shock state improved, she was also weaned off all vasopressor support. For a complete discussion of cardiogenic shock and right ventricular failure, please see this other Air Care Series post on the subject.

Wellness 52

Wellness Hospitals Shock Outcomes 52

ACEP Now

MARCH 14, 2024

Fatal outcomes postoperatively may be due to re-bleeding after attempts to preserve flow in the innominate artery or using sutures or prosthetic material in an infected area.22,23 Tracheoinnominate fistula: acute bleeding and hemorrhagic shock due to a trachea-innominate artery fistula. Tracheo-innominate artery fistula after stroke.

Operations 52

Operations Pediatrics Radiology Radiology 52

EB Medicine

SEPTEMBER 1, 2018

Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them. Instead, since no treatment has been shown to improve outcome, you should prioritize prompt transport. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Nachi: Let’s move on to diagnostic studies.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

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 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

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 First up is the link between cannabis use and stroke or TIA. times higher risk of stroke or TIA. times higher risk of stroke or TIA. million, and cocaine at 1.9 Effects can be seen within 3 minutes.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40