Sensible Medicine

APRIL 1, 2024

In the same session, Jacob Eifer Møller, MD, PhD, from Odense University in Denmark, will present the results of the DanGer-Shock trial. I rank this trial—of the Impella ventricular assist device in patients with cardiogenic shock—as one of the most important trials of this decade. I predict no benefit.

Shock 126

Shock Wellness Outcomes 126

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 105

Sepsis Shock Resuscitation Outcomes 105

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. The RV is supplied during systole as well as diastole.

Shock 82

Shock EKG/ECG Academics Stroke 82

Stop and Think

AUGUST 28, 2024

Trial after trial after trial finds that fixing stable coronary artery disease does not improve outcomes over basic medications and lifestyle changes. The trial found no difference in outcomes. of patients had a primary outcome (death or heart attack). of the patients had a primary outcome (death or heart attack).

Outcomes 117

Outcomes Shock Hospitals Wellness 117

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Three outcomes were evaluated, with none being deemed the primary outcome. Background: Sepsis remains one of the leading causes of morbidity and mortality. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

Sensible Medicine

AUGUST 26, 2024

In population studies, AF associates with worse outcomes. In CABANA, ablation reduced AF episodes on monitors, but hard outcomes did not differ significantly. The problem here is that it’s hard to compare a subjective outcome (like feeling better) when one group of patients get a procedure and the other group gets tablets.

Stroke 82

Stroke Outcomes Shock Research 82

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

AED Leader

APRIL 23, 2024

In this blog post, we will explore these advanced techniques and discuss how they can be implemented to improve emergency outcomes. A manual defibrillator is a device used to deliver an electric shock to the heart to restore its normal rhythm. It consists of two paddles or electrode pads placed on the patient’s chest.

Shock 52

Shock Best Practices Outcomes Pediatrics 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He was admitted on oxygen and was doing fairly well with saturations of 100% on 2 L nasal cannula. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Assessment was severe sudden cardiogenic shock. He remained hypotensive and in shock.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. 6 What Can I Do Outside of Repeated Shocks and Standard ACLS? amiodarone or lidocaine).

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

AED Leader

SEPTEMBER 21, 2024

Why is defibrillation important Defibrillation is the process of delivering an electrical shock to a person experiencing life-threatening heart rhythms, like ventricular fibrillation (VF) or pulseless ventricular tachycardia. The defibrillator administers a shock measured in joules to the heart at precisely the right moment.

CPR 52

CPR Shock Resuscitation Hospitals 52

Sensible Medicine

AUGUST 7, 2023

It is shocking. The brave investigators in London decided to study the idea that medical therapy of heart failure has become so outstanding, that adding revascularization (fixing the obstructions with stents) might not improve outcomes. Their primary outcome was death or hospitalization for heart failure. First some background.

Shock 81

Shock Outcomes Hospitals Wellness 81

Don't Forget the Bubbles

OCTOBER 7, 2024

Was the patient thrown from the source (suggestive of DC shock and may result in further blunt force trauma)? Children, especially toddlers, may insert objects into outlets, leading to shocks or burns. Electrical devices used near water sources can cause severe shocks. Was the voltage high or low (as below)?

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

Taming the SRU

MARCH 10, 2024

critical AS, ASD, HCM) Arrhythmogenic right ventricular cardiomyopathy Pulmonary embolism Thoracic aortic dissection Transient occult shock Sepsis Hemorrhagic shock (ex. Can’t miss ED diagnosis for syncope Brady/tachy dysrhythmia, arrhythmias such as ARVC, channelopathy (Brugada) Acute MI Structural heart disease (ex.

EKG/ECG 96

EKG/ECG Shock Wellness EMS 96

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 81

Outcomes Hospitals Operations Shock 81

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. 4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

RebelEM

APRIL 22, 2024

Intervention: Target PaO2 = 60 mm Hg Control: Target PaO2 = 90 mm Hg Outcome (primary): Absolute number of days without life support in 90 days defined as the absence of mechanical ventilation, circulatory support, or kidney replacement. Outcomes (secondary): 90-day all-cause mortality. CI) Secondary Outcomes 90-day Mortality 34.7%

Outcomes 75

Outcomes Best Practices EMS Shock 75

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

Sensible Medicine

JUNE 16, 2024

I watched a case as a young doctor and came away shocked that patients survive this surgery. Well, there is less debris than I would have thought. Because you know how scary it is to try and compare outcomes in two groups of patients who were not randomized. We discuss that as well. TAVR is even more stunning.

Stroke 72

Stroke Shock Wellness Outcomes 72

AED Leader

AUGUST 22, 2024

By delivering an electric shock to restore normal heart rhythm in cases of ventricular fibrillation or other arrhythmias, AEDs play a vital role in increasing survival rates following sudden cardiac arrests. If it detects such a problem, it delivers an electric shock to restore normal heart function. How does an AED Work?

CPR 52

CPR Shock Operations Outcomes 52

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. He writes an […] The post SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock first appeared on The Skeptics Guide to Emergency Medicine. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

PulmCCM

OCTOBER 9, 2023

Intensive blood glucose control in the ICU: Try, try again (TGC-FAST trial) Hyperglycemia is associated with worse outcomes in the ICU (and in medical patients generally), so correcting it must improve outcomes … right? ICU lengths of stay (the primary outcome) were identical between groups. and many other countries.

Shock 52

Shock Outcomes Hospitals Wellness 52

AED Leader

JULY 2, 2024

They are designed to rapidly deliver a high energy level, allowing the AED to administer a life-saving shock to the heart. An AED with a weak or expired battery may not deliver the required shock to restore the heart’s normal rhythm effectively. When a cardiac emergency occurs, every second counts.

Shock 52

Shock Operations Outcomes Wellness 52

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

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

NOVEMBER 18, 2024

Research and guidelines from Australian centres, like those published by the Australian and New Zealand Neonatal Network (ANZNN), emphasize early detection and management to improve outcomes. However, if the infant is well-perfused, cardiovascularly stable, and showing no signs of organ dysfunction, active treatment may not be necessary.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Dr. Smith's ECG Blog

AUGUST 28, 2020

Now appears to be in cardiogenic shock." However, cardiogenic shock usually takes some time to develop, so it is probably subacute." A fixed stenosis in that other artery, especially in the context of hypotension from the occlusion of the first coronary artery, can lead to ischemia and very poor LV function and worsening shock.

Shock 52

Shock EKG/ECG Wellness Outcomes 52

Don't Forget the Bubbles

OCTOBER 10, 2024

The others, such as respiratory rate, heart rate, and decompensated shock, were excluded due to the presumed difficulty for non-healthcare professionals to assess them accurately. Reviewed by: Isabella Davenport Article 2: Does it improve outcomes if you replace the nail in nail bed repair? The assessors scored both groups 5.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

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% The primary outcome was patient oriented. 906 randomized to the Placebo cohort.

Sepsis 98

Sepsis Outcomes Administration EMS 98

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. The six-year trial was not stopped.

Stroke 90

Stroke Academics Outcomes Shock 90

PulmCCM

FEBRUARY 12, 2024

SCCM Guideline Update: Steroids for Community-Acquired Pneumonia, ARDS, Septic Shock Steroids are good medicine in the ICU, U.S. Recent studies, though, have shown steroids’ benefit in Covid pneumonia with ARDS, and for steroids improving outcomes in severe community-acquired pneumonia.

Shock 52

Shock Administration Sepsis Fractures 52

AED Leader

NOVEMBER 15, 2023

The device will perform charge and shock tests and prompt the user to press the shock button (on semi-automatic units) when required. Please note that running a manual self-test on this unit depletes the battery capacity by one shock. As the pads dry out, they may not attach as well to the skin, resulting in poor conductivity.

Shock 52

Shock CDC Pediatrics Wellness 52

AED Leader

NOVEMBER 15, 2023

The device will perform charge and shock tests and prompt the user to press the shock button (on semi-automatic units) when required. Please note that running a manual self-test on this unit depletes the battery capacity by one shock. As the pads dry out, they may not attach as well to the skin, resulting in poor conductivity.

Shock 52

Shock CDC Pediatrics Wellness 52

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 130

Ultrasounds Outcomes COPD Hospitals 130

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

PulmCCM

JULY 31, 2023

severe hypoxemia not doing well or on a bad trajectory while receiving conventional care). is to restrict caloric delivery in patients with this degree of shock. To make that leap, I for one would need to see improved outcomes with caloric restriction in patients with less-severe shock. Usual practice in the U.S.

Shock 98

Shock Documentation/Coding Outcomes Wellness 98

PulmCCM

NOVEMBER 27, 2023

Beta-blockers for septic shock (STRESS-L trial) Septic shock deranges multiple complex signaling systems in the body. A meta-analysis of 7 randomized trials (n=503) previously suggested that co-administration of esmolol to blunt vasopressor-induced tachycardia and arrhythmias could reduce mortality in septic shock by one-third.

Sepsis 52

Sepsis Shock Administration Leadership 52