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

Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED?

CPR 90

CPR Burns Airway Management Wellness 90

Emergency Medicine Ireland

JULY 5, 2021

Rash and shock or rash and SOB means anaphylaxis * the term mucosal involvement can mean the tongue and pharynx but also the rest of the GI tract. Let’s say you eat a peanut get tummy cramps, diarroeah and a BP of 60 systolic. .

Anaphylaxis 40

Anaphylaxis Radiology Radiology Shock 40

Dr. Smith's ECG Blog

MARCH 12, 2018

When there is tachycardia, the patient is in cardiogenic shock with very poor LV function on bedside echo. We hope you can see the difference: See these cases for more examples: Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation. The pulmonary artery trunk is dilated at 35mm per radiology report.

EKG/ECG 40

EKG/ECG Radiology Radiology COPD 40

RebelEM

JANUARY 25, 2023

Radiology US 90% 96% 14.1 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 0.27 – 0.83 Abdominal Distension 62 – 67% 89 – 96% 5.64 – 16.8 0.34 – 0.43 Abdominal X-ray 75% 66% 1.6

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

ACEP Now

MARCH 14, 2024

15,19 Endovascular intervention depends upon the patient’s hemodynamic stability and availability of interventional radiology. Tracheoinnominate fistula: acute bleeding and hemorrhagic shock due to a trachea-innominate artery fistula. The anatomical basis for post tracheostomy innominate artery ruptures. Laryngoscope. 1998;98:1061-64.

Operations 52

Operations Pediatrics Radiology Radiology 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

The operative report and radiology reads do not comment specifically as to whether the dissection flap was partially or fully obstructing coronary flow, or whether it was obstructing the left main or the RCA. Diffuse ST-T wave depression on the initial tracing was the result of shock from the patient's aortic dissection.

Ultrasounds 40

Ultrasounds EKG/ECG EMS Radiology 40

EM Ottawa

APRIL 4, 2024

Point-of-care ultrasound (PoCUS) is becoming a cornerstone tool in our assessment of patient presentations and is helping us guide our clinical management. This is also represented in the amount of literature that has been published on the use of PoCUS in 2023.

Ultrasounds 73

Ultrasounds Infectious Diseases COPD Shock 73

EB Medicine

JULY 8, 2019

Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. Internal hernia after laparoscopic Roux-en-Y gastric bypass: a correlation between radiological and operative findings. Jeff: Even more shockingly, some series showed a 52% repeat operation rate. J Gastrointest Surg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

PulmCCM

APRIL 10, 2025

Most Clinicians Ignore New “Steroids-For-All” Septic Shock Guideline In 2024, the major U.S. critical care society recommended steroids be given to virtually all patients with septic shock. The American College of Radiology wrote a letter of opposition to the move. Soni et al Crit Care Explorations 2025).

CDC 40

CDC Stroke Sepsis Radiology 40

Don't Forget the Bubbles

FEBRUARY 5, 2025

E.g. burns, neurosurgery, interventional radiology. Fluid Resuscitation in Trauma In trauma where the cause of shock is most likely to be haemorrhagic, fluid resuscitation should ideally be with blood products – replacing losses. What are your next priorities, and how do these differ from a non-traumatic cardiac arrest?

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

EMDocs

DECEMBER 6, 2024

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality. doi: 10.1097/PEC.0b013e3182302604.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

ED ECMO

JANUARY 1, 2021

The patient was resuscitated with REBOA and her pathology was fixed by an Iliac Artery stent placed in Interventional Radiology. Amazing patient who had an Iliac pseudo-aneurysm causing hemorrhagic shock through the urinary tract, resuscitated using REBOA.

Shock 52

Shock Resuscitation Radiology Radiology 52

EMDocs

MAY 24, 2023

He and his physician are shocked at the report and the lack of follow-up. A mediastinal mass – or any “OMG” imaging result warrants discussion with radiology and sharing the information with the patient. Give the patient a copy of the radiology report and provide follow-up information in writing. Mueller DK.

Radiology 92

Radiology Radiology EKG/ECG Patient Safety 92

RebelEM

JUNE 26, 2023

Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03

Administration 144

Administration Outcomes Resuscitation Radiology 144

Taming the SRU

OCTOBER 1, 2023

J Emerg Trauma Shock. doi:10.1148/radiology.144.4.7111716 Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. Ann Emerg Med. 1983;12(6):411-412. doi:10.1016/s0196-0644(83)80502-2 Sharma A, Jindal P. Principles of diagnosis and management of traumatic pneumothorax. 2008;1(1):34-41. AJR Am J Roentgenol.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

EMDocs

NOVEMBER 4, 2023

Radiology Key. J Emerg Trauma Shock. Tracy CR, Steers WD, Costabile R. Diagnosis and management of epididymitis. Urol Clin North Am. 2008;35(1):101-vii. doi:10.1016/j.ucl.2007.09.013 2007.09.013 Adhikari, L. Testicular. December 27, 2016. Accessed May 2, 2023. link] Wampler SM, Llanes M. Common scrotal and testicular problems.

EMS 95

EMS Ultrasounds Emergency Department Infectious Diseases 95

ACEP Now

SEPTEMBER 3, 2024

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. Private equity firm, accused of trying to build a monopoly in radiology, dismissed as defendant in FTC lawsuit. Radiology Business. Accessed August 25, 2024. Stempniak M.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

PHEM Cast

FEBRUARY 23, 2017

Priorities for the bleeding trauma patient must include: Minimum time to control of bleeding (tourniquets / haemostatics / knife / interventional radiology) Normothermia Appropriate choice of destination (knife / IR) ? We believed in permissive hypotension – we were probably wrong. Lots to think about! 2016 Jul;46(1):3–16.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 52

PEMBlog

JUNE 5, 2024

You should also consider the possibility of quote unquote spinal shock. than it is spinal shock. And hypotension, bradycardia, or temperature instability can result from hemorrhagic and or spinal shock. This is due to the loss of sympathetic output and vasodilatation. Resuscitate with volume and blood.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

RebelEM

OCTOBER 5, 2023

Pneumonia diagnosis supported by clinical and radiologic criteria. About 25% of the excluded patients had septic shock, but the classification of hypotension as septic shock was at the discretion of the treating team. Population Inclusion Criteria: Adult patients (≥18 years old).

Research 94

Research Outcomes Administration Shock 94

Mind The Bleep

AUGUST 5, 2023

Complications Short bowel syndrome (following significant resection, and more common following removal of the ileocaecal valve) Intestinal stricture Sepsis / shock DIC Intestinal perforation Mortality (1, 3) References Ginglen JG, Butki N. Management It is useful to be aware of Bell’s modified staging for NEC for deciding on treatment.

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

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: 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

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Pediatric Emergency Playbook

FEBRUARY 1, 2016

They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. After balloon occlusion, blood pressure improved sufficiently to take the patient either to interventional radiology or to the OR. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

RebelEM

NOVEMBER 20, 2023

Patients with torso hemorrhage present a clinical conundrum often requiring interventional radiology or surgery, both of which take time to mobilize. Theoretically, the use of REBOA with aortic occlusion should help limit hemorrhage, maintain cerebral/myocardial perfusion, and allow more time for interventional and surgical procedures.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

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." Committee on Shock. 1950s & 1960s Resuscitation Research. Trimble, Tom, RN CEN.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Pediatric Education

JULY 28, 2024

Patients are at risk for salt-wasting and adrenal crisis and may present with emesis, diarrhea, hypotension and shock. What is the role of consultants such as endocrinology or radiology in the evaluation of a patient with possible clitoromegaly or other potential genitourinary abnormalities?

Pediatrics 40

Pediatrics Radiology Radiology Wellness 40

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’. The most common presenting features in children with myocarditis are: shortness of breath, vomiting, poor feeding, hepatomegaly, respiratory distress, and fever.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Pediatric Emergency Playbook

MARCH 1, 2016

On arrival, he was in compensated shock, with tachycardia. Adults tolerate hypotension relatively well, and is sufficient until we send them to the OR or interventional radiology suite. A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. He decompensates and needs blood.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

Don't Forget the Bubbles

OCTOBER 28, 2024

These definitions include blood loss of 40 mL/kg over 24 hours, transfusion of ≥50% of total blood volume in 3 hours, transfusion of 100% of total blood volume in 24 hours, and bleeding with clinical signs of hypovolaemic shock that is unlikely to be controlled. This makes comparing data across research trials challenging.

Blood Transfusions 72

Blood Transfusions Hyperthermia / Hypothermia Shock Pediatrics 72

EMDocs

MARCH 6, 2024

shock index > 1, evidence of poor systemic perfusion). In other patients who are stable and the bleeding has resolved, CTA is of low yield If they are critically ill and have severe bleeding, resuscitate first and consult IR, radiology, and surgery. CTA is not necessarily in all patients with LGIB.

Blood Transfusions 106

Blood Transfusions Outcomes Resuscitation Radiology 106

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. Note placement over the greater trochanters. An x-ray in the trauma bay demonstrated an AP grade III fracture.

Fractures 65

Fractures Resuscitation Operations EMS 65

EMDocs

NOVEMBER 13, 2023

However, IgE-mediated or not, anaphylactic shock is possible in either case. The American College of Radiology (ACR) recommends a premedication schedule 12 hours before a contrasted CT with steroids and diphenhydramine in patients who are at high risk for hypersensitivity reaction but recognizes that this is not feasible in the acute setting.

Stroke 106

Stroke Radiology Radiology Emergency Department 106

EB Medicine

JANUARY 2, 2019

Jeff: All patients with a positive pregnancy test and vaginal bleeding should receive an ultrasound performed by either an emergency physician or by radiology. Nachi: It’s worth noting that the American College of Radiology actually lists several radiographs that are such low exposure that checking a urine pregnancy test isn’t even necessary.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

Sensible Medicine

MARCH 19, 2025

The three of us took the elevator down to the radiology department to examine the patients’ CT scans. He made a point, though, of meeting his colleague face-to-face, and everyone we visited was both shocked and delighted that we made the time for them. Prasad and I sat back and took in the information.

Radiology 70

Radiology Radiology Hospitals Administration 70

Don't Forget the Bubbles

OCTOBER 9, 2023

Both studies found external specialities , particularly cardiology and radiology, were more hostile than their own teams. It shocked me how big an effect this expert had on the teams, especially given the studied teams usually worked together and had an average of seven years of neonatal experience. My confidence took a knock.

Seizures 116

Seizures Incident Reporting Emergency Department Research 116