EMDocs

SEPTEMBER 7, 2024

Clinical features include abdominal or flank pain; ecchymosis to the flank, periumbilical region, proximal thighs, or scrotum; and hemorrhagic shock early in the disease course. 5 Clinical Presentation: 1-3 Variable presentation but may present with dropping hemoglobin/hematocrit without other findings in spontaneous cases.

EMS 93

EMS Fluid Resuscitation Resuscitation Radiology 93

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 139

Administration Outcomes Resuscitation Radiology 139

EMergucate

NOVEMBER 27, 2018

Critically unwell 59 year old returned traveller with shock and uncertain cause. CXR reveals large pleural effusion (Radiology case of … Continue reading →

Radiology 40

Radiology Radiology Shock EMS 40

EMDocs

NOVEMBER 1, 2023

2 , 4 , 5 Recommended by the American College of Radiology (ACR) Appropriateness Criteria but otherwise limited for cervical perforations or alternative etiologies of chest pain. 4 Prompt consultation is imperative with thoracic surgery, interventional radiology (IR), gastroenterology (GI), and/or critical care.

Operations 86

Operations Radiology Radiology Fluid Resuscitation 86

Total Medical ComplianceHIPAA

OCTOBER 9, 2024

Maintenance should be performed on any equipment before using in the delivery of patient care, this includes autoclaves, suction lines, ultrasounds, radiology equipment, etc. For dental facilities only: Dental Unit Waterlines should be shocked then tested before use. If the testing reveals failing water quality, shock and test again.

Hazardous Materials 59

Hazardous Materials Infectious Diseases PPE Shock 59

PEMBlog

OCTOBER 26, 2023

Other complications include obstruction due to intussusception or volvulus, leading to bowel ischemia and shock. Radiology of Meckel’s Diverticulum. The most common presentation in children under 5 years of age is rectal bleeding, which may be intermittent or massive. The bleeding is usually painless. Clin Radiol.

Radiology 64

Radiology Radiology Administration Resuscitation 64

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

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

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

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

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 87

EMS Ultrasounds Emergency Department Infectious Diseases 87

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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 103

Blood Transfusions Outcomes Resuscitation Radiology 103

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 60

Fractures Resuscitation Operations EMS 60

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

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

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 103

Stroke Radiology Radiology Emergency Department 103

Don't Forget the Bubbles

AUGUST 13, 2023

However, if radiological evidence of raised intracranial pressure is seen, do not perform lumbar puncture. cerebral abscess, tubercular meningitis, traumatic injuries), with suspected structural defects of the brain or with abnormally large heads. Raised intracranial pressure to be determined clinically rather than by CT scan.

Seizures 97

Seizures Pediatrics Dehydration Radiology 97

Taming the SRU

JUNE 6, 2023

mg/kg of IBW Seek to match a patient's minute ventilation with TV and RR after intubation Intentionally match patient's intrinsic RR noted prior to intubation Note that healthy lungs can handle 8 mL/kg, based on IBW, if that is useful for compensation Secure your ETT Thomas Tube Holder is a new ETT holder on Air Care for ETT down to size 6.5

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

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 Research Emergency Department 116