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Adjunctive Methylene Blue in Septic Shock?

RebelEM

septic shock). Judicious fluid resuscitation is indicated in patients with signs of hypo perfusion but is often inadequate necessitating the administration of vasoactive medications. Most of the research on the use of MB has been in patients with vasoplegia following cardiopulmonary bypass. Paper: Ibarra-Estrada, M et al.

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The ECLS-SHOCK Trial: ECPR in Infarct-Related Cardiogenic Shock

RebelEM

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. Many centers have attempted ECLS to achieve hemodynamic stabilization in this group of patients. Control: 53.4%

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Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management

RebelEM

This systematic review and meta-analysis attempts to elucidate whether a more conservative fluid resuscitation approach is warranted in volume sensitive sepsis patients, such as those with congestive heart failure (CHF). What They Did: Researchers performed a systematic review and meta-analysis. Am J Emerg Med. 2023;73:34-39.

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Diastolic Shock Index: A clinically relevant predictor of poor outcome in septic shock?

Taming the SRU

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.

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Trends in survival from out-of-hospital cardiac arrest with a shockable rhythm and its association with bystander resuscitation: a retrospective study

Emergency Medicine Journal

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.

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Is the blind Subclavian “trauma line” a thing of the past?

Greater Sydney Area HEMS

Obtaining access in shocked trauma patients can be notoriously difficult due to circulatory collapse. Those who are shocked, shut down with limited or no other options for peripheral access require central access. It is currently the subject of future research and publication in the emergency department setting. Green et al.

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Sniffing out Sepsis - Vibes vs Scoring Systems?

Taming the SRU

National campaigns to improve sepsis care, namely the Centers for Medicare and Medicaid Services’ introduction of “Severe Sepsis and Septic Shock Early Management Bundle”, have faced many challenges in physician and provider adherence. Importantly, only patients triaged to resuscitation bays were enrolled.

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