The Trauma Pro

JANUARY 11, 2024

They cautioned against the use of TXA in the setting of whole-blood resuscitation. Specific ones that come to mind are shock, long bone or spine fractures, and TBI. Reference: Does whole blood resuscitation increase risk for venous thromboembolism in trauma patients? increase in risk. Bottom line: A lot is going on here.

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Resuscitation Fractures Shock 264

Dr. Smith's ECG Blog

JULY 25, 2024

For clarity in Figure-1 — I've reproduced today's ECG — obtained following successful resuscitation of out-of-hospital cardiac arrest. == MY Comment , by K EN G RAUER, MD ( 7/5 /2024 ): == Clinical ECG interpretation is a 2-Step process. Figure-1: The initial ECG in today's case. —

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Resuscitation EKG/ECG CPR Shock 124

EM Ottawa

APRIL 18, 2024

Bag-Valve-Mask Ventilation and Survival From Out-of-Hospital Cardiac Arrest: A Multicenter Study Background and Objectives Around 60,000 out-of-hospital cardiac arrests (OHCA) occur in Canada each year, which […] The post PTM Journal Club: BVM Ventilation and Refractory Shock in Out-Of-Hospital Cardiac Arrest appeared first on EMOttawa Blog. (..)

Shock 101

Shock Hospitals Wellness Resuscitation 101

PulmCCM

OCTOBER 14, 2024

Albumin has thus been a physiologically attractive therapy as a resuscitation fluid for hypotensive critically ill patients. How well does it work?

Resuscitation 52

Resuscitation Shock Wellness 52

The Trauma Pro

JUNE 18, 2024

Early resuscitation, particularly with blood products in patients with hemorrhage, is literally a lifesaver. To facilitate this, massive transfusion protocols (MTP) have been designed to rapidly deliver sizable quantities of blood products to the trauma resuscitation bay. As each minute ticks by, survival slowly diminishes.

Pediatrics 113

Pediatrics Blood Transfusions Resuscitation Shock 113

EM Ottawa

APRIL 18, 2024

Resuscitation with blood products in patients with trauma-related hemorrhagic shock receiving prehospital care (RePHILL): a multicentre, open-label, randomized, controlled, phase 3 trial Background The use […] The post PTM Journal Club: Blood Product and ACE-CPR use Prehospital appeared first on EMOttawa Blog.

CPR 115

CPR Resuscitation Shock Wellness 115

Dr. Smith's ECG Blog

MAY 26, 2023

A 20-something presented after a huge verapamil overdose in cardiogenic shock. He was admitted to the ICU and was unstable, in shock, overnight. This was a very complex case and the details are too much for an ECG Blog, but suffice it to say that, s hortly thereafter, the patient had an asystolic arrest and was resuscitated.

Shock 98

Shock EKG/ECG Documentation/Coding Resuscitation 98

RebelEM

FEBRUARY 24, 2025

13 That is to say nothing of the effect that the type and response to shock has on the individual patients involved in these studies. As seen in the Andromeda Shock Trial, and multiple other trials involving shocked patients, capillary return also reigns supreme regarding physical examination. Am J Respir Crit Care Med.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

Mount Sinai EM

OCTOBER 2, 2023

Standard mid-range size for trauma resuscitation is around 8Fr (the ones at Elmhurst for example are 8.5Fr) Pros : Large access with very high flow rate (lower flow rate if another catheter placed through the sheath such as a central line) to allow you to rapidly infuse fluids – often blood on our case, through them.

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Resuscitation Fluid Resuscitation Administration Shock 231

PHARM

APRIL 28, 2023

Some joker on Twitter called Chrimes took this at Aspen, Colorado It is an oft quoted maxim of trauma resuscitation that shock is haemorrhagic until proven otherwise. Cardiac causes of shock in trauma? Albeit yes he/she may be in shock due to a smashed femur but what of their cardiogenic shock from the acute anterior MI?

Shock 52

Shock Resuscitation Wellness 52

ACEP Now

JULY 7, 2023

However, between four and five percent of cases of VT or VF will be refractory to standard management, with nonperfusing arrhythmia persisting despite repeated shocks. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. Resuscitation. Resuscitation. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Emergency Medicine Cases

SEPTEMBER 12, 2023

The post EM Quick Hits 51 – Methylene Blue in Septic Shock, TMJ Dislocation, Crohn’s Disease, Analgesia for Renal Colic, Inhaled Steroids for Asthma, Hypocalcemia in Bleeding Trauma Patients appeared first on Emergency Medicine Cases.

Dislocations 91

Dislocations Shock EMS Sepsis 91

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Sepsis 92

Sepsis Shock Resuscitation Fluid Resuscitation 92

Dr. Smith's ECG Blog

JULY 9, 2024

He underwent resuscitation including vasopressors, inotropic support, and intubation. Despite anticipation by many that the initial post-resuscitation ECG will show an obvious acute infarction — this expected "STEMI picture" is often not seen. The Post-Resuscitation ECG: I thought the initial ECG in today's case was not obvious.

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EKG/ECG Resuscitation Shock CPR 116

Emergency Medicine Cases

JANUARY 14, 2020

In this CritCases blog, Shock and Hypoxia in Blunt Chest Trauma, a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, Mike Misch guides us through a hairy thoracic trauma case, reviewing principles of trauma resuscitation, airway considerations, tension pneumothorax management and a rare and challenging trauma diagnosis.

Shock 52

Shock Ambulance Services Resuscitation EMS 52

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Abdominal pain may be absent in up to 60%.

EMS 97

EMS Sepsis Shock Fluid Resuscitation 97

The Trauma Pro

AUGUST 6, 2024

Early availability of blood is a key component in the successful resuscitation of severely injured trauma patients. The resuscitation continues. The two most common ones are the ABC score and the Shock Index. Critically injured patients result in an intense and highly charged trauma activation. “Hang another unit.”

Resuscitation 113

Resuscitation Shock 113

EMDocs

JUNE 29, 2024

. #1: Re-DOSE VF… DSED for Shock-Refractory VF? Source The impact of alternate defibrillation strategies on shock-refractory and recurrent ventricular fibrillation: A secondary analysis of the DOSE VF cluster randomized controlled trial. Resuscitation. 2024 May;198:110186. doi: 10.1016/j.resuscitation.2024.110186. 2024.110186.

Shock 95

Shock Emergency Department Administration Resuscitation 95

RebelEM

APRIL 29, 2024

Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. This can often lead to significant delays in proper resuscitation. Studies reviewed landmark-based CVC compared to IO; using IJ, subclavian, and femoral CVC sites.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Emergency Medicine Cases

JANUARY 4, 2022

What is the preferred order of vasopressors and ionotropes in the management of cardiogenic shock? How can we best pick up occult cardiogenic shock before it floured shock kicks in? What is the evidence for intra-aortic balloon pumps, percutaneous ventricular assist devices and ECMO in the patient with cardiogenic shock?

Shock 52

Shock Operations Ultrasounds Resuscitation 52

EM Literature of Note

JANUARY 27, 2024

A brief post collating a few bits of my various work published across the interwebs … The Annals of Emergency Medicine Podcast continues to summarise the meatiest articles from each month, featuring a cycle of new co-hosts, as well: Apple Podcasts Google Podcasts Soundcloud Naturally, there are continuing Journal Club features, covering the (..)

Resuscitation 96

Resuscitation Emergency Department Shock Wellness 96

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Either approach in severe sepsis with shock seems reasonable.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

EMDocs

MARCH 4, 2025

Bacterial Meningitis Mimics: Other flu-like illnesses: COVID, influenza, toxic shock syndrome, myocarditis, endocarditis, spinal epidural abscess, pneumonia. Start resuscitating with fluids, and add a vasopressor like norepinephrine. A 2020 Cochrane review found the pooled sensitivity was 65%. MAP minus the ICP equals CPP.

Infectious Diseases 82

Infectious Diseases Seizures Poisoning Sepsis 82

Emergency Medicine Cases

APRIL 23, 2024

In this month's EM Quick Hits podcast: Justin Morgenstern on the first RCT of high dose nitroglycerin in SCAPE, Andrew Neill on Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) indications and evidence, Brit Long on indications for CT in suspected diverticulitis, Tahara Bhate on Central Retinal Artery Occlusion (CRAO) and diagnostic (..)

EMS 120

EMS Resuscitation Outcomes Allergic Reactions 120

Emergency Medicine Cases

MARCH 26, 2019

Sara Gray, intensivist and emergency physician, co-author of The CAEP Sepsis Guidelines, answers questions such as: How does one best recognize occult septic shock? Which fluid and how much fluid is best for resuscitation of the septic shock patients? What are the indications for a second vasopressor after norepinephrine?

Sepsis 40

Sepsis Shock EMS Resuscitation 40

PulmCCM

NOVEMBER 1, 2024

Neither of two large randomized trials in the 2000s showed a benefit from albumin solutions as a resuscitation fluid for patients with septic shock. Significant uncertainty remained, though, as we discussed further here: Another randomized trial was therefore performed, dubbed ABC-SEPSIS.

Sepsis 40

Sepsis Shock Resuscitation 40

EMDocs

SEPTEMBER 7, 2024

Laborator evaluation: CBC, CMP, lipase, type and screen, coagulation panel Treatment: 1-3 Resuscitation with blood products as necessary for hemodynamic stability. 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.

EMS 97

EMS Fluid Resuscitation Resuscitation Radiology 97

Pediatric Emergency Playbook

JUNE 1, 2016

Do we recognize shock early enough? World wide, shock is a leading cause of morbidity and mortality in children, mostly for failure to recognize or to treat adequately. So, what is shock? Simply put, shock is the inadequate delivery of oxygen to your tissues. How do we prioritize our interventions? Pericardial Effusion?

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

University of Maryland Department of Emergency Med

DECEMBER 8, 2022

This paper outlines a training course by Hartford Hospital for general surgery and emergency medicine residents. Their goal was to assess pre-a. Click to view the rest

Resuscitation 40

Resuscitation Shock Hospitals 40

EMDocs

NOVEMBER 6, 2023

Use of 20% intravenous lipid emulsion can be efficacious in the resuscitation of life-threatening local anesthetic toxicity, especially from bupivacaine. Venoarterial extracorporeal membrane oxygenation can be lifesaving for patients with cardiogenic shock or dysrhythmias that are refractory to other treatment measure s.

Poisoning 115

Poisoning Hyperthermia / Hypothermia Seizures Administration 115

Greater Sydney Area HEMS

FEBRUARY 20, 2024

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. Right Brachiocephalic Vein Origin Access for the Resuscitation of Shocked Adult Trauma Patients. Green et al.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

EB Medicine

NOVEMBER 17, 2020

Write us at emplify@ebmedicine.net. Write us at emplify@ebmedicine.net.

Emergency Department 40

Emergency Department Shock Resuscitation CPR 40

Emergency Medicine Cases

AUGUST 24, 2021

What is the utility of the Shock Index in older patients? The post Ep 159 Geriatric Trauma Part 1: The Under-Triaging Problem, Resuscitation, Airway, Head and C-spine Imaging, Clearing the C-spine appeared first on Emergency Medicine Cases. How should we adjust airway management for the older trauma patient? and many more.

Resuscitation 52

Resuscitation Head Injuries Airway Management Shock 52

EMDocs

JANUARY 13, 2024

sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock. Source Multiple Electrolytes Solution Versus Saline as Bolus Fluid for Resuscitation in Pediatric Septic Shock: A Multicenter Randomized Clinical Trial. Crit Care Med. 2023 Nov 1;51(11):1449-1460.

Stroke 85

Stroke Shock Pediatrics Resuscitation 85

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. were they in the resuscitative phase? Many of these patients are started on vasopressor and inopressor medications to assist in efforts to normalize blood pressure to help improve organ perfusion. to 1.12; p = 0.03 to 0.99; p <0.01 to 1.09; p = 0.01

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Resuscitation Outcomes EMS Sepsis 125

Taming the SRU

JULY 24, 2024

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.

Sepsis 89

Sepsis Resuscitation Emergency Department Wellness 89

Dr. Smith's ECG Blog

JUNE 9, 2024

Over the next 10 minutes we resuscitated with high doses of Calcium, Epinephrine, and Bicarbonate. A middle aged man with unwitnessed cardiac arrest Severe shock, obtunded, and a diagnostic prehospital ECG. I called for 2 grams of Calcium Chloride. How will you save this critically ill patient? Also: How did this happen?

EKG/ECG 101

EKG/ECG Resuscitation Shock Wellness 101