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

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. were they in the resuscitative phase? 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

Resuscitation 126

Resuscitation Outcomes EMS Sepsis 126

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

PulmCCM

NOVEMBER 17, 2023

Operating point guided resuscitation How do we make sense of this? The trick, I believe, lies in ‘operating point guided resuscitation’ [OPGR]. For any given hemodynamic state, measure or estimate the P ra and CO [or stroke volume, SV] simultaneously and repeatedly after each intervention. What does this mean?

Operations 124

Operations Ultrasounds Resuscitation Blood Transfusions 124

Taming the SRU

NOVEMBER 29, 2023

Complex trauma resuscitations Blunt cardiac injury represents a range of conditions from clinically silent to fatal injuries. Hemorrhagic shock is the most common etiology of instability in trauma and should always be highest on the differential. Posterior circulation stroke Patients with posterior strokes will likely have a low NIH.

Stroke 53

Stroke EKG/ECG Resuscitation Shock 53

RebelEM

JUNE 26, 2023

Clinical Take Home Point: In adult patients with trauma at risk of massive transfusion, receiving standard trauma resuscitation management, the addition of 4F-PCC did not result in a decrease in blood product consumption over 24 hours compared to placebo. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03

Administration 145

Administration Outcomes Resuscitation Radiology 145

JournalFeed

MARCH 26, 2022

Epi vs. NorEpi Spoon feed: Continuous epinephrine infusion for post-resuscitation shock in out of hospital cardiac arrest (OHCA) was associated with both higher all-cause and cardiovascular specific mortality when compared to norepinephrine. Check out journalfeed.org for details.

Stroke 40

Stroke Documentation/Coding Emergency Department Resuscitation 40

Don't Forget the Bubbles

NOVEMBER 18, 2024

Neonatal hypotension can result from inadequate cardiac output, low systemic vascular resistance, or a combination of both, which are influenced by: Cardiac Output: Neonates, particularly preterm ones, may have compromised cardiac output due to myocardial immaturity, leading to reduced stroke volume and heart rate. Fernandez, E.

Sepsis 57

Sepsis Shock Hyperthermia / Hypothermia Administration 57

Taming the SRU

JULY 31, 2024

Barometric pressure, humidity, and temperature changes may influence stroke and fall incidence (especially in elderly patients with cardiovascular risk factors). Nice people are not more likely to get cancer. Black clouds don’t exist (but I still sort of think they do).

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

PulmCCM

MAY 22, 2023

More patients (9% vs 4%) had adverse events in the early mobilization group, including 7 serious events in the early-mobilization group (mostly arrhythmias and one stroke) vs 1 in the usual care group. At least one expert questioned whether the study was adequately powered. In an NHLBI-sponsored trial enrolling 1563 patients at 60 U.S.

Fluid Resuscitation 64

Fluid Resuscitation Resuscitation Hospitals Sepsis 64

AED Leader

SEPTEMBER 11, 2023

Atrial fibrillation increases the risk of blood clots, strokes, heart failure, and other heart-related complications. It’s essential to note that atrial flutter also carries a potential risk of stroke. Administering an electric shock to the heart in cases of ventricular fibrillation increases the patient’s chance of survival.

Shock 52

Shock Stroke CPR Resuscitation 52

Downeast Emergency Medicine

APRIL 26, 2021

The primary outcome was 30-day mortality with secondary outcomes looking at 24 hour in-hospital mortality, blood resuscitation at 6 and 24 hours, incidence of multiorgan failure, ARDS, nosocomial infection, early seizures, PE/DVT, crystalloid resuscitation after 24 hours, and the incidence of coagulopathy. MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

RebelEM

JUNE 8, 2023

They can be associated with side effects such as reflex bradycardia, decreased stroke volume in phenylephrine, tachycardia and hypertension associated with epinephrine. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. 2006;130(4):941–6.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

Pediatric Emergency Playbook

NOVEMBER 1, 2015

We have a few minutes to optimize, to resuscitate before we intubate. Etomidate is perfectly acceptable, but ketamine is actually a superior drug to etomidate in the rapid sequence intubation of children in septic shock. Types of shock mnemonic : this is how people COHDe – Cardiogenic, Obstructive, Hypovolemic, Distributive.

Shock 40

Shock Sepsis Airway Management Pediatrics 40

PulmCCM

JANUARY 4, 2022

For example, should a fluid challenge fail to raise stroke volume [SV], a state of physiological preload intolerance exists and additional volume is arguably harmful ; further attempts to increase tissue perfusion might then be best achieved with vasoactives. For what are intravenous fluids diagnostic? ED50] and in 90% [i.e., mL/kg and 4.2

Wellness 40

Wellness Outcomes Sepsis Stroke 40

EB Medicine

NOVEMBER 1, 2018

Thankfully, that gentleman was successfully resuscitated despite no bystander CPR, and if you listen carefully, we hope to arm you with the tools to do so similarly. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. Thankfully, fatalities are declining, with just 565 in 2015.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Jeff: Rivaroxaban, trade name Xarelto, the second FDA approved DOAC, is used for stroke prevention in those with nonvalvular afib and VTE treatment.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Pediatric Emergency Playbook

APRIL 1, 2016

Less common causes of troponemia are: Kawasaki disease, pediatric stroke, or neuromuscular disease. There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We should use lactate to detect occult shock.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Taming the SRU

APRIL 13, 2023

Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C EtOH, amphetamines, or cocaine) Prescription drugs (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

EMDocs

DECEMBER 16, 2023

Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C. C, and heat stroke occurs at a core temperature > 40°C. Temps greater than 41.5C

Hyperthermia / Hypothermia 69

Hyperthermia / Hypothermia EMS Stroke Seizures 69

RebelEM

JUNE 12, 2024

Background and Physiology Shock secondary to beta-blocker (BB) or calcium-channel blocker (CCB) toxicity bears a tremendous degree of morbidity and mortality. 1 Recall that cardiac output is a function of both stroke volume and heart rate. 1 Recall that cardiac output is a function of both stroke volume and heart rate.

Poisoning 105

Poisoning Stroke Shock Administration 105

ACEP Now

NOVEMBER 7, 2023

Double sequential external defibrillation (DSED) is a technique in which rapid sequential shocks are placed from two defibrillators, with defibrillation pads in two planes, such as anterior-lateral and anterior-posterior. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Resuscitation.

Resuscitation 52

Resuscitation Hospitals Shock CPR 52

Taming the SRU

APRIL 26, 2023

First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. Resuscitation 2020. Misdiagnosis of exertional heat stroke and improper medical treatment. Cooling Methods in Heat Stroke. Druyan A, Janovich R, Heled Y. Mil Med 2011. Epstein Y, Yanovich R. Heatstroke.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

ACEP Now

OCTOBER 10, 2023

The CT scan reveals a hemorrhage in the right internal capsule, suggestive of acute hypertensive hemorrhagic stroke. 2022 guideline for the management of patients with spontaneous intracerebral hemorrhage: a guideline from the American Heart Association/American Stroke Association. Symptoms began just prior to presentation.

Outcomes 52

Outcomes Stroke Hospitals Emergency Department 52

EB Medicine

SEPTEMBER 1, 2018

If EMS has placed bandages, leave them in place until antivenom and resuscitative equipment is ready. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Nachi: And definitely involve the poison control center or a medical toxicology service early as they are an amazing resource. 1-800-222-1222.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Pediatric Emergency Playbook

JUNE 1, 2017

Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. The previously well child now decompensated: undiagnosed thrombophilia Asymptomatic patent foramen ovale (PFO) is the cause of some cases of cryptogenic vascular disease, such as stroke and MI.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Pediatric Emergency Playbook

JANUARY 1, 2017

Use soothing sensory measures: speak softly, offer a pacifier, and stroke the skin softly. Unexplained tachycardia may be the early signs of shock. Neonate and Infant (0-12 months) Involve the parent, and have the parent visible to the child at all times if possible. Engage their developing sensorimotor skills to distract them.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40