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. Antiemetics as needed.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

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

Don't Forget the Bubbles

MARCH 31, 2025

Sepsis is a significant cause of mortality in children, and fluid resuscitation is a key treatment strategy. It also emphasizes the need for better fluid management strategies, including early de-resuscitation in high-risk patients. 41% of patients with septic shock had MODS. Why does it matter? Am J Emerg Med. 2025.01.054.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

RebelEM

FEBRUARY 24, 2025

Well, the established cutoff for the distensibility index is 18%. 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. Why does it matter? A cutoff of 18% has a positive predictive value (PPV) of 92% and NPV of 90% for fluid responsiveness.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. 2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. 2-4 Any patient with evidence of complications or septic shock may need surgical management or a higher level of care.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

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

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

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. 6 What Can I Do Outside of Repeated Shocks and Standard ACLS? amiodarone or lidocaine).

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Taming the SRU

MARCH 30, 2023

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.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Liberal: 14.9%

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

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

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

Taming the SRU

JULY 24, 2024

Ann Emerg Med 2024 Background Sepsis remains an increasingly common emergency department condition that is tied to higher morbidity and mortality across the United States as well as the rest of the world. They then tested the LASSO model using the remaining 20% of data to see how well it could detect sepsis at the same time points.

Sepsis 89

Sepsis Resuscitation Emergency Department Wellness 89

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. The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i].

Ultrasounds 98

Ultrasounds Shock Research Operations 98

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

The ST elevation in V2-V6 as well as in I and aVL becomes easily recognizable. Resuscitation efforts were undertaken. ECG#3 Resuscitation efforts were ongoing. The patient ultimately did well. The patient was shocked — and then began a long intensive process of resuscitation. Is there OMI? An ICD was placed.

EKG/ECG 133

EKG/ECG Resuscitation Academics EMS 133

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. 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.

Administration 145

Administration Outcomes Resuscitation Radiology 145

Dr. Smith's ECG Blog

JUNE 9, 2024

Over the next 10 minutes we resuscitated with high doses of Calcium, Epinephrine, and Bicarbonate. There are no P-waves (this can also happen in hyperkalemia due to sino-ventricular rhythm), but here is it slow and even wider than 9 minutes later: The patient eventually did well and fully recovered. Also: How did this happen?

EKG/ECG 101

EKG/ECG Resuscitation Shock Wellness 101

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Don't Forget the Bubbles

OCTOBER 7, 2024

Was the patient thrown from the source (suggestive of DC shock and may result in further blunt force trauma)? Children, especially toddlers, may insert objects into outlets, leading to shocks or burns. Electrical devices used near water sources can cause severe shocks. Was the voltage high or low (as below)?

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

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

EMDocs

JUNE 25, 2024

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. Fluid resuscitation target and fluid Fluid resuscitation is one of the most important parts of management; goal is to increase intravascular volume and ensure end organ perfusion.

Burns 97

Burns Fluid Resuscitation Resuscitation Poisoning 97

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Although told several times, the story of the development by Henning Ruben of the prototypical modern manual resuscitator, the self-refilling bag with unidirectional non-rebreathing valves which now dominate the world of resuscitation, is still not well-known. Czech Military resuscitation kit, 1969, mfr.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

EMDocs

OCTOBER 8, 2024

Tachycardia may be present both from many medications or drugs, as well as withdrawal. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? Does the patient require blood, a procedure to address obstructive shock, or other source control? Do they have edema?

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. Guest Skeptic: Dr. Rory Spiegel (@EMNerd_) is a clinical instructor at University of Maryland, a recent graduate of Stony Brook’s Resuscitation Fellowship, and a current Critical Care fellow at University of Maryland. NEJM January 2018. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He was admitted on oxygen and was doing fairly well with saturations of 100% on 2 L nasal cannula. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Assessment was severe sudden cardiogenic shock. He remained hypotensive and in shock.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

Taming the SRU

JANUARY 24, 2024

The case highlights how we as providers can grieve the loss of our patients, as well as the profound relationships with can make with their family members. ETT Depth = ETT size x3 initial defibrillation: 2J/kg (next shock is 4J/kg) Toxicology Quick Hits Fomepizole is the treatment for both polyethylene glycol and methanol toxicity.

Fractures 89

Fractures Leadership Dislocations Resuscitation 89

Taming the SRU

FEBRUARY 7, 2024

Tillotson and Hinckley Simulation Communication on arrival to a scene is key, both between you and your flight nurse before you enter the ambulance and with the EMS crew Reassessing the potential reasons for shock in a trauma is important to pick up causes that are not initially on your mind initially (blood products for hemorrhage, controlling a significant (..)

PPE 98

PPE Administration Ultrasounds Poisoning 98

Don't Forget the Bubbles

MAY 10, 2023

A shocked friend is being ushered out of the way. Resuscitation is a team sport. Role stickers or role aprons with names on them are simple measures to highlight resuscitation roles. A study in Denmark in 2021 explored barriers to effective resuscitation in over 900 in-hospital resuscitations across six hospitals in Denmark.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. You will be running the show today, and you want to use your preparation time well. In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. But unfortunately for Ranulf, as Tarquin stood, he slipped on a blob of spilt quince jelly.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Pediatric Emergency Playbook

FEBRUARY 1, 2016

Protocols work well for adults, but trauma in children requires that we exercise our clinical muscles just a bit more. Resuscitative Thoracotomy in Children In a 40-year review of ED thoracotomy, Moore et al. They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. Brenner et al. Pediatrics.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

AED Leader

JUNE 27, 2024

Its user-friendly interface and clear voice prompts guide the rescuer through each step, from applying the pads to delivering a shock if necessary. Its intelligent algorithms analyze the heart’s rhythm and determine if a shock is needed. One of the standout features of the Heart Start AED is its Quick Shock capability.

CPR 52

CPR Shock Resuscitation Wellness 52

Greater Sydney Area HEMS

APRIL 15, 2023

At one of our recent education days we heard Dr Mark Russell and Dr Mark Newcombe deliver excellent presentations of cases which they had been involved in, involving resuscitative hysterotomy and neonatal resuscitation respectively. Resuscitate in air first, and use higher inflation pressures than you would with adults.

Hospitals 85

Hospitals Resuscitation Hyperthermia / Hypothermia Teamwork 85

EMDocs

NOVEMBER 1, 2023

ECG – May show tachycardia or rate related ST depressions Laboratory evaluation: CBC w/ differential – may reveal leukocytosis with left shift CMP, Lipase – can reveal alternative intra-abdominal diagnoses as well as show findings of end-organ hypoperfusion (elevated serum creatinine, transaminitis, etc.)

Operations 93

Operations Radiology Radiology Fluid Resuscitation 93

AED Leader

SEPTEMBER 23, 2024

Avoid using it on someone with a Do Not Resuscitate (DNR) order. That tiny shock given by the defibrillator? Also, if the person has a Do Not Resuscitate (DNR) order in place, using a defibrillator isn’t recommended. Before even thinking about a electric shock , check if they really need help. Safety first, always.

Shock 52

Shock Resuscitation CPR Pediatrics 52

AED Leader

DECEMBER 3, 2024

Automated External Defibrillators (AEDs) are vital devices that deliver shocks to restore normal heart rhythms, making them essential in emergency response situations. These compact and easy-to-use external defibrillators deliver lifesaving shocks to restore a regular heart rhythm. Durability : Built to perform in various environments.

Resuscitation 52

Resuscitation Shock CPR Operations 52