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

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

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 95

Resuscitation Emergency Department Shock Wellness 95

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 101

Sepsis Shock Resuscitation Outcomes 101

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

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 81

Shock EKG/ECG Documentation/Coding Resuscitation 81

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

Taming the SRU

DECEMBER 17, 2024

Fluid management in the Emergency Department (ED) is crucial in the adequate resuscitation of the acutely ill and decompensating patient. Patients present to the ED with hypovolemia secondary to a plethora of causessome requiring IV fluid resuscitation and others requiring none. AtherlyJohn et al. A systematic review by Freedman et al.

Dehydration 82

Dehydration Fluid Resuscitation Administration Resuscitation 82

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 88

Sepsis Resuscitation Emergency Department Wellness 88

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 102

EKG/ECG Resuscitation Shock Wellness 102

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 140

Administration Outcomes Resuscitation Radiology 140

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 126

EKG/ECG Resuscitation Academics EMS 126

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

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

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 87

Fractures Leadership Dislocations Resuscitation 87

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 (..)

Administration 97

Administration PPE Ultrasounds Poisoning 97

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

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 95

Shock Emergency Department Pediatrics EKG/ECG 95

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 94

Poisoning Hyperthermia / Hypothermia Seizures Administration 94

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

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 73

Burns Fluid Resuscitation Resuscitation Poisoning 73

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

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

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

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

AED Leader

APRIL 29, 2024

In today’s fast-paced world, businesses must prioritize their employees’ and customers’ safety and well-being. AEDs are portable devices that can be used to deliver an electric shock to the heart in case of sudden cardiac arrest (SCA), a condition that can strike anyone, anywhere, at any time.

Shock 52

Shock Resuscitation Pediatrics CPR 52

Taming the SRU

SEPTEMBER 15, 2023

Limited availability of radiology-performed US services in certain hospitals, especially overnight Can avoid unnecessary anticoagulation in patients Reduce time in ED to disposition In terms of workflow, when there is suspicion for a DVT, you need to first calculate a Wells’ Score for a DVT If low/moderate risk, can start with a D-dimer prior to committing (..)

CPR 88

CPR Burns Airway Management Wellness 88

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. Large volume fluid resuscitation was undertaken.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

RebelEM

SEPTEMBER 26, 2022

Patients from both groups are well balanced regarding results from a wide range of coagulation studies. Rezaie, MD (Twitter: @srrezaie ) The post TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding appeared first on REBEL EM - Emergency Medicine Blog. Significant coagulopathy: INR > 1.8

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

The Skeptics' Guide to EM

JANUARY 9, 2021

Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest. Association of Intra-arrest Transport vs Continued On-Scene Resuscitation With Survival to Hospital Discharge Among Patients With Out-of-Hospital Cardiac Arrest.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

In a PICU setting, sodium can come from various sources (resuscitation fluids, IV drugs and infusions, enteral feed), not just the maintenance fluids we prescribe. There is growing interest in giving no maintenance fluid and using the input from drug infusions and resuscitative boluses only. Most drugs are chosen to be dissolved in 0.9%

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

Taming the SRU

JUNE 24, 2024

Follow this algorithm in patients with unstable bradycardia with acute heart failure, change in mental status, or concern for shock, physicians should start with atropine, 1 mg and may be continued every 3 to 5 minutes if effective. Resuscitation , Volume 181,2022,Pages 140-146,ISSN 0300-9572, [link] Scott Weingart, MD FCCM.

Advances Cardiac Life Support (ACLS) 88

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 88