Don't Forget the Bubbles

NOVEMBER 27, 2023

What is Shock? Shock is defined as a type of circulatory failure where lack of oxygen leads to dysfunction of vital organs. There are many types of shock which may affect children, and management is specific to the type of shock. The overall goal in managing any cause of shock is to restore oxygen delivery to the organs.

Shock 143

Shock Sepsis Fluid Resuscitation Resuscitation 143

EM Ottawa

JANUARY 29, 2024

Editorial: Routine Early ECLS in Infarct-Related Cardiogenic Shock? Question: Does early ECLS therapy confer a mortality benefit in patients with MI complicated by cardiogenic shock?

Shock 103

Shock 103

Emergency Live

APRIL 17, 2024

Cardiology has a new ray of hope for patients affected by myocardial infarction complicated by cardiogenic shock. The study called DanGer Shock has revolutionized the treatment of this serious condition using the Impella CP heart pump. It’s a small but incredibly powerful life-saving device.

Shock 98

Shock 98

Dr. Smith's ECG Blog

MAY 3, 2024

She was found by medics agitated, hypotensive, diaphoretic, and in shock. But this time the Queen gets it wrong (thinks it is not OMI): There were runs of VT: Tha patient arrived in profound shock and had an ED ECG: Now there is some evolution to include the ST elevation (rather than ST depression) in V4-V6.

Shock 122

Shock EKG/ECG Hospitals EMS 122

The Bottom Line

APRIL 26, 2024

Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock Møller JE et al. DOI: 10.1056/NEJMoa2312572 Clinical Question In adults presenting with STEMI and cardiogenic shock does the use of a microaxial flow pump (Impella CP) compared to standard care reduce death from any cause at day 180?

Shock 79

Shock 79

St. Emlyn

OCTOBER 21, 2024

FOAMed @stemlyns The post JC: AP or AL pad position for first choice shock in VF? Critical appraisal of an observational study in JAMA suggests a better outcome with AP, but there are many biases in this study. appeared first on St.Emlyn's.

Shock 104

Shock Outcomes 104

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

The VSR is what is causing the cardiogenic shock! Mechanical complications occur acutely and significantly alter hemodynamics leading to comp ensatory mechanism which usually involve vasoconstriction and tachycardia, both hallmarks of cardiogenic shock. PIRP is strongly associated with myocardial rupture.

Shock 109

Shock EKG/ECG Hospitals Wellness 109

University of Maryland CC Project

AUGUST 18, 2024

In this talk, he discusses the management of refractory distributive shock with a focus one of the novel therapeutics, angiotensin II (trade name Giapreza).

Shock 75

Shock Academics 75

St. Emlyn

JUNE 23, 2024

Patients presenting […] The post JC: The impact of double sequential shock timing on outcomes during refractory out-of-hospital cardiac arrest appeared first on St.Emlyn's.

Shock 105

Shock Outcomes Hospitals EMS 105

Dr. Smith's ECG Blog

MARCH 7, 2024

A young man presented with a gunshot wound to the right chest, with hemo-pneumothorax and hemorrhagic shock. He got a chest tube and intubation and massive transfusion and stabilized. CT of chest showed the bullet path through his right lung but nowhere near his heart. But he did get an EKG: What is this?

Shock 123

Shock EKG/ECG Documentation/Coding 123

University of Maryland Department of Emergency Med

NOVEMBER 17, 2023

This small study suggests using reverse shock index times the Glasgow Comma Scake score may give a prognostication on pediatric trauma seve. Click to view the rest

Shock 90

Shock Pediatrics 90

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. Today's patient is a young male who presented in cardiogenic shock following a massive verapamil overdose. The initial K was 3.0 mEq/L and ionized calcium was 5.5 What is going on here?

Shock 91

Shock EKG/ECG Documentation/Coding Resuscitation 91

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 87

Dislocations Shock EMS Sepsis 87

ALiEM

FEBRUARY 20, 2024

Author information Timothy Harmon, MD Emergency Medicine Resident Inova Fairfax Medical Campus, George Washington University | The post ACMT Toxicology Visual Pearl: Salt, not Shock appeared first on ALiEM.

Shock 73

Shock EKG/ECG Poisoning Burns 73

Pediatric EM Morsels

JUNE 2, 2023

Food Protein Induced Enterocolitis Syndrome (FPIES): Basics Non IgE-mediated food allergy ( Calvani, 2021 ) Profuse vomiting and diarrhea that can progress to lethargy , pallor , and shock Usually seen in infants (<1 year) as new foods are being introduced in diet Common dietary triggers include grains, cow milk and soy ( Michelet, 2017 ) Can also (..)

Dehydration 189

Dehydration Shock Pediatrics Emergency Department 189

The Trauma Pro

AUGUST 13, 2024

This includes sources of obstructive shock such as tension pneumothorax and tamponade. The Second Law Of Trauma Your trauma patient is bleeding to death until you prove otherwise. Obviously, there are a few uncommon exceptions to this rule. But by and large, you will find this law a solid one.

Operations 198

Operations Shock 198

Emergency Live

SEPTEMBER 24, 2024

New allergist task force in action The shortage of adrenaline self-injectors, essential life-saving drugs to counter anaphylactic shocks, is taking on alarming proportions in Italy.

Allergic Reactions 52

Allergic Reactions Shock 52

The Trauma Pro

JANUARY 11, 2024

Specific ones that come to mind are shock, long bone or spine fractures, and TBI. Similarly, was there a relationship between the number of units of whole blood and possible “protection” from VTE? Did you examine other physiologic or anatomic variables and their relationship with VTE?

Resuscitation 264

Resuscitation Fractures Shock 264

St. Emlyn

JUNE 23, 2024

Patients presenting […] The post JC: The impact of double sequential shock timing on outcomes during refractory out-of-hospital cardiac arrest appeared first on St.Emlyn's.

Shock 67

Shock Outcomes Hospitals EMS 67

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4%

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Mount Sinai EM

AUGUST 20, 2023

Presentation CNS symptoms Cardiovascular symptoms Tongue and perioral numbness Hypertension and tachycardia Paresthesias Vasodilation and hypotension Restlessness Bradycardia, AV blocks Tinnitus Prolonged PR and QRS Fasciculations or tremors Ventricular arrhythmias Tonic-clonic seizures Refractory shock Altered mental status Cardiac arrest Apnea Neurologic (..)

Seizures 238

Seizures Shock Outcomes 238

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Figure B At this point, with the ECG changing from diffuse ST depression to widespread ST elevation and the patient presenting in cardiogenic shock, left main coronary artery (LMCA) occlusion is the likely diagnosis. Complete LMCA occlusion is associated with clinical shock and/or cardiac arrest. This is an ominous sign.

EKG/ECG 132

EKG/ECG Shock Emergency Department Ambulance Services 132

Sensible Medicine

SEPTEMBER 11, 2023

Investigators from Leipzig Germany called the trial ECLS-SHOCK. It studied the use of extracorporeal life support in patients with cardiogenic shock due to acute myocardial infarction. ECLS-SHOCK delivered shocking results. Cardiogenic shock often leads to death. First some background. Think pump failure.

Shock 115

Shock Outcomes 115

St. Emlyn

OCTOBER 21, 2024

FOAMed @stemlyns The post AP or AL pad position for first choice shock in VF? Critical appraisal of an observational study in JAMA suggests a better outcome with AP, but there are many biases in this study. appeared first on St.Emlyn's.

Shock 52

Shock Outcomes 52

Ken Grauer, MD

OCTOBER 19, 2024

BOTTOM Line: Today's patient presented in shock ( presumably cardiogenic ) — with acute dyspnea, hypotension, and the ECG that is shown in Figure-2. There is another PVC that occurs immediately after the lead change in lead aVL — but the lead change ( vertical black line ) blocks our view of the P wave before this beat.

EKG/ECG 282

EKG/ECG Shock 282

Sensible Medicine

APRIL 26, 2024

A special discussion, offered as a thank you for our subscribers Read more

Shock 73

Shock 73

The Trauma Pro

JANUARY 3, 2024

They postulated that, since hemorrhagic shock can cause hyperfibrinolysis (HF) and early administration of agents like TXA seem to work better when given early, wouldn’t it be nice to have a more objective way of identifying it as early as possible? The study was prospective and observational and involved two Level I trauma centers.

Shock 113

Shock Administration Operations Hospitals 113

PulmCCM

NOVEMBER 11, 2024

Since the vast majority of mortality from cardiogenic shock occurs in the first 30 days, why would the survival benefit of an Impella be so delayed? The control arm had 59% mortality at 6 months—higher than other trials enrolling cardiogenic shock patients at a similar severity of illness. Patients in the Impella arm had 2.8

Shock 98

Shock Sepsis Outcomes Research 98

Sensible Medicine

APRIL 1, 2024

In the same session, Jacob Eifer Møller, MD, PhD, from Odense University in Denmark, will present the results of the DanGer-Shock trial. I rank this trial—of the Impella ventricular assist device in patients with cardiogenic shock—as one of the most important trials of this decade.

Shock 129

Shock Wellness Outcomes 129

The Trauma Pro

APRIL 9, 2024

T he following were considered the hard signs: Active hemorrhage Expanding or pulsatile hematoma Bruit or thrill over the injured area Unresponsive shock Hemoptysis or hematemesis Air bubbling from the wound These patients were immediately taken to the OR and explored through an appropriate incision.

Operations 223

Operations Shock 223

Mount Sinai EM

APRIL 7, 2023

Here’s a list on how TB might present: Region Symptoms Imaging Pulmonary – apical and posterior upper lobes, superior segment of lower lobe Productive cough, dyspnea, hemoptysis, pleuritic chest pain Immunocompromised may have more atypical findings Lymph Tends to be unilateral and non-tender Can develop scrofula= enlarged cervical nodes that (..)

Shock 130

Shock Hospitals 130

Emergency Live

MAY 8, 2024

The importance of a life-saving tool An Automatic External Defibrillator is a life-saving device that can deliver an electric shock in the event of a cardiac arrest. With a shock from a defibrillator, the normal heart rhythm can be restored.

CPR 98

CPR Shock 98

St. Emlyn

JULY 22, 2024

You may be shocked to […] The post JC: Evaluation of Lidocaine Patches for Elderly Patients with Rib Fractures: A Feasibility Study appeared first on St.Emlyn's.

Fractures 112

Fractures Shock 112

Sensible Medicine

JUNE 24, 2024

One of the most common uses of LV assist devices is cardiogenic shock due to an acute MI. As I covered in April , the DANGER-Shock trial produced positive results. DANGER-Shock, like many trials, had caveats. More than DANGER-Shock). I took a picture of my thoughts about DANGER-Shock. I am not against this device.

Shock 94

Shock Hospitals 94

Dr. Smith's ECG Blog

FEBRUARY 22, 2024

Physician also reads it as normal) Severe shock, obtunded, and a diagnostic prehospital ECG. ST elevation in aVL with reciprocal ST depression in the inferior leads Shock, bradycardia, ST Elevation in V1 and V2. You are handed a triage ECG interpreted as "normal" by the computer. Also: How did this happen? Another Shark Fin.

EKG/ECG 141

EKG/ECG EMS Shock Wellness 141

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 112

CPR Resuscitation Shock Wellness 112

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Shocked x 2 without effect. Warning: if this is VT, a calcium channel blocker can result in shock and death. Today's case is insightful in many ways — especially since despite prompt electrical cardioversion, we are told that this patient "was shocked X 2 without effect". However, this is not SVT. What to do now? K returned 3.6

EKG/ECG 141

EKG/ECG Shock Academics Documentation/Coding 141