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 91

Shock Sepsis Outcomes Research 91

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. Thus, since high dose insulin's (HDI) primary beneficial effect on calcium channel overdose is to as a positive inotrope, it does not work well for dihydropyridine overdose.

Shock 88

Shock EKG/ECG Documentation/Coding Resuscitation 88

The Trauma Pro

AUGUST 22, 2023

The EMS report indicates that your incoming patient is in shock. The patient is doing well but has an unexplained pressure dip. A simple one is the use of any of your blood refrigerator products or emergency release blood , or a calculated score such as the ABC score or shock index (SI). And it happens again.

Shock 100

Shock Wellness EMS 100

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. The patient was in clinical shock with a lactate of 8. This confirms inferior, posterior, lateral, and RV MI RV MI often leads to shock and (systolic) hypotension. RVMI explains part of the shock. The RV is supplied during systole as well as diastole.

Shock 82

Shock EKG/ECG Academics Stroke 82

Pediatric EM Morsels

JUNE 2, 2023

Our patients have varied past medical histories that require us to be well-versed in even the most uncommon disorders (or know where to look things up in a pinch)! Rare diseases are not confined to the pages of a textbook or computer screen.

Dehydration 189

Dehydration Shock Pediatrics Emergency Department 189

EM Ottawa

APRIL 18, 2024

In this Prehospital Journal Club Recap, let us take a deep dive into the use of blood products, as well as the adjunct use of automated controlled elevation in CPR.

CPR 110

CPR Resuscitation Shock Wellness 110

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 125

EKG/ECG Shock Emergency Department Ambulance Services 125

The Trauma Pro

JUNE 18, 2024

Objective MTP activation criteria have been developed and are well-supported by the literature. The ABC score and the shock index are two of the more common methods. The Shock Index (SI) uses the initial vital signs to perform a quick and dirty calculation by dividing the heart rate by the systolic blood pressure.

Pediatrics 147

Pediatrics Blood Transfusions Resuscitation Shock 147

EM SIM Cases

SEPTEMBER 19, 2024

WHY IT MATTERS Patients in hemorrhagic shock require blood products expeditiously as well as identification and definitive management of the source of bleeding. This case provides an opportunity to practice identification and treatment of multiple sources of blood loss in hemorrhagic shock.

Shock 52

Shock Emergency Nursing Administration Operations 52

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 126

Shock Wellness Outcomes 126

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

PulmCCM

NOVEMBER 18, 2024

Intermediate-risk patients are generally defined as having clinically significant PE without shock but with elevated troponin and acute right ventricular strain (i.e., systolic dysfunction) on echocardiogram or CT. This is a highly heterogeneous group.

Shock 52

Shock Wellness 52

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

RebelEM

FEBRUARY 15, 2024

Additionally, intubation can risk hemodynamic instability as well as hypoxemia from the procedure itself. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits. of the risk of pneumonia by not intubating patients (NNT = 13) Additionally there was an absolute reduction of 12.2%

Poisoning 141

Poisoning Airway Management Seizures Shock 141

Dr. Smith's ECG Blog

FEBRUARY 22, 2024

She did well and stabilized after dialysis. Here is her ECG the next day with normal potassium level: She did well. 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.

EKG/ECG 136

EKG/ECG EMS Shock Wellness 136

PEMBlog

OCTOBER 18, 2023

The night prior to presentation, mom noticed he was not feeding as well and seemed fussy. Initially in the emergency department he was generally well-appearing with normal vital signs. Neonatal Toxic Shock Syndrome C. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease E. Overnight, she had to wake him to feed.

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

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%

Sepsis 105

Sepsis Shock Resuscitation Outcomes 105

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? Referring to Figure-1 — this 53-year old woman who presented in extremis with cardiogenic shock and an initial pH = 6.9, This was sent by a reader.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG 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? Sinus Tachycardia.

Shock 95

Shock Emergency Department Pediatrics EKG/ECG 95

Stop and Think

APRIL 16, 2024

I wrote this week, on Sensible Medicine, a summary of the DanGer-Shock trial of a mechanical assist device in patients with cardiogenic shock due to acute myocardial infarction (heart attack). Because doctors and hospital are compensated well for its use—which may be a reason why it became a popular device.

Shock 46

Shock Wellness Hospitals 46

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% NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Ken Grauer, MD

AUGUST 16, 2024

See ECG Blog #435 — ECG Blog #313 — as well as My Comment at the bottom of the page in the June 17, 2024 post in Dr. Smith's ECG Blog ). PEARL # 2: In the absence of associated heart failure ( cardiogenic shock ) — sinus tachycardia is not a common finding in acute MI. Acute PE remains one of the most commonly overlooked diagnoses.

EKG/ECG 394

EKG/ECG Wellness Shock 394

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 94

Resuscitation Emergency Department Shock Wellness 94

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

University of Maryland CC Project

JUNE 16, 2023

The first annual Mid-Atlantic Neurocritical Care Symposium will bring together experts from The University of Maryland/Shock Trauma Hospital, Johns Hopkins University, INOVA, Christiana Care, and beyond to discuss the basics of caring for critically ill neurological patients, as well as highlight recent innovations in the field.

Shock 70

Shock Hospitals Wellness Stroke 70

AED Leader

APRIL 23, 2024

A manual defibrillator is a device used to deliver an electric shock to the heart to restore its normal rhythm. When activated, the defibrillator delivers a controlled electric shock, interrupting the heart’s chaotic electrical activity and allowing it to reset and resume its regular beating pattern.

Shock 52

Shock Best Practices Outcomes Pediatrics 52

Dr. Smith's ECG Blog

AUGUST 28, 2020

Now appears to be in cardiogenic shock." However, cardiogenic shock usually takes some time to develop, so it is probably subacute." A fixed stenosis in that other artery, especially in the context of hypotension from the occlusion of the first coronary artery, can lead to ischemia and very poor LV function and worsening shock.

Shock 52

Shock EKG/ECG Wellness Outcomes 52

The Trauma Pro

APRIL 26, 2024

A multi-center trial published in 2015 showed an astounding 32% mortality rate for patients with shock from pelvic fracture. Years ago, we tried to pack the pelvis from the inside (peritoneal cavity), but it never worked very well. As I continue to preach, going anywhere but the OR is dangerous for the patient.

Fractures 147

Fractures Head Injuries Radiology Radiology 147

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. He writes an […] The post SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock first appeared on The Skeptics Guide to Emergency Medicine. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

EMDocs

JANUARY 23, 2024

Episode 93: BRASH syndrome Background: Brash syndrome has 5 components: bradycardia, renal failure, AV nodal blocker, shock, hyperkalemia. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. BRASH syndrome: Bradycardia, Renal failure, Av blocker, Shock, and Hyperkalemia. J Emerg Med. 2020.05.001.

Shock 87

Shock Dehydration Sepsis EKG/ECG 87

Taming the SRU

MARCH 10, 2024

critical AS, ASD, HCM) Arrhythmogenic right ventricular cardiomyopathy Pulmonary embolism Thoracic aortic dissection Transient occult shock Sepsis Hemorrhagic shock (ex. Can’t miss ED diagnosis for syncope Brady/tachy dysrhythmia, arrhythmias such as ARVC, channelopathy (Brugada) Acute MI Structural heart disease (ex.

EKG/ECG 96

EKG/ECG Shock Wellness EMS 96

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

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

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

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

Sensible Medicine

JUNE 17, 2024

PFA destroys myocardium with electricity (shocks). Every “application” is actually a shock. Europeans do PFA ablation in well under an hour. PFA is especially concerning because the shocks in the left atrium create intense microbubbles. Sensible Medicine is a reader-supported publication.

Shock 125

Shock Stroke Operations Ultrasounds 125

AED Leader

JULY 10, 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 the event of sudden cardiac arrest (SCA), potentially saving a person’s life.

CPR 52

CPR Shock Operations Resuscitation 52