PHEM Cast

APRIL 27, 2023

– Wiles – 2017 – Anaesthesia Blood pressure management in trauma: from feast to famine?

Resuscitation 52

Resuscitation Shock Operations Hospitals 52

Pediatric EM Morsels

APRIL 5, 2024

Jensenius 2004) Complications: pneumonitis, acute respiratory distress syndrome (ARDS), myocarditis, septic shock, meningoencephalitis, pericarditis, and disseminated intravascular coagulation (Xu 2017) Fatality can reach up to 70% if untreated depending on the strain. Global Change Research Program. Kyasanur Forest Disease (KFD).

CDC 161

CDC Infectious Diseases Pediatrics Wellness 161

RebelEM

SEPTEMBER 28, 2023

The STREAM-1 trial found that for [2] patients with STEMI presenting within 3 hours of symptom onset and unable to attain PCI within 1 hour of first medical contact, a pharmaco-invasive strategy resulted in similar rates of death, shock, heart failure, or reinfarction compared to primary PCI. Primary PCI: 95.7% Primary PCI: 95.7%

EKG/ECG 129

EKG/ECG Allergic Reactions Shock Stroke 129

Pediatric EM Morsels

NOVEMBER 3, 2023

2013 Sep 4; 89(3): 527–530. This is otherwise known as Blackwater fever (Forgie 2022) Severe Malaria laboratory findings include acute kidney injury , hyperbilirubinemia , hemoglobinuria , severe anemia, hypoglycemia, lactic acidosis , and hyperparasitemia (Forgie 2022) Severe Malaria is almost entirely attributed to infection with P.

Seizures 247

Seizures Pediatrics CDC Infectious Diseases 247

Stop and Think

MARCH 31, 2024

Our main finding was that industry paid doctors more than $12 billion dollars between 2013-2022. His list of device approvals despite dodgy evidence is shocking. The influential Journal of the American Medical Association published our data this week. The numbers surprised me. B as in billions. Let me make two points. We use devices.

Research 130

Research Shock Hospitals 130

Pediatric EM Morsels

FEBRUARY 2, 2024

While there is no “right” work up for these patients, hopefully this morsel will help illuminate your evaluation of Travel-Related Illness in Children: Travel-related Illness: Basics International travel has been significantly increasing since commercial airlines made travel much easier.

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

Taming the SRU

FEBRUARY 19, 2024

A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. In general, radial artery readings in patients with shock likely underestimate central pressure which can lead to increasing vasopressor dosing. PMID: 35338337. Keville, M.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Mind The Bleep

DECEMBER 19, 2023

Majority of DKA patients are in a fluid deficit and present acutely with shock. Signs of shock to be mindful for are tachycardia, hypotension, prolonged CRT, pallor, and a weak thready pulse. Fluid boluses are given according to local guidelines, but generally shocked patients should receive a 10ml/kg 0.9% Marcdante, R.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

EMDocs

FEBRUARY 12, 2024

First, there can be a poor correlation between venous and arterial gases in states of shock, hemodynamic instability, or extremes of acid-base disturbances, due to poor cardiac output/circulatory failure impairing venous and arterial flow, with associated poor gas exchange as well as hypercapnia and acidemia at the tissue level (8).

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

ETM Course

JUNE 28, 2015

Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Intra-Aortic Balloon Occlusion to Salvage Patients with Life-Threatening Hemorrhagic Shocks from Pelvic Fractures J Trauma 2010; 68(4): 942–8 (full article free text) 3. J Trauma Acute Care Surg 2013; 75(3): 506–11 5.

Hospitals 52

Hospitals Shock Resuscitation Military 52

RebelEM

JANUARY 25, 2023

Acad Emerg Med 2013; 20(6): 528-44. Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43 Absent bowel sounds Peritoneal signs (i.e. rebound and guarding) Diagnostics Laboratory Tests Commonly ordered lab tests (i.e. 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Don't Forget the Bubbles

OCTOBER 9, 2023

It shocked me how big an effect this expert had on the teams, especially given the studied teams usually worked together and had an average of seven years of neonatal experience. I was shocked by the way I had been spoken to, scared about breaking the baby, and felt out of my depth. That was the end of the conversation. and Ramsel D.

Seizures 116

Seizures Incident Reporting Research Hospitals 116

EMDocs

OCTOBER 9, 2023

6 However, due to the vasoconstrictive effects, hydrocortisone may be useful in refractory shock. Published 2013 Aug 15. Corticosteroids in septic shock: a systematic review and network meta-analysis. Given its mineralocorticoid properties, hydrocortisone is traditionally used for adrenal insufficiency. 2013;9(1):30.

Basic Life Support 81

Basic Life Support CPR Fractures Emergency Department 81

RebelEM

MAY 15, 2024

Pathogens ( Gudiol 2013 ) : The pathogens responsible for neutropenic fever have changed over time. Clin Microbiol Infect 2013; 19:474 Klastersky J. Antibiotics are effectively the only thing standing between these patients and overwhelming sepsis. Give appropriate fluids, vasopressors, and antibiotics. Why empirical therapy?

Infectious Diseases 78

Infectious Diseases Administration Sepsis Anaphylaxis 78

Pediatric Emergency Playbook

AUGUST 1, 2020

2013 Jul-Aug; 48(4): 546–553. Pediatrics 2011; 128:e741. Casa DJ et al. The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations. J Athl Train. DeFranco MJ et al. Environmental issues for team physicians. Am J Sports Med. 2008 Nov;36(11):2226-37. Ishimine P.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Stroke Best Practices Pediatrics 52

PHEM Cast

APRIL 16, 2018

The outcomes from different resuscitative interventions in a haemorrhagic shock model in porcine model: From: Watts et al. Use of CPR in hemorrhagic shock, a dog model. 2013; 74: 634-8. The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest. 2012; 73: 102-10. EMJ 2017; 34: 860-900.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

PHEM Cast

JULY 14, 2016

2013 May 13;30(6):516–6. 2013 Jul 19;30(8):679–82. 2013 Dec 22;31(1):86–6. Journal of Emergencies, Trauma, and Shock. Elsevier Ltd; 2013 Jan 1;44(1):122–7. 2013 Dec 1;30(12):1067–9. 2013 May 23. : A systematic review. Elsevier Ltd; 2015 Apr 1;46(4):528–35. Smyth M, Cooke MW. The University of Warwick.

Hospitals 52

Hospitals Fractures Shock Research 52

ACEP Now

APRIL 3, 2024

1,2 However, the European TTM1 trial in 2013 showed similar outcomes for those cooled to 33 degrees Celsius compared to 36 degrees Celsius, leading to a 2015 AHA class I recommendation of “cooling between 32 degrees Celsius-36 degrees Celsius.” degrees Celsius. 5,6 In 2021, the TTM2 trial was published.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Resuscitation Outcomes Hospitals 40

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. ST elevation (STE) in lead augmented vector right (aVR), coexistent with multilead ST depression, was endorsed as a sign of acute occlusion of the left main or proximal left anterior descending coronary artery in the 2013 STEMI guidelines.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

PHEM Cast

APRIL 10, 2016

One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. Arriving by Emergency Medical Services Improves Time to Treatment Endpoints for Patients With Severe Sepsis or Septic Shock. 2013 Jun;44(6):1116–25.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

PulmCCM

SEPTEMBER 23, 2021

Critical Care 2013, 17(2):213. Guarracino F, Ferro B, Morelli A, Bertini P, Baldassarri R, Pinsky MR: Ventriculoarterial decoupling in human septic shock. Landesberg G, Gilon D, Meroz Y, Georgieva M, Levin PD, Goodman S et al : Diastolic dysfunction and mortality in severe sepsis and septic shock. Critical Care 2014, 18(2):R80.

Stroke 40

Stroke Sepsis Shock Ultrasounds 40

Mind The Bleep

AUGUST 5, 2023

Complications Short bowel syndrome (following significant resection, and more common following removal of the ileocaecal valve) Intestinal stricture Sepsis / shock DIC Intestinal perforation Mortality (1, 3) References Ginglen JG, Butki N. England: Oxford University Press; 2013. Necrotizing Enterocolitis. Updated 2022 Aug 8].

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

PulmCCM

JULY 10, 2023

In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours). However, the practice has not been supported by randomized trials.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Pediatric Emergency Playbook

APRIL 1, 2016

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. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later. 23: 353–360.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

PHEM Cast

FEBRUARY 23, 2017

Scand J Trauma Resusc Emerg Med 21(Suppl1):S27, 2013. In patients with penetrating trauma permissive hypotension may remain useful for longer or at least until a patient can be differentiated and the bleeding controlled. Lots to think about! References: RePhill Trial Homepage: [link] Smith IM, James RH, Dretzke J, Midwinter MJ.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 52

Mind The Bleep

JUNE 17, 2023

per 100,000 (Samad L, 2013) As these patients may be too young to vocalise, they tend to present very irritable, drawing their legs up to their tummy, and inconsolable and the pain is intermittent. It causes bowel obstruction, venous congestion and bowel wall ischaemia and therefore causes severe abdominal pain. JAMA Paediatrics , 1053-1060.

Wellness 93

Wellness Shock Emergency Department Ultrasounds 93

RebelEM

JANUARY 29, 2024

Am J Cardiol 2013. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 A Randomized Trial of the Optimum Duration of Acoustic Pulse Thrombolysis Procedure in Acute Intermediate-Reisk Pulmonary Embolism: The OPTALYSE PE Trial. JACC Cardiovasc Interv 2018. PMID: 30025734 Sharifi M et al. PMID: 23102885 Aykan AC et al.

Outcomes 121

Outcomes Stroke Hospitals Administration 121

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 79

CPR Burns Airway Management Wellness 79

Emergency Medicine Ireland

APRIL 5, 2021

There is an interesting concept called the furosemide stress test that was first described by Chawla in 2013 and then repeated by Rewa in 2019. Next enter the IDEAL-ICU trial by Barbar in 2018 which is yet another French multi centre RCT which randomised septic shock patients to CRRT or not at 12 hrs after meeting the F on the RIFLE criteria.

Shock 40

Shock 40

PEMBlog

JANUARY 17, 2024

Camargo, Clinical Trial: Comparative Effectiveness of Cephalexin Plus Trimethoprim-Sulfamethoxazole Versus Cephalexin Alone for Treatment of Uncomplicated Cellulitis: A Randomized Controlled Trial, Clinical Infectious Diseases, Volume 56, Issue 12, 15 June 2013, Pages 1754–1762, [link] Liu C, Bayer A, Cosgrove SE, et al.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

Holbrook MD September 01, 2013 Umbilical Cord Prolapse and Other Cord Emergencies Marybeth Lore, MD Complications of Labor and Delivery by Jeanie Ward Pulmonary Embolism: Evaluation in the pregnant patient Journal of Emergencies, Trauma and Shock, 3(1), 39. Emergency medicine international, 2013. Phelan MD, Bradley D.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Pediatric Emergency Playbook

AUGUST 1, 2017

2013; 95(6): 474-477. 2013; 48:1789-1793. 2013; 44(1):53-57. 2013; 200:969-973. 2013; 50:54-86 Intestinal Obstruction Babl FE et al. Mercer AE, Phillips R. Can a conservative approach to the treatment of hypertrophic pyloric stenosis with atropine be considered a real alternative to pyloromyotomy? Arch Dis Child.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

EMDocs

JANUARY 16, 2024

However, consideration of infection, endocrine shock (adrenal, thyroid disease), electrolyte abnormalities, hypoglycemia or central nervous system (CNS) disasters is important. 2013 Jan 24;368(4):394]. 17 It is crucial to figure out why the patient is hypothermic and reverse the underlying cause if possible. Resuscitation. Hypothermia.

Hyperthermia / Hypothermia 83

Hyperthermia / Hypothermia Resuscitation CPR EMS 83

Dr. Smith's ECG Blog

AUGUST 9, 2019

Hint: patient is in shock and was put on ECMO ST depression in aVR Here is the angiogram from Rohin's case: Case 5. 7) The 2013 ACC/AHA STEMI guidelines consider this a “STEMI equivalent,” where thrombolytic therapy is not contraindicated (Evidence level B, no specific class of recommendation).(16) Which artery? Knotts et al.

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

ACEP Now

OCTOBER 10, 2023

Goal-directed resuscitation for patients with early septic shock. link] Published June 30, 2013. ARISE Investigators; ANZICS Clinical Trials Group; Peake SL, et al. N Engl J Med. 2014;371(16):1496-506. The adventure of the cardboard box. EMCrit website. Accessed September 17, 2023. Spiegel R. Published November 10, 2014.

Outcomes 52

Outcomes Stroke Hospitals Emergency Department 52

Taming the SRU

AUGUST 30, 2023

Similarly, a 2013 meta-analysis of 6 studies with 1,006 patients published in the American Journal of Emergency Medicine showed neither CRP nor PCT are sufficient to rule-in or rule-out infective endocarditis, with PCT having a pooled sensitivity of 64% and specificity of 73% and CRP having a pooled sensitivity of 75% and specificity of 73% [40].

Infectious Diseases 78

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 78

Mind The Bleep

JUNE 17, 2023

per 100,000 (Samad L, 2013) As these patients may be too young to vocalise, they tend to present very irritable, drawing their legs up to their tummy, and inconsolable and the pain is intermittent. It causes bowel obstruction, venous congestion and bowel wall ischaemia and therefore causes severe abdominal pain. JAMA Paediatrics , 1053-1060.

Wellness 52

Wellness Shock Emergency Department Ultrasounds 52