AED Leader

APRIL 23, 2024

In this blog post, we will explore these advanced techniques and discuss how they can be implemented to improve emergency outcomes. A manual defibrillator is a device used to deliver an electric shock to the heart to restore its normal rhythm. It consists of two paddles or electrode pads placed on the patient’s chest.

Shock 52

Shock Best Practices Outcomes Pediatrics 52

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 111

Shock Outcomes 111

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. His prehospital ECG was diagnostic of inferior posterior OMI.

Shock 75

Shock EKG/ECG Academics Stroke 75

Emergency Medicine Cases

MARCH 26, 2019

Sara Gray, intensivist and emergency physician, co-author of The CAEP Sepsis Guidelines, answers questions such as: How does one best recognize occult septic shock? How does SIRS, qSOFA and NEWS compare in predicting poor outcomes in septic patients? Which fluid and how much fluid is best for resuscitation of the septic shock patients?

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Sepsis Shock EMS Resuscitation 40

EMDocs

JANUARY 13, 2024

Spoon Feed High-dose nitroglycerin improves outcomes in patients with sympathetic crashing acute pulmonary edema (SCAPE) without significant side effects when compared to low-dose nitroglycerin. sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock. Crit Care Med.

Stroke 61

Stroke Shock Pediatrics Resuscitation 61

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

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. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19).

Shock 52

Shock EKG/ECG Outcomes Hospitals 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 83

Sepsis Shock Resuscitation Outcomes 83

University of Maryland Department of Emergency Med

JULY 1, 2023

Shock index (heart rate/systolic blood pressure) has been used to predict trauma outcomes. This study from American Journal of Emergency Medici. Click to view the rest

Hospitals 71

Hospitals Shock Outcomes 71

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Three outcomes were evaluated, with none being deemed the primary outcome. Background: Sepsis remains one of the leading causes of morbidity and mortality. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26

Sepsis 119

Sepsis Hospitals Administration Outcomes 119

RebelEM

APRIL 22, 2024

Intervention: Target PaO2 = 60 mm Hg Control: Target PaO2 = 90 mm Hg Outcome (primary): Absolute number of days without life support in 90 days defined as the absence of mechanical ventilation, circulatory support, or kidney replacement. Outcomes (secondary): 90-day all-cause mortality. CI) Secondary Outcomes 90-day Mortality 34.7%

Outcomes 72

Outcomes Best Practices EMS Shock 72

JournalFeed

JANUARY 13, 2024

Monday Spoon Feed: This expert panel from Canada has compiled a list of what they deem to be the most influential POCUS papers with regard to cardiac arrest as well as evaluation of shock. Whether you want to further educate yourself or guide your residents to learn more on the subject, this primer is a great place to start.

Shock 52

Shock Outcomes Wellness 52

Don't Forget the Bubbles

MAY 6, 2024

Outcomes included clinical status when urine culture was available, subsequent antibiotic treatment within seven days and subsequent UTI within 30 days. The primary outcome was the successful intubation on the second attempt. Secondary outcomes included tracheal intubation adverse events (TIAEs) or severe desaturation.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Emergency Medicine Journal

OCTOBER 26, 2023

Inclusion criteria were non-traumatic cardiac arrests treated with at least one external electric shock with an automated external defibrillator from the basic life support team and resuscitated by a physician-staffed ALS team. Primary outcome was survival at hospital discharge with a good neurological outcome.

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Resuscitation Basic Life Support Hospitals CPR 75

Sensible Medicine

SEPTEMBER 18, 2023

They then looked at a primary outcome of death. Earlier surgery may improve outcomes in these high-risk patients. Differences in baseline characteristics between the 2 groups likely largely explain the differences in their outcomes as discussed above, and propensity matching was not performed. vs 18.2% ; P =.036).

Operations 123

Operations Academics Shock Outcomes 123

Sensible Medicine

AUGUST 7, 2023

It is shocking. The brave investigators in London decided to study the idea that medical therapy of heart failure has become so outstanding, that adding revascularization (fixing the obstructions with stents) might not improve outcomes. Their primary outcome was death or hospitalization for heart failure. First some background.

Shock 82

Shock Outcomes Hospitals Wellness 82

The Bottom Line

FEBRUARY 9, 2023

In patients with severe cardiogenic shock does immediate initiation of VA-ECMO, compared to a trial of conservative therapy and the possibility of rescue VA ECMO, reduce a composite outcome of death, resuscitated cardiac arrest or commencement of another mechanical circulatory support?

Shock 52

Shock Resuscitation Outcomes 52

AED Leader

APRIL 24, 2024

Their AEDs are designed to be user-friendly, reliable, and effective in delivering life-saving shocks to restore a normal heart rhythm. It has advanced features that simplify the rescue process and improve outcomes. Let’s delve into the key features and benefits of Cardiac Science AEDs.

Shock 52

Shock CPR Pediatrics Documentation/Coding 52

EMDocs

AUGUST 24, 2023

PICO Population Inclusion criteria Age ≥ 18 years old Patients with septic shock Must have 2/4 SIRS criteria plus Confirmed or suspected source plus Lactate ≥ 4mmo/L or systolic blood pressure ≤ 90 mmHg Had blood cultures completed before antibiotics and were available for collection of an additional set of antibiotics following antibiotics.

Administration 67

Administration Sepsis Shock Outcomes 67

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

Sensible Medicine

MAY 6, 2024

Among patients with aortic stenosis undergoing TAVR, the use of the *device* did not have a significant effect on the incidence of periprocedural stroke, but on the basis of the 95% confidence interval around this outcome, the results may not rule out a benefit of the *device* during TAVR. Sensible Medicine is a reader-supported publication.

Stroke 88

Stroke Shock Outcomes 88

EB Medicine

FEBRUARY 13, 2017

For the first episode, we are going to focus on one of the most popular articles from last year, the October 2016 issue, entitled “Optimizing Survival Outcomes For Adult Patients With Nontraumatic Cardiac Arrest.” Welcome to the inaugural episode of EMplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice journal.

Outcomes 40

Outcomes Shock Resuscitation 40

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%

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EKG/ECG Allergic Reactions Shock Stroke 127

Taming the SRU

MAY 5, 2023

doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

PulmCCM

FEBRUARY 12, 2024

SCCM Guideline Update: Steroids for Community-Acquired Pneumonia, ARDS, Septic Shock Steroids are good medicine in the ICU, U.S. Recent studies, though, have shown steroids’ benefit in Covid pneumonia with ARDS, and for steroids improving outcomes in severe community-acquired pneumonia.

Shock 52

Shock Administration Sepsis Fractures 52

Stop and Think

JANUARY 10, 2024

They found no significant improvement in the primary endpoint of survival with a favorable neurologic outcome. Another dire scenario that doctors thought ECLS might work for was in patients who have acute MI that is large enough to cause cardiogenic shock. And thanks to the shocking number of people who support this Substack.

CPR 44

CPR Shock Outcomes Resuscitation 44

Taming the SRU

SEPTEMBER 21, 2023

Exclusion criteria were pre-intubation hypotension, use of topical anesthesia, or missing data including primary outcome, patient weight, etomidate / ketamine dose. Primary outcome was post-intubation hypotension, defined as SBP < 100mg Hg within the first 15 minutes post-intubation.

Outcomes 81

Outcomes Emergency Department Shock 81

Sensible Medicine

JUNE 5, 2023

Did the new treatment reduce the bad outcome so much so that the difference meets a statistical threshold? Two examples explain the challenge of using statistics to judge science In large studies, a tiny difference in outcomes—one that is not “clinically” significant can easily reach statististical significance.

Stroke 92

Stroke Outcomes Hyperthermia / Hypothermia Shock 92

The Trauma Pro

SEPTEMBER 12, 2023

This work comes from the Shock Trauma Center in Baltimore and is a follow on to a paper published in the New England Journal of Medicine earlier this year. Our orthopedic surgery colleagues have been trying to use aspirin for venous thromboembolism (VTE) prophylaxis for decades.

Fractures 147

Fractures Head Injuries Research Outcomes 147

The Skeptics' Guide to EM

JUNE 6, 2020

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Significant effort has been placed on the administration of IV crystalloids to address concerns for hypovolemia in septic shock. increase in MAP).

Sepsis 52

Sepsis Shock Resuscitation Outcomes 52

Emergency Medicine Cases

APRIL 23, 2024

The post EM Quick Hits 56 – Nitroglycerin in SCAPE, REBOA, Diverticulitis Imaging, CRAO, Penicillin Allergy, Physician Personality appeared first on Emergency Medicine Cases.

EMS 104

EMS Resuscitation Outcomes Allergic Reactions 104

PulmCCM

NOVEMBER 27, 2023

Beta-blockers for septic shock (STRESS-L trial) Septic shock deranges multiple complex signaling systems in the body. A meta-analysis of 7 randomized trials (n=503) previously suggested that co-administration of esmolol to blunt vasopressor-induced tachycardia and arrhythmias could reduce mortality in septic shock by one-third.

Sepsis 52

Sepsis Shock Administration Outcomes 52

Emergency Medicine Journal

MAY 23, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension by Shapiro et al Topic: sepsis Outcome rating: head turner Several studies (FEAST, CLASSIC) have challenged the benefit of large volumes of fluid for septic shock. Game changer—this paper could/should change practice.

Sepsis 52

Sepsis Shock Resuscitation Outcomes 52

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

Shock 52

Shock Resuscitation Outcomes Fluid Resuscitation 52

PulmCCM

JANUARY 29, 2024

three shocks with 2 minutes CPR in between) have been performed. No strong evidence exists to suggest that detecting and treating nonconvulsive seizures improves neurologic outcomes after arrest, but there’s a compelling pathophysiologic rationale to prevent further brain injury. ECMO used as CPR is referred to as ECPR.)

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

The Skeptics' Guide to EM

AUGUST 14, 2021

Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Date: August 12th, 2021 Reference: Daya et al.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

The Bottom Line

JUNE 19, 2023

In adult patients with major trauma, who are at risk for trauma-induced coagulopathy does early administration of 1g of tranexamic acid (TXA) followed by an infusion of 1g over 8 hours, compared with placebo, increase survival with a favourable functional outcome at 6 months?

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Administration Outcomes Shock 145

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Outcomes 52