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1. Do Corticosteroids Improve Mortality or Shock Reversal in Patients With Septic Shock? (SRS therapy)

Do Corticosteroids Improve Mortality or Shock Reversal in Patients With Septic Shock? (SRS therapy) TAKE-HOME MESSAGE No studied corticosteroid regimen is superior to placebo or any other regimen in patient-centered outcomes including mortality; however, hydrocortisone infusion improves shock reversal compared with placebo or methylprednisolone. Do Corticosteroids Improve Mortality or Shock Reversal in Patients With Septic Shock? EBEM Commentators Brit Long, MD Michael D. April, MD, DPhil (...) Department of Emergency Medicine SAUSHEC Fort Sam Houston, TX Results Authorsincluded22studiesinthe network meta-analysis, excluding 11 from the 2015 Cochrane re- view. Hydrocortisone infusion demonstrated superior shock reversal compared with placebo (OR 3.68; 95% CI 1.52 to 8.93) (Table). Methylpredniso- lone bolus was less likely to reverse shock than hydrocorti- sone bolus (OR 0.37; 95% CI 0.19 to 0.72). No regimens demon- strated superiority for the out- comes of mortality at 28 days, hospital

2018 Annals of Emergency Medicine Systematic Review Snapshots

2. The 4 Physiologic Etiologies of Shock, and the 3 Etiologies of Cardiogenic Shock

The 4 Physiologic Etiologies of Shock, and the 3 Etiologies of Cardiogenic Shock Dr. Smith's ECG Blog: The 4 Physiologic Etiologies of Shock, and the 3 Etiologies of Cardiogenic Shock Friday, November 30, 2018 A 60-something presented with hypotension, bradycardia, chest pain and back pain. She had a h/o aortic aneurysm, aortic insufficiency, peripheral vascular disease, and hypertension. She had a mechanical aortic valve. She was on anti-hypertensives including atenolol, and on coumadin (...) in aVR: Is this pattern specific for global ischemia due to left main coronary artery disease? J Electrocardiol 2013;46:240-8. Case continued: The chest X-ray was consistent with pulmonary edema, and the ultrasound showed a "plump" inferior vena cava. (This data is all consistent with high right and left sided filling pressures, which is the hallmark of cardiogenic shock -- not obstructive, distributive, or hypovolemic) Aortic dissection was considered (with involvement of the coronary arteries

2019 Dr Smith's ECG Blog

3. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. (PubMed)

Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. Abnormal peripheral perfusion after septic shock resuscitation has been associated with organ dysfunction and mortality. The potential role of the clinical assessment of peripheral perfusion as a target during resuscitation in early septic shock has not been established.To determine if a peripheral (...) perfusion-targeted resuscitation during early septic shock in adults is more effective than a lactate level-targeted resuscitation for reducing mortality.Multicenter, randomized trial conducted at 28 intensive care units in 5 countries. Four-hundred twenty-four patients with septic shock were included between March 2017 and March 2018. The last date of follow-up was June 12, 2018.Patients were randomized to a step-by-step resuscitation protocol aimed at either normalizing capillary refill time (n = 212

2019 JAMA

4. Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute Myocardial Infarction: Long-Term 6-Year Outcome of the Randomized IABP-SHOCK II Trial

Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute Myocardial Infarction: Long-Term 6-Year Outcome of the Randomized IABP-SHOCK II Trial The role of intraaortic balloon counterpulsation (IABP) in cardiogenic shock is still a subject of intense debate despite the neutral results of the IABP-SHOCK II trial (Intraaortic Balloon Pump in Cardiogenic Shock II) with subsequent downgrading in international guidelines. So far, randomized data on the impact of IABP on long-term clinical (...) outcomes in patients with cardiogenic shock complicating acute myocardial infarction are lacking. Furthermore, only limited evidence is available on general long-term outcomes of patients with cardiogenic shock treated by contemporary practice.The IABP-SHOCK II trial is a multicenter, randomized, openlabel trial. Between 2009 and 2012, 600 patients with cardiogenic shock complicating acute myocardial infarction undergoing early revascularization were randomized to IABP versus control.Long-term follow

2019 EvidenceUpdates

5. Shock

Shock Shock - Symptoms, diagnosis and treatment | BMJ Best Practice You'll need a subscription to access all of BMJ Best Practice Search  Shock Last reviewed: February 2019 Last updated: January 2019 Summary Commonly diagnosed when signs of hypoperfusion are associated with low or declining blood pressure. It may result from a number of disease processes, including pump failure (cardiogenic), loss of intravascular volume (hypovolaemic), failure of vasoregulation (distributive), or obstruction (...) to blood flow (obstructive). Initial treatment aims to optimise oxygen delivery and reverse hypoperfusion through volume resuscitation, vasopressors for refractory hypotension due to vasodilation, management of cardiac dysfunction, and treatment of the underlying cause. Management of shock is best undertaken in a critical care environment. Definition Shock is most commonly defined as the life-threatening failure of adequate oxygen delivery to the tissues and may be due to decreased blood perfusion

2019 BMJ Best Practice

6. Extracorporeal shock wave therapy (ESWT) for heel pain

Extracorporeal shock wave therapy (ESWT) for heel pain 1 Translation of the key statement of the final report N15-06 Extrakorporale Stoßwellentherapie beim Fersenschmerz (Version 1.0; Status: 29 March 2017). Please note: This document was translated by an external translator and is provided as a service by IQWiG to English-language readers. However, solely the German original text is absolutely authoritative and legally binding. Extract IQWiG Reports – Commission No. N15-06 Extracorporeal shock (...) wave therapy (ESWT) for heel pain 1 Extract of final report N15-06 Version 1.0 ESWT for heel pain 29 March 2017 Institute for Quality and Efficiency in Health Care (IQWiG) - i - Publishing details Publisher: Institute for Quality and Efficiency in Health Care Topic: Extracorporeal shock wave therapy (ESWT) for heel pain Commissioning agency: Federal Joint Committee Commission awarded on: 30 July 2015 Internal Commission No.: N15-06 Address of publisher: Institut für Qualität und Wirtschaftlichkeit

2019 Institute for Quality and Efficiency in Healthcare (IQWiG)

7. Age shock index, shock index, and modified shock index for predicting postintubation hypotension in the emergency department. (PubMed)

Age shock index, shock index, and modified shock index for predicting postintubation hypotension in the emergency department. Hypotension after emergent ETI is a relatively common complication during and after emergency airway management. We aimed to evaluate SI, MSI, and age SI to predict PIH in patients who presented to the emergency department. Moreover, which factors would be better for predicting the event or similar to the others.A retrospective, standardized chart review of consecutive

2019 American Journal of Emergency Medicine

8. Does the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Improve Survival in Septic Adults?

Does the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Improve Survival in Septic Adults? Does the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Improve Survival in Septic Adults? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 73, Issue 4, Pages 363–365 Does the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) Improve Survival in Septic Adults? x (...) all Collapse all Article Outline Take-Home Message No high- or moderate-level evidence shows that the Severe Sepsis and Septic Shock Early Management Bundle (SEP-1) hemodynamic interventions improve survival in sepsis. Methods Data Sources The authors searched PubMed, EMBASE, Scopus, Web of Science, and without language restrictions from inception to November 28, 2017. They also searched the references of analyzed studies and other review articles. Study Selection Investigators included randomized

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2019 Annals of Emergency Medicine Systematic Review Snapshots

9. Restricted fluid bolus versus current practice in children with septic shock: the FiSh feasibility study and pilot RCT

Restricted fluid bolus versus current practice in children with septic shock: the FiSh feasibility study and pilot RCT Restricted fluid bolus versus current practice in children with septic shock: the FiSh feasibility study and pilot RCT Journals Library An error occurred retrieving content to display, please try again. >> >> >> Page Not Found Page not found (404) Sorry - the page you requested could not be found. Please choose a page from the navigation or try a website search above to find

2018 NIHR HTA programme

10. Early Norepinephrine Administration in Septic Shock

Early Norepinephrine Administration in Septic Shock Early Norepinephrine Administration in Septic Shock | Emergency Medicine | Washington University in St. Louis Open Menu Back Close Menu Search for: Loading... Welcome Our Team Sections Education Alumni Research ECRC Journal Club Events Jermyn Lectures Open Search Vignette You are working an overnight shift in TCC one evening when you get the following page: “Triage patient to 3L.” No other information is provided, but when the patient finally (...) is transported to hte MICU, you begin to wonder what evidence there is looking at early norepinephrine administration in patients with sepsis and hypotension. After your shift, you go home and do your own literature search….. PICO Question Population: Adult patients septic shock, defined as the presence of plus an infectious source plus a mean arterial pressure (MAP) <65 Intervention: Early norepinephrine drip, initiated prior to completion of fluid resuscitation Comparison: Standard of care (typically

2019 Washington University Emergency Medicine Journal Club

11. What is the clinical effectiveness of extracorporeal Shock Wave Therapy or barbotage in the management of rotator cuff calcific tendinopathy?

What is the clinical effectiveness of extracorporeal Shock Wave Therapy or barbotage in the management of rotator cuff calcific tendinopathy? Getting Evidence into Clinical Practice: Barbotage for calcific cuff tendinopathy Musculoskeletal Research Facilitation Group (CAT Group) Date: 25.7.18 CAT Lead: Emma Salt Date CAT completed: Email: emma.salt@nhs.net Date CAT to be reviewed: 2021 Specific Question: What is the clinical effectiveness of extracorporeal Shock Wave Therapy or barbotage (...) in the management of rotator cuff calcific tendinopathy? Clinical bottom line There is moderate evidence that shock wave therapy and barbotage are safe procedures. There is limited evidence to suggest it is effective for rotator cuff calcific tendinopathy. Of the two interventions, available limited evidence suggests barbotage may be more effective than shockwave. Why is this important? Calcific tendonopathy commonly affects supraspinatus and infraspinatus muscles of the rotator cuff in adults aged 30 to 60

2019 Public Health England

12. Medical Follow-up and Discharge of Individuals Receiving Electric Shock or Blunt Trauma from Non-Lethal Weapons: Guidelines

Medical Follow-up and Discharge of Individuals Receiving Electric Shock or Blunt Trauma from Non-Lethal Weapons: Guidelines Medical Follow-up and Discharge of Individuals Receiving Electric Shock or Blunt Trauma from Non-Lethal Weapons: Guidelines | CADTH.ca Find the information you need Medical Follow-up and Discharge of Individuals Receiving Electric Shock or Blunt Trauma from Non-Lethal Weapons: Guidelines Medical Follow-up and Discharge of Individuals Receiving Electric Shock or Blunt (...) Trauma from Non-Lethal Weapons: Guidelines Last updated: August 16, 2019 Project Number: RB1378-000 Product Line: Research Type: Devices and Systems Report Type: Summary of Abstracts Result type: Report Question What are the evidence-based guidelines regarding medical follow-up and discharge of people who have received an electric shock from a conducted electrical weapon or blunt trauma from a projectile-based weapon? Key Message Two evidence-based guidelines were identified regarding medical follow

2019 Canadian Agency for Drugs and Technologies in Health - Rapid Review

13. Does the Addition of Vasopressin to Catecholamine Vasopressors Affect Outcomes in Patients With Distributive Shock?

Does the Addition of Vasopressin to Catecholamine Vasopressors Affect Outcomes in Patients With Distributive Shock? Does the Addition of Vasopressin to Catecholamine Vasopressors Affect Outcomes in Patients With Distributive Shock? - Annals of Emergency Medicine Email/Username: Password: Remember me Search Terms Search within Search Share this page Access provided by Volume 74, Issue 1, Pages 153–155 Does the Addition of Vasopressin to Catecholamine Vasopressors Affect Outcomes in Patients (...) With Distributive Shock? x Steven K. Roumpf , MD (EBEM Commentator) , x Benton R. Hunter , MD (EBEM Commentator) Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN DOI: | Publication History Published online: November 13, 2018 Expand all Collapse all Article Outline Take-Home Message In patients with distributive (eg, septic) shock, the addition of vasopressin or vasopressin analogues to catecholamine therapy may decrease the rate of atrial fibrillation and need for renal

2019 Annals of Emergency Medicine Systematic Review Snapshots

14. Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. (PubMed)

Inotropic agents and vasodilator strategies for the treatment of cardiogenic shock or low cardiac output syndrome. Cardiogenic shock (CS) and low cardiac output syndrome (LCOS) as complications of acute myocardial infarction (AMI), heart failure (HF) or cardiac surgery are life-threatening conditions. While there is a broad body of evidence for the treatment of people with acute coronary syndrome under stable haemodynamic conditions, the treatment strategies for people who become (...) 2017. We also searched four registers of ongoing trials and scanned reference lists and contacted experts in the field to obtain further information. No language restrictions were applied.Randomised controlled trials in people with myocardial infarction, heart failure or cardiac surgery complicated by cardiogenic shock or LCOS.We used standard methodological procedures expected by Cochrane.We identified 13 eligible studies with 2001 participants (mean or median age range 58 to 73 years) and two

2018 Cochrane

15. Extracorporeal shock wave therapy for the healing and management of venous leg ulcers. (PubMed)

Extracorporeal shock wave therapy for the healing and management of venous leg ulcers. Leg ulcers are chronic wounds of the lower leg, caused by poor blood flow, that can take a long time to heal. The pooling of blood in the veins can damage the skin and surrounding tissues, causing an ulcer to form. Venous leg ulcers are associated with impaired quality of life, reduced mobility, pain, stress and loss of dignity. The standard treatment for venous leg ulcers is compression bandages or stockings (...) . Shock wave therapy may aid the healing of these wounds through the promotion of angiogenesis (the formation and development of blood vessels) and reduction of inflammation, though this process is poorly understood at present.To assess the effects of extracorporeal shock wave therapy on the healing and management of venous leg ulceration.In April 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process

2018 Cochrane

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