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Shock

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  • Extracorporeal Life Support Does Not Improve Outcomes in Patients¬†with Cardiogenic Shock Receiving Early Revascularization

    The use of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with acute myocardial infarction-related cardiogenic shock who underwent early revascularization did not result in improved mortality at 30 days and resulted in more major bleeding and peripheral vascular complications.

  • Traumatic Hemorrhagic Shock

    This issue will review the management of traumatic hemorrhage in the emergency department, highlighting prehospital care, recognition of hemorrhagic shock, initial resuscitative measures, massive hemorrhage protocol, reversal agents, and technological advancements in medical and mechanical support for traumatic hemorrhage.

  • Emerging Treatment for Refractory Vasodilatory Shock

    Shock is a common cause for intensive care unit admission, necessitating rapid treatment of the underlying cause while supporting patients with fluids and vasopressor agents. Typical vasopressor agents include adrenergic agonists and vasopressin. When shock persists despite these interventions, this is labeled refractory shock.

  • Role of Early VA-ECMO Implementation in Patients with Rapidly Deteriorating Severe Cardiogenic Shock

    The ECMO-CS trial found that using early VA-ECMO in patients with rapidly deteriorating or severe cardiogenic shock (Society for Cardiovascular Angiography and Interventions stages D or E) did not result in better patient outcomes compared to initial conservative care.

  • Differentiating and Managing Pediatric Shock

    Early recognition and management of pediatric shock is critical for acute care providers. The authors review the subtle presentations, different approaches, and management strategies to effectively manage the different types of pediatric shock.

  • Shocking Injuries: Knowing the Risks and Management for Electrical Injuries

    Approximately 5,000 patients present to the emergency department each year for evaluation and treatment of electrical injuries. This article will discuss the different classifications of electrical exposures and describe the recommended initial evaluation, diagnostic workup, and treatment. In addition, the authors also discuss special situations, such as lightning exposures, pediatric exposures, and electrical exposures during pregnancy.

  • Pediatric Cardiothoracic Point-of-Care Ultrasound: Part II

    Ultrasound has emerged as a critical tool for use at the bedside to guide both diagnosis and treatment strategies. In this article, the authors discuss cardiac arrest, congenital abnormalities, pneumothorax, pleural effusion, and pneumonia.

  • Pediatric Sepsis and Septic Shock

    Pediatric sepsis is a high-stakes diagnosis that requires vigilance to make an early, timely diagnosis. Aggressive resuscitation, including fluids, antibiotics, and vasoactive agents, may be necessary. Rapidly changing standard of care also makes sepsis a critical diagnosis for clinicians.

  • Tranexamic Acid in Trauma

    Tranexamic acid or TXA is a potent antifibrinolytic that has the potential to decrease clot breakdown and reduce bleeding in trauma patients. Studies have shown that the use of TXA in trauma patients improves overall survival, although these studies have been discounted as not being relevant to trauma care as practiced in well-resourced countries. Thus, the adoption of TXA into trauma protocols in U.S. centers has been slow and controversial. Further studies are needed to answer questions about which patient populations can benefit most from TXA and how it should be used in highly developed and well-resourced trauma systems and centers.

  • Penetrating Thoracic Trauma

    Trauma continues to be a significant cause of morbidity and mortality. Accidental death remained the fifth most common cause of death for all ages in 2009. Thoracic injuries reportedly have been involved in up to 75% of all deaths related to trauma and may be directly responsible in up to 25% of these deaths.