Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

Troponin T peaked at "only" just above 2000 ng/L. The patient was shocked — and then began a long intensive process of resuscitation. The hospital stay was complicated by aspiration pneumonia, recurring ventricular tachycardia and a mural thrombus. Echocardiography showed and anterior and apical WMA with estimated LVEF 40%.

EKG/ECG 133

EKG/ECG Resuscitation Academics EMS 133

Pediatric Emergency Playbook

NOVEMBER 1, 2015

Etomidate is perfectly acceptable, but ketamine is actually a superior drug to etomidate in the rapid sequence intubation of children in septic shock. in Anethesia and Analgesia in 2000. On the other side of the spectrum, permissive hypotension is not described in children, as hypotension is a late and dangerous sign of shock.

Shock 40

Shock Sepsis Airway Management Pediatrics 40

Don't Forget the Bubbles

NOVEMBER 15, 2023

She had septic shock on presentation and was resuscitated with 60ml/kg of balanced crystalloid solution and escalating vasoactive medications. Park, The role of albumin in critical illness, BJA: British Journal of Anaesthesia , Volume 85, Issue 4, 1 October 2000, Pages 599–610, [link] Malbrain MLNG, Regenmortel N Van, Saugel B, et al.

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

ACEP Now

SEPTEMBER 13, 2023

In 2000, as he was completing his second term on ACEP’s Board, he was elected to the IOM – now National Academy of Medicine – in 2000. He then moved to Atlanta, to establish the Emory Center for Injury Control and later served as founding chair of Emory’s Department of Emergency Medicine. National Academics.

EMS 45

EMS Research Academics Military 45

Taming the SRU

NOVEMBER 29, 2023

Lumbar puncture with xanthochromia or > 2000 RBCs in tube 4 should increase suspicion for SAH. Hemorrhagic shock is the most common etiology of instability in trauma and should always be highest on the differential. There is growing evidence that negative NCHCT + CTA outside of traditional 6-hour window is sufficient for diagnosis.

Stroke 53

Stroke EKG/ECG Resuscitation Shock 53

Dr. Smith's ECG Blog

OCTOBER 17, 2024

PR depression — has been shown to be a relatively common ECG sign associated with clinically silent PE ( Kudo et al — JACC 39(12): 2000-2004, 2002 ). As often emphasized by Dr. Smith — sinus tachycardia is not a common finding with acute OMI unless something else is going on (ie, cardiogenic shock ).

EKG/ECG 73

EKG/ECG EMS Shock Ultrasounds 73

ACEP Now

SEPTEMBER 3, 2024

Private equity investment in health care has increased more than 20-fold since 2000, with 70 percent of this activity since 2010. He was shocked when the hospital CEO took him up on it, but a year later, volumes increased 30 percent with his emphasis on quality rather than cost-cutting.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

ETM Course

SEPTEMBER 27, 2022

We have just done this to 6 flat drills we had laying around, saving them from landfill and saving $2000 in the process.

Emergency Department 52

Emergency Department Hospitals Shock 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Perhaps, not insignificantly, they were accustomed to receiving systematized government-supplied medical and trauma care, with "shock rooms" receiving an influx of victims, as contrasted to those later who opposed "socialized medicine." Committee on Shock. Mouth-to-Airway (adjunct). Advanced Emergency Nursing Blog.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. 2000 May 4; PMID: 10793162 Harvey CE, et al. Patients at risk for ARDS were stratified by the Lung Injury Prevention Score (LIPS) which predicts the probability of developing ARDS and subsequent mortality. N Engl J Med.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Emergency Medicine Ireland

DECEMBER 5, 2022

Expect to see this more in the cold, shocked post bypass patient or in someone who’s already having a lot of arrhythmias. 2000 Nov;28(11):3631-6. Expect to see this more in the cold, shocked post bypass patient or in someone who’s already having a lot of arrhythmias. Crit Care Med.

Shock 40

Shock Wellness 40

Taming the SRU

AUGUST 30, 2023

Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. 2000 Aug;30(1):17-24. Intensive Care Med. 2021 Nov;47(11):1181-1247. doi: 10.1007/s00134-021-06506-y. Epub 2021 Oct 2. PMID: 34599691; PMCID: PMC8486643. Semin Arthritis Rheum. doi: 10.1053/sarh.2000.8366. PMID: 10966209.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Pediatric Emergency Playbook

JUNE 1, 2017

The infant in shock after a ‘cold’: myocarditis Beware of the poor feeding, tachycardic, ill appearing infant who “has a cold” because everyone else around him has a ‘cold’. 2000; 35(6):618-622. That may very well be true, but any virus can be invasive with myocardial involvement. Infectious Cunningham R et al. Ann Emerg Med.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

EB Medicine

AUGUST 6, 2019

Jeff: That is simply shocking! Isaac Tawil from the University of New Mexico. Nachi: And just as with traumatic head bleeds, a small observational study of those with blunt abdominal trauma found 8% vs 30% mortality for those on DOACs vs warfarin, respectively. Let’s also talk lab studies.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EMDocs

OCTOBER 5, 2024

Pressors where indicated for septic shock (typically Norepinephrine starting at 0.05 2000; 6:460–3. Management 9-12 Patients such receive standard resuscitation care including: Antipyretics such as Tylenol (650-1000 mg PO), Ibuprofen (600 mg PO), or Toradol (15mg IV). IV fluid resuscitation as needed. Lee JA, Kang CI, Joo EJ, et al.

EMS 97

EMS Infectious Diseases Sepsis Hospitals 97

Pediatric Emergency Playbook

JANUARY 1, 2017

Facial grimacing is a weak indicator of pain in neonates ( Liebelt 2000 ). Unexplained tachycardia may be the early signs of shock. 2000 Aug;106(2 Pt 1):351-7. 2000; 1(4):260-269. Do not expect typical pain behaviors in neonates. Tailor your regimen to your young patient’s physiologic pitfalls and needs. Pediatrics.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

EMDocs

JUNE 3, 2023

4 Patients with pelvic fractures are considered unstable when systolic blood pressure < 90mmHg and heart rate >120bpm, or in those with dyspnea, altered mental status, or skin findings of shock. Demographic epidemiology of unstable pelvic fracture in the United States from 2000 to 2009: trends and in-hospital mortality.

Fractures 64

Fractures Resuscitation Operations EMS 64

EB Medicine

JANUARY 2, 2019

Interestingly, groups have examined outpatient care with 2 days of daily IM ceftriaxone vs inpatient IV antibiotic therapy and they found that there may be a higher than acceptable risk in the outpatient setting as several required eventual admission and one developed septic shock in their relatively small trial.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

PulmCCM

MAY 22, 2023

Read in NEJM Fluid resuscitation and vasopressors are both usually needed in septic shock , but the ideal volume of fluid to infuse before starting vasopressors has been unclear. At least one expert questioned whether the study was adequately powered. In an NHLBI-sponsored trial enrolling 1563 patients at 60 U.S.

Fluid Resuscitation 86

Fluid Resuscitation Resuscitation Hospitals Sepsis 86

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 89

Psychiatric Seizures Emergency Department Pediatrics 89

Mind The Bleep

DECEMBER 16, 2023

It is the most commonly imported tropical disease in the UK, and is a medical emergency.

Rapid Diagnostic Testing 52

Rapid Diagnostic Testing Infectious Diseases Best Practices Seizures 52

Sensible Medicine

AUGUST 14, 2024

In his work, Dr. Goldwater describes a kind of toxic-shock (cytokine) reaction in the body that results from the combination of a cold virus plus being infected with a common bacterium—each pathogen relatively harmless on its own but deadly together. A safer version of the pertussis vaccine was introduced in 1996.

CDC 94

CDC Sepsis Research Pediatrics 94

RebelEM

DECEMBER 17, 2024

A large observational study of > 2000 patients found an association with fever at presentation and ICU survival for patients with severe sepsis or septic shock ( Sunden-Culberg 2017 ). Importantly, all of the patients in this study had septic shock requiring vasopressors and mechanical ventilation.

Sepsis 75

Sepsis Shock EMS Emergency Department 75

Sensible Medicine

MARCH 19, 2025

He made a point, though, of meeting his colleague face-to-face, and everyone we visited was both shocked and delighted that we made the time for them. Why was the system willing to spend more than $100,000 on a cancer treatment but not $2000 on a needed scan? Now it’s all emails and Zoom meetings.

Radiology 71

Radiology Radiology Hospitals Administration 71

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Rupture can be either free wall rupture (causing tamponade) or septal rupture, causing ventricular septal defect with left to right flow and resulting pulmonary edema and shock. Fo r more on hemodynamic effects and how to manage a patient with VSR see this post: Why the sudden shock after a few days of malaise? link] [2] Oliva, P.

EKG/ECG 89

EKG/ECG Shock COPD Wellness 89

EMDocs

MARCH 11, 2024

The clinical picture of this patient was consistent with hypovolemic shock secondary to acute cholera infection. 18 Patients with signs and symptoms of severe dehydration or shock, including stupor, coma, uncontrollable vomiting, extreme fatigue that prevents drinking, and unstable vital signs should receive IV fluid resuscitation.

Dehydration 111

Dehydration CDC Rapid Diagnostic Testing Fluid Resuscitation 111