Dr. Smith's ECG Blog

NOVEMBER 19, 2016

In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. Fundamentally, cardiogenic shock is an issue of decreased cardiac output. NEJM 362(9):779; March 4, 2009.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

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. 2014;30: 493-495.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

RebelEM

MARCH 27, 2023

What They Did: Retrospective, observational cohort study in a single high-volume academic hospital The ED had a 5 bed area used for ongoing management and resuscitation of patients who clinically deteriorate while boarding or while actively undergo a workup in other sections of the ED. J Crit Care. Crit Care Explor. Crit Care Med.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Pediatric Emergency Playbook

JUNE 1, 2017

Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. 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’. 2009; 8:67-69. 2009; 24:156-8.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

EMDocs

JANUARY 16, 2024

Hypothermic Arrest In general, hypothermic patients in cardiac arrest should be aggressively resuscitated. Patients can have excellent outcomes despite prolonged resuscitation. 2,3 If the patient meets criteria for resuscitation, they generally are not declared dead until their core temperature is above 32℃ (“warm and dead”).

Hyperthermia / Hypothermia 83

Hyperthermia / Hypothermia Resuscitation CPR EMS 83

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. What are the most up-to-date guidelines for managing this patient?

Sepsis 64

Sepsis Fluid Resuscitation Resuscitation Shock 64

Taming the SRU

NOVEMBER 13, 2024

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

Psychiatric 88

Psychiatric Seizures Emergency Department Pediatrics 88

Pediatric Emergency Playbook

AUGUST 1, 2017

2009; 197:211-215. 2009 Jun;123(6):1548-55 Chinn WM, Zavala DC, Ambre J. Evid Based Rev Surg. 2013;216(3):501-505. Petroianu A. Diagnosis of acute appendicitis. Int J Surg. 2012; 10:115-119. Mazeh H et al. Tip appendicitis: clinical implications and management. Amer J Surg. Puig S et al. Semin Roentgenol. 2008; 22-28. Pediatrics.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

EMDocs

JANUARY 20, 2024

Symptoms of heart failure and cardiogenic shock may develop in more severe cases. Answer: Takotsubo Cardiomyopathy 1-18 Background: Also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, stress cardiomyopathy, Gebrochenes-Herz syndrome, and broken-heart syndrome.

EMS 73

EMS Fluid Resuscitation Shock EKG/ECG 73

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

The latter 1950s and 1960s, quested for nerve gas defense studying expired air resuscitation and modern resuscitology; developing intensive care units. To me, it harkens a new scientific renaissance of resuscitation science, emergency care, and creating systems for care. 1950s & 1960s Resuscitation Research.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 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. 13 Massive transfusion protocols (MTP) are hallmarks of trauma resuscitation, and they are critical to the unstable pelvic fracture patient.

Fractures 54

Fractures Resuscitation Operations EMS 54

Pediatric Emergency Playbook

JANUARY 1, 2017

Further, children participate in and absorb their family’s culture and specific personality from a very young age ( Finley 2009 ). Some children are ultra-rapid-metabolizers of codeine to morphine, causing a rapid “bolus” of the available drug, with respiratory depression and death in some cases ( Ciszkowski 2009 , Racoosin 2013 ).

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

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

EMDocs

DECEMBER 16, 2023

Evaporative cooling is the preferred method to actively reduce body temperature in the emergency department , as it can be performed with ongoing resuscitation efforts. Ice water immersion and iced peritoneal lavage are additional methods used to lower temperature but are more invasive or can prevent additional resuscitative efforts.

Hyperthermia / Hypothermia 67

Hyperthermia / Hypothermia EMS Stroke Seizures 67

RebelEM

MAY 15, 2024

Neutropenic Fever: Fever (one reading of 38.3C Give appropriate fluids, vasopressors, and antibiotics.

Infectious Diseases 87

Infectious Diseases Administration Sepsis Anaphylaxis 87