Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. Written By Magnus Nossen — with edits by Ken Grauer and Smith.

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

RebelEM

JANUARY 29, 2024

appeared first on REBEL EM - Emergency Medicine Blog. in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 Management of Massive and Submassive Pulmonary Embolism, Iliofemoral Deep Vein Thrombosis, and Chronic Thromboembolic Pulmonary Hypertension: A Scientific Statement from the American Heart Association.

Stroke 136

Stroke Outcomes Hospitals Administration 136

The Skeptics' Guide to EM

DECEMBER 7, 2018

You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). He is unsuccessfully shocked. published in Resuscitation 2011. Case: A 51-year-old man experiences a cardiac arrest on the street. A limitation of these studies is their observational nature.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

EMDocs

JANUARY 4, 2024

Cardiogenic shock and hypotension can occur (systolic heart failure with reduced ejection fraction.) 10,12 Refractory shock or malignant arrhythmias occur in < 5% of patients. 2011; 109: 418-422. Cardiotoxicity: Overdose can cause prolonged QRS and QTc intervals. American Journal of Emergency Medicine. 2022; 55:232.e3-232.e4

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

PHEM Cast

APRIL 10, 2016

And from our buddies at HEFT EM CAST: [link] A bit more detail covering some of the research in an easy to understand way. An amazing podcast on the subject can be found at SMART EM: SMART Testing: Back to Basics As always, any feedback, comments etc. 2011 Aug 30;18(9):934–40. St Emlyns Induction podcast on Sepsis. March 2016.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

The Skeptics' Guide to EM

JUNE 15, 2018

Usually they just shock me and send me home.” Dr. Ian Stiell and colleagues published an article in 2011 in Annals of EM looking at variation in recent-onset atrial fibrillation management in Canada and found a lot of variability. I’ve had atrial fibrillation a number of time before.

Emergency Department 52

Emergency Department Fluid Resuscitation Sepsis Hospitals 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. En route, EMS administered aspirin 325mg by mouth, but withheld nitroglycerin due to initial hypotension. Answer below in the still shot.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

EMDocs

APRIL 22, 2024

EMS verbalized concern to EPs that an “intracranial bleed” may have precipitated the event. However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). 2011 Mar;123(16):1788-1830. RV pressures > LV pressures. Circulation. PMID: 21422387.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

Pediatric Emergency Playbook

FEBRUARY 1, 2016

They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. 2011 Dec;71(6):1869-72. Brenner et al. described a case series of 6 patients from two Level I trauma centers. J Pediatr Surg.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. 2011 Feb 15; Epub 2010 Aug 27. Rezaie, MD (Twitter: @srrezaie ) The post Impact of Emergency Department Crowding on Lung Protective Ventilation appeared first on REBEL EM - Emergency Medicine Blog.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

RebelEM

NOVEMBER 3, 2022

Albert 2011, Jabre 2009) However, the existing literature comparing etomidate and ketamine is conflicting. 2/3rds of the population were trauma patients, and more patients in the ketamine arm had shock, hypoxemia, extremes of size, and anatomic challenges, potentially biasing the results to favor etomidate. in the etomidate cohort.

Emergency Department 52

Emergency Department Outcomes Sepsis Operations 52

EB Medicine

AUGUST 1, 2018

Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 million, and cocaine at 1.9

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

OCTOBER 5, 2024

We’ll keep it short, while you keep that EM brain sharp. Pressors where indicated for septic shock (typically Norepinephrine starting at 0.05 Microb Drug Resist 2011; 17:267. 2018.12163 The post EM@3AM: ESBL-Producing Organisms and Their Management appeared first on emDOCs.net - Emergency Medicine Education.

EMS 97

EMS Infectious Diseases Sepsis Hospitals 97

EMDocs

DECEMBER 16, 2023

We’ll keep it short, while you keep that EM brain sharp. A 34-year-old male is brought via EMS after collapsing during an outdoor adventure race. EMS reports the patient was conscious but altered, with slurred speech and confusion. The post EM@3AM: Hyperthermia appeared first on emDOCs.net - Emergency Medicine Education.

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

EMDocs

FEBRUARY 12, 2024

Authors: Rachel Kelly, MD ( EM Resident Physician, Stony Brook University Hospital); Robert Nocito, MD (EM Attending Physician, Stony Brook University Hospital) // Reviewed by: Jessica Pelletier, DO (EM Education Fellow, Washington University in St. Epub 2011 Dec 12. is more likely to portend death (13, 14). 2011.09.027.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

RebelEM

MAY 15, 2024

2011 Jun;153(6):773-9. Epub 2011 Apr 22 Coyne CJ, Le V, Brennan JJ, Castillo EM, Shatsky RA, Ferran K, Brodine S, Vilke GM. Rezaie, MD (Twitter/X: @srrezaie ) The post REBEL Core Cast 122.0 – Neutropenic Fever appeared first on REBEL EM - Emergency Medicine Blog. Neutropenic Fever: Fever (one reading of 38.3C

Infectious Diseases 101

Infectious Diseases Administration Sepsis Anaphylaxis 101

EB Medicine

JANUARY 2, 2019

I know this is a HOTLY debated topic among EM Docs. Per a 2010 and 2011 Cochrane review, there is not evidence to recommend one antibiotic over another, so let your local antibiograms guide your treatment. Jeff: Oh it certainly is. Nachi: And this trial specifically examined the utility of nitrofurantoin.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

Pediatric EM Morsels

MARCH 7, 2025

2011 Mar26;377(9771):1096-101, 1101.e1-2. 2022.01.069 The post TXA (Tranexamic Acid) in Pediatrics appeared first on Pediatric EM Morsels. Roberts I, Shakur H, Afolabi A, Brohi K, Coats T, Dewan Y, Gando S, Guyatt G, HuntBJ, Morales C, Perel P, Prieto-Merino D, Woolley T. Am J Emerg Med. 2022;55:103-110. doi:10.1016/j.ajem.2022.01.069

Pediatrics 231

Pediatrics Blood Transfusions Anaphylaxis Military 231

RebelEM

DECEMBER 4, 2024

PMID: 25701296 The SGEM: Shock Through the Heart (Ottawa Aggressive Atrial Fibrillation Protocol) ALiEM: Atrial Fibrillation Rate Control in the ED: Calcium Channel Blockers or Beta Blockers. Ann Emerg Med 2011; 57(1): 32-3. Ann Emerg Med 2011; 57(1): 31-2. Acad EM 2010; 17: 408-15. Ann of EM 2011; 58: 517-20.

Emergency Department 96

Emergency Department Stroke EMS Shock 96

EMDocs

JANUARY 20, 2025

Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. 13 While there is good data that early antibiotics for patients in septic shock reduce mortality 18-19 the role of early and aggressive volume resuscitation and its impacts on patient-centered outcomes remain unclear. Andrews et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

PEMBlog

APRIL 4, 2025

Certainly any child who’s ill appearing or has unstable vitals should be managed for presumed sepsis or septic shock, and that’s not the focus of this podcast episode in well Appearing Children with Fever. And Van den Bruel in BMJ 2011 found procalcitonin to have better specificity than white blood cell count.

Infectious Diseases 59

Infectious Diseases Pediatrics Emergency Department Wellness 59