Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. LAD — 100% proximal occlusion; with 70-89% mid-vessel narrowing. LCx — 50-69% stenosis of the 1st marginal branch; with 100% distal LCx occlusion. RCA — 100% proximal occlussion.

EKG/ECG 134

EKG/ECG Shock Hospitals Sepsis 134

Pediatric Emergency Playbook

AUGUST 1, 2020

Pediatrics 2011; 128:e741. Council on Sports Medicine and Fitness and Council on School Health, Policy statement—Climatic heat stress and exercising children and adolescents. Casa DJ et al. The Inter-Association Task Force for Preventing Sudden Death in Secondary School Athletics Programs: Best-Practices Recommendations. J Athl Train.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Stroke Burns Pediatrics 52

EMDocs

DECEMBER 6, 2024

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality. McGraw Hill; 2016.

Poisoning 88

Poisoning Fluid Resuscitation Seizures Resuscitation 88

Emergency Medicine Ireland

JUNE 10, 2024

Patients are going to be pretty sick often from multiple pathologies but COHb on its own is enough to produce severe neurological injury, shock and even cardiac injury is also quite prevalent. A follow up trial in 2011 by ICU steroid guru Djilalli Annane did not find a benefit. Intensive Care Medicine 37 , 486–492 (2011).

Poisoning 52

Poisoning EMS Burns Shock 52

RebelEM

JANUARY 29, 2024

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. PMID: 21422387 Wan S et al. Circ 2004.

Stroke 130

Stroke Outcomes Hospitals Administration 130

The Skeptics' Guide to EM

DECEMBER 7, 2018

He is unsuccessfully shocked. published in Resuscitation 2011. You are the first provider on scene with Emergency Medical Services (EMS) and start high-quality Cardiopulmonary Resuscitation (CPR). A cardiac defibrillator is hooked up and the patient is in ventricular fibrillation.

Advances Cardiac Life Support (ACLS) 52

Advances Cardiac Life Support (ACLS) CPR Resuscitation Hospitals 52

The Skeptics' Guide to EM

JANUARY 9, 2021

CPR is currently in progress with a single shock having been delivered. JAMA 2020 * Population: Adults 18 years and older with non-traumatic OHCA between 2011 and 2015treated by 192 EMS agencies in the USA. On the other end of the line is one of your local crews who have responded to a 54-year-old male with a witnessed cardiac arrest.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

PHEM Cast

APRIL 10, 2016

One year mortality of patients treated with an emergency department based early goal directed therapy protocol for severe sepsis and septic shock: a before and after study. Arriving by Emergency Medical Services Improves Time to Treatment Endpoints for Patients With Severe Sepsis or Septic Shock. 2011 Aug 30;18(9):934–40.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Don't Forget the Bubbles

MAY 6, 2024

The data was collected from a cohort from 2011- 2015 (nearly ten years ago). Criteria for the sepsis scoring systems were not defined explicitly. Data post 30 days was not reviewed, nor was functional health or quality of health outcomes. Is this truly reflective of the current population? Why does it matter?

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Greater Sydney Area HEMS

APRIL 26, 2023

In contrast, shock (leading to syncope and rarely cardiac arrest) from ST can occur well before mechanisms of crush injury come into play, with low-flow states described as early as within 6 minutes (2). . 2011, 22:77-86. Nope they’re different. Organ failure from rhabdo? Health and Safety Executive Research Report 451. 10.1016/j.wem.2010.10.008

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

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. On the other side of the spectrum, permissive hypotension is not described in children, as hypotension is a late and dangerous sign of shock. Relax, it’s a myth.

Shock 40

Shock Sepsis Airway Management Pediatrics 40

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

Journal of Emergencies, Trauma and Shock, 3(1), 39. Reid, C (2011) Prehospital resuscitative hysterotomy op.cit. Third Trimester Bleeding [ppt] Scott Ramshur, MD Third trimester bleeding [ppt] Tom Archer, MD MBA UCSD Anesthesiology Kinney-Ham, L., Nguyen, H. Steele, R., & Walters, E. de Boisblanc, B., & Suresh, M.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

PHEM Cast

JULY 14, 2016

2011 May;70(5):1282–5. Journal of Emergencies, Trauma, and Shock. Removing a Patient From the Spine Board: Is the Lift and Slide Safer Than the Log Roll? I J, A M, Yu E, Tulman D, Jones C, Stawicki S. 2014 Feb 11;7(4):251–5. Sundstrøm T, Asbjørnsen H, Habiba S, Sunde GA, Wester K.

Fractures 52

Fractures Hospitals Shock Research 52

The Skeptics' Guide to EM

APRIL 28, 2018

Background: There have been a large number of trials on steroids for a variety of conditions in the last year and we have covered some of them on the SGEM: * The ADRENAL trial on steroids in septic shock demonstrating no all-cause mortality benefit at 90 days ( SGEM#208 ).

Hospitals 40

Hospitals Emergency Department Outcomes Shock 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. This patient’s severe aortic stenosis (AS) and associated severe cardiogenic shock likely created the ECG pattern, resulting in a very difficult challenge for our inpatient team. Fundamentally, cardiogenic shock is an issue of decreased cardiac output.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

PEMBlog

JANUARY 17, 2024

2011 Mar;127(3):e573-80. Epub 2011 Feb 21. Clin Infect Dis 2011; 52:e18. Full blown sepsis and toxic shock syndrome. Randomized controlled trial of cephalexin versus clindamycin for uncomplicated pediatric skin infections. Pediatrics. doi: 10.1542/peds.2010-2053. PMID: 21339275; PMCID: PMC3387913. Pallin, William D.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Pediatric Emergency Playbook

OCTOBER 1, 2016

It is important to note that 15% of necrotizing enterocolitis occurs in full-term babies; malrotation can present simply in shock, without initial overt bleed. Give blood for compensated shock, prepare for massive transfusion if giving more than 40 mL/kg total blood products. 2011 Mar;74(1):45-66. Acta Gastroenterol Belg.

Pediatrics 52

Pediatrics Wellness Shock Resuscitation 52

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’. 2011; 2(1):70-72. 2011 Jan-Jun; 4(1): 81–83. 2011; 32:492-497. 2011; 552-555. 2011; 128(6):1-6 Munk K et al. Arq Bras Cardiol.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

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

PHEM Cast

SEPTEMBER 6, 2017

You can also see when your treatment is working- if you give a patient in septic shock some fluid and improve their CO, you’ll see a rise in ETC02 You can confirm adequacy of respiratory function in the fitting or post-ictal patient when all other methods fail PITFALLS Device failure- lines blocking, batteries running out, pump failure.

CPR 52

CPR Resuscitation Operations Wellness 52

ACEP Now

AUGUST 8, 2023

Circulation 2011; 123: 2213-2218. Many of these “high risks” may be absent from ED medical records or unknown to patients (connective tissue disease, valvular heart disease), are subjective (onset, pain descriptors, and severity) while the interrater reliability of physical examination and subjective historical features is unknown.

Shock 52

Shock Hospitals Wellness 52

Mind The Bleep

FEBRUARY 9, 2024

Circulation Is there evidence of shock – think hypoperfusion; confusion, chest pain, rising lactate, low BP.What is the most likely cause of this? 2011 Dec;11(6):601-4. Breathing Is there evidence of respiratory failure?If If so, what is the most likely cause and the most appropriate means of respiratory support? Clin Med (Lond).

Hospitals 52

Hospitals Resuscitation Fluid Resuscitation Shock 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.

Outcomes 52

Outcomes Emergency Department Sepsis Operations 52

PEMBlog

JUNE 5, 2024

Guidelines for field triage of injured patients: recommendations of the National Expert Panel on Field Triage, 2011. 2011 Aug;58(2):145-55. You should also consider the possibility of quote unquote spinal shock. than it is spinal shock. MMWR Recomm Rep. 2012 Jan 13;61(RR-1):1-20. PMID: 22237112. Ann Emerg Med.

Fractures 52

Fractures Pediatrics Radiology Radiology 52

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. Patients at risk for ARDS were stratified by the Lung Injury Prevention Score (LIPS) which predicts the probability of developing ARDS and subsequent mortality. PMID: 19325480 Gajic O, et al.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

PulmCCM

SEPTEMBER 9, 2021

Yet in 2011 a landmark randomized, controlled trial measured the effect that an intravenous bolus had on mortality in children with severe febrile illness in 3 African countries. With ANDROMEDA-SHOCK-2 enrolling patients, this distinction could become more salient.

Resuscitation 40

Resuscitation Fluid Resuscitation Sepsis Outcomes 40

Dr. Smith's ECG Blog

APRIL 15, 2019

In this abstract from 2011, we found that 4%(4 of 99) type 2 MI and 38% of type 1 MI had ST Elevation. I said I think there is a fixed stenosis in the LAD and the tachycardia and stress caused a type 2 STEMI. link] An angiogram was done: It showed no culprit and no coronary disease, but did show a myocardial bridge in the mid LAD.

EKG/ECG 40

EKG/ECG Sepsis Documentation/Coding Shock 40

Pediatric EM Morsels

JULY 21, 2023

2011 Apr;48(4):331-2. Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. Fun fact for animal lovers!- cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! PMID: 33303004; PMCID: PMC7726605.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Greater Sydney Area HEMS

FEBRUARY 20, 2024

Obtaining access in shocked trauma patients can be notoriously difficult due to circulatory collapse. Those who are shocked, shut down with limited or no other options for peripheral access require central access. 2011; 106 : 732–737. [iv] The supraclavicular approach is not a new technique, but it is underutilised. Green et al.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

ALiEM

JUNE 5, 2023

Glucocorticoid therapy should be considered in anthrax meningitis, cutaneous anthrax with extensive tissue edema involving the head and neck, or anthrax with vasopressor-resistant shock [9]. 2011 Dec;1(6):496-501. When should you administer post-exposure prophylaxis (PEP)? Anthrax: A disease of biowarfare and public health importance.

Infectious Diseases 102

Infectious Diseases CDC PPE Military 102

Pediatric Emergency Playbook

AUGUST 1, 2017

2011; 364(3):255-264. 2011; 29:1136-1140.:205-211. 2011; 523-527. 2011; 24: 552-561. 2011; 146(6):660-665. Necrotizing Enterocolitis. N Eng J Med. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. 2016; 13:590-600. Walsh MC et al. Am J Emerg Med. Chien M et al. J Emerg Med.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

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 88

Psychiatric Seizures Emergency Department Pediatrics 88

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 77

Seizures EKG/ECG Poisoning Shock 77

EMDocs

APRIL 22, 2024

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. A thin wall (diameter <5mm) is suggestive of an acute etiology”. RV pressures > LV pressures. Circulation. doi: 10.1161/CIR.0b013e318214914f.

Ultrasounds 93

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 93

Pediatric Emergency Playbook

MAY 1, 2017

He will be dehydrated – possibly in shock. 2011; 128(4):825-31. 2011; 32(8):341-9. My take away: we now have some evidence basis for using filtered sunlight as an adjunct for babies well enough to go home. Critical Care Although rare, the critically ill neonate with hyperbilirubinemia requires immediate intervention.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Taming the SRU

APRIL 26, 2023

Mil Med 2011. Classification of sepsis, severe sepsis and septic shock: the impact of minor variations in data capture and definition of SIRS criteria. Misdiagnosis of exertional heat stroke and improper medical treatment. Epstein Y, Yanovich R. Heatstroke. N Engl J Med 2019. Gaudio FG, Grissom CK. Cooling Methods in Heat Stroke.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

Dr. Smith's ECG Blog

JUNE 1, 2020

Follow-Up to This Case: Although I did not learn specific details of this case — I did find out that this patient failed to respond to antiarrhythmic treatment and multiple shock attempts. He could not be resuscitated. — My sincere appreciation to Zhang Mingming ( of China ) for contributing this case.

EKG/ECG 52

EKG/ECG Resuscitation Shock Outcomes 52