Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenic shock). As per Dr. Frick — sinus tachycardia is usually not seen with acute OMI unless the patient is in cardiogenic shock. Additionally, there is borderline right axis deviation. Both were wrong.

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EKG/ECG Ultrasounds Shock EMS 129

Pediatric EM Morsels

MARCH 17, 2023

J Emerg Trauma Shock. In the US, the venomous snakes include rattlesnakes , copperheads, cottonmouths/water moccasins , and coral snakes [ CDC, 2021 ] Rattlesnakes live all across the United State s Copperheads inhabit the eastern U.S. as far west as Texas Cottonmouths/Water Moccasins live in the southeastern U.S. 2008;1(2):97-105.

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CDC Poisoning Pediatrics Shock 130

ALiEM

NOVEMBER 1, 2023

Critical illness requiring intubation and propofol sedation Cyanide toxicity requiring sodium thiosulfate Iron toxicity treated with deferoxamine Refractory vasoplegic shock treated with methylene blue Septic shock treated with vancomycin and cefepime Reveal the Answer 3. Intensive Care Med 2014; 40(1):104. PMID

Shock 64

Shock Poisoning Pediatrics 64

Pediatric Emergency Playbook

FEBRUARY 1, 2020

2014; 1492-1496. Glycocalyx shedding is anhanced by age and correlates with increased fluid requirement in patients with major burns. 2017; 50(1):60-65. Sebastian R et al. Percutaneous pigtail catheter in the treatment of pneumothorax in major burns: The best alternative? 2015; e24-227 Sherren PB et al. Lethal triad in severe burns.

Burns 52

Burns Pediatrics Shock 52

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. In 2014, the Society of Critical Care Medicine and the European Society of Intensive Care Medicine started a task force, and by 2016, updated definitions were out again! I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 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.

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Sepsis Shock Administration Resuscitation 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. 2014 Oct 28;:1–9. Elsevier B.V;

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

PHEM Cast

JULY 14, 2016

Journal of Emergencies, Trauma, and Shock. 2014 Feb 11;7(4):251–5. 2014 Mar 15;31(6):531–40. 2014 Jul 3;14(1):1–5. 2014 Mar 15;31(6):531–40. A systematic review of the need for MRI for the clearance of cervical spine injury in obtunded blunt trauma patients afternormal cervical spine CT. J Neurotrauma. Emerg Med J.

Fractures 52

Fractures Hospitals Shock Research 52

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation. were more likely to respond.

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Shock Resuscitation Fluid Resuscitation Sepsis 52

EMergucate

DECEMBER 9, 2014

I presented this talk at the ACEM Annual Scientific Meeting 2014 – Wednesday 10/12/14 References Evidence FOR fluid resus … Continue reading →

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Sepsis Shock 52

Downeast Emergency Medicine

APRIL 5, 2021

Findings from 12-lead electrocardiography that predict circulatory shock from pulmonary embolism: systematic review and meta-analysis. Ann Noninvasive Electrocardiol 2014.[ Electrocardiographic abnormalities in patients with acute pulmonary embolism complicated by cardiogenic shock. Am J Emerge Med 2014.[ Pubmed ]

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EKG/ECG Shock Burns Academics 40

PHEM Cast

FEBRUARY 23, 2017

Emerg Med J 31(2):93–95, 2014. In patients with penetrating trauma permissive hypotension may remain useful for longer or at least until a patient can be differentiated and the bleeding controlled. Lots to think about! References: RePhill Trial Homepage: [link] Smith IM, James RH, Dretzke J, Midwinter MJ. 2016 Jul;46(1):3–16.

Blood Transfusions 52

Blood Transfusions Head Injuries Resuscitation Radiology 52

RebelEM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 CHEST 2010. PMID: 19741062 Kucher N et al. Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. PMID: 24226805 Piazza G et al.

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Stroke Outcomes Hospitals Administration 133

RebelEM

JANUARY 25, 2024

2014 Aug;2(8):638-46. Epub 2014 Jul 3. POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. Point-of-care ultrasonography in patients admitted with respiratory symptoms: a single-blind, randomised controlled trial. Lancet Respir Med. PMID: 24998674. Eur J Intern Med. 2022 Dec;106:9-38.

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Ultrasounds Outcomes COPD Hospitals 125

ACEP Now

JUNE 14, 2024

And the Board approved a new clinical policy, “Critical Issues in the Management of Adult Patients Presenting to the ED with Seizures,” rescinding the 2014 clinical policy with same title.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 52

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

2014) Emergency Care Institute, New South Wales. 2014) Tiny Tip: PRE -eclampsia. Journal of Emergencies, Trauma and Shock, 3(1), 39. 2014) Medscape.com Sullivan, MG (2007) Time Is Critical for Success in Perimortem C-Section ACEP News. 2014) Trauma in the Obstetric Patient: A Bedside Tool. Stafford, I.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

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). 2014 May;145(5):950-957. A thin wall (diameter <5mm) is suggestive of an acute etiology”. RV pressures > LV pressures. doi: 10.1378/chest.13-1087. PMID: 24092475. Marino, P.

Ultrasounds 97

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Shock 97

EMDocs

NOVEMBER 1, 2023

6 Treatment : Airway Definitive airway management should be performed in those with respiratory distress with attention to appropriate resuscitation started beforehand in the setting of potential distributive shock from mediastinitis. McGraw-Hill Education; 2014. 4 Fluid resuscitation and vasopressor use as appropriate.

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Operations Radiology Radiology Fluid Resuscitation 86

Pediatric Emergency Playbook

JANUARY 1, 2016

Be aware that later stages of malrotation may present as shock – they present in hypovolemic shock due to third-spacing from necrotic bowel and/or septic shock from translocation or perforation. 2014; (38): 1275–1281. ISPAD Clinical Practice Consensus Guidelines 2014. 2014 Sep;15 Suppl 20:154-79.

Head Injuries 40

Head Injuries Pediatrics Shock Sepsis 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

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. 2014 Sep;45(9):1287-95. But unfortunately for Ranulf, as Tarquin stood, he slipped on a blob of spilt quince jelly.

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Resuscitation Operations Sepsis Pediatrics 139

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." Erratum in Mouth-to-Airway [adjunct] 4/22/2014. Committee on Shock.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 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; 14:83.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

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). . Halliwill JR, Sieck DC, Romero SA, Buck TM, Ely MR (2014) Blood pressure regulation X: what happens when the muscle pump is lost?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Methods STEMI activations between January 2014 and April 2018 at the University of Arizona Medical Center were identified. 2 cases of Aortic Stenosis: Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? Knotts et al.

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EKG/ECG Shock Sepsis Emergency Department 52

RebelEM

MARCH 2, 2023

Essentially there was no difference, meaning we wouldn’t expect to find a difference in outcomes Although not patient oriented, why is there no breakdown of how many patients had cardiogenic shock, congestive heart failure, echocardiographic findings, or even troponin levels. Circulation 2014. that was barely statistically significant.

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52

ACEP Now

AUGUST 8, 2023

Methodologic standards for interpreting clinical decision rules in emergency medicine: 2014 update. Ann Emerg Med 2014; 64: 286-291 Phillips B. How to avoid missing an aortic dissection. ACEP NOW 2023; 42 (6): 14. Green SM, Schriger DL, Yealy DM. Clinical decision rules: how to build them. Arch Dis Child Educ Pract Ed 2010; 95: 83-87.

Shock 52

Shock Hospitals Wellness 52

Pediatric Emergency Playbook

AUGUST 1, 2017

J Pediatr Surg 2014; 49:1619. 2014; 8(5):533-541. 2014; 15(4):859-871. J Pediatr Surg 2005; 40:197. Sulkowski JP, Cooper JN, Congeni A, et al. Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Pyloric Stenosis Aspelund G, Langer JC. Semin Pedaitr Surg. Applegate KE.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Dr. Smith's ECG Blog

DECEMBER 14, 2016

The patient had no hypertension, no tachycardia, a normal hemoglobin, no drug use, no hypotension/shock, no murmur of aortic stenosis. This is from the 2014 ACC/AHA guidelines. If it is MI, is it type 1 or type 2? Is it STEMI or NonSTEMI? Is it acute persistent occlusion? Earlier versions are more specific. "A

EKG/ECG 52

EKG/ECG Shock Hospitals Wellness 52

RebelEM

JANUARY 25, 2023

Emery Med J 2014; 31(3): 248-9. 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

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 ). Figure-2: From Grauer K: ECG Pocket Brain-2014 ePub — regarding "My Take" on defining the ST segment baseline. There is sinus tachycardia at ~100/minute.

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EKG/ECG EMS Shock Ultrasounds 75

Pediatric Emergency Playbook

FEBRUARY 1, 2016

They used REBOA for refractory hemorrhagic shock due to either blunt or penetrating injury. 2014 Apr;133(4):e1104-16. Resuscitative endovascular balloon occlusion of the aorta (REBOA) as an adjunct for hemorrhagic shock. Brenner et al. described a case series of 6 patients from two Level I trauma centers. Pediatrics.

Resuscitation 40

Resuscitation Pediatrics Fractures Emergency Department 40

Advanced Emergency Nursing from AENJ

MAY 3, 2014

link] Accessed 04/24/2014 ** An Eighteenth-Nineteenth century bellows kit for artificial ventilation, or for insufflating the rectum with tobacco smoke. Wellcome Images Copyrighted work available under Creative Commons Attribution only licence CC BY 4.0 Committee on Shock. Fell-O’Dwyer Apparatus. Inspired much rescue training.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

Taming the SRU

AUGUST 30, 2023

According to a 2014 review in the Journal of Rheumatology, PCT may be useful to determine the presence of bacterial infection in patients with rheumatologic disease because it is highly specific for bacterial inflammation, although it lacks sensitivity and should not be used to rule-out bacterial infection. Epub 2014 Dec 3.

Infectious Diseases 89

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

Pediatric Emergency Playbook

MARCH 1, 2016

On arrival, he was in compensated shock, with tachycardia. 2014 Apr;63(4):460-2. 2014 Aug;49(8):1295-9. A 5-year-old boy was playing with his older brother in front of their home when he was struck by a car. He sustained a femur fracture, splenic laceration, and blunt head trauma – the so-called Waddell’s triad. Acad Emerg Med.

Resuscitation 40

Resuscitation Pediatrics Hyperthermia / Hypothermia Operations 40

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’. 2014; 14(1): 23-227. 2014; 5(4)L631-634. 2014; 12:15. That may very well be true, but any virus can be invasive with myocardial involvement.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Don't Forget the Bubbles

JANUARY 10, 2024

3,950 children were recruited between September 2014 to May 2017. These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Do you believe the results?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78