ALiEM

OCTOBER 30, 2024

Clinical impact: The patient’s DVT ultrasounds were negative. 2015 Apr 28;313(16):1636-44. Evaluation for nephrotic syndrome due to viral hepatitis, endocarditis, venous thromboembolism or other cause of chronic lymphedema is reasonable. Clonidine is often added back to their regimens inpatient as their vital signs tolerate.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

Taming the SRU

AUGUST 30, 2023

A 2015 prospective, cross-sectional study of 78 Thai patients published in the International Journal of Rheumatic Disease demonstrated a sensitivity of 59% and specificity of 84% for PCT with a cut-off of 0.5 Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45].

Infectious Diseases 89

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

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

She arrives in the emergency department (ED) with decreased level of consciousness and shock. Her point-of-care ultrasound (POCUS) shows appropriate-appearing global ejection fraction and no marked wall motion abnormalities.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Pediatric Emergency Playbook

AUGUST 1, 2017

Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. J Ultrasound. 2015; 18 Gilmore AW et al. The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study? 2015 Jun;50(6):923-7 Herliczek TW et al. Ultrasound Evaluation for Appendicitis.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 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.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Taming the SRU

FEBRUARY 19, 2024

A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. In general, radial artery readings in patients with shock likely underestimate central pressure which can lead to increasing vasopressor dosing. Cite As: Snyder, B. Broadstock, A.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

Keep your ultrasound handy. Journal of Emergencies, Trauma and Shock, 3(1), 39. Geoff Jara-Almonte, MD and Hilary Fairbrother, MD // Editor: Alex Koyfman, MD Resuscitation of the Pregnant Trauma Patient – Pearls and Pitfalls www.emdocs.net 2/6/2015 Desjardins, G. Here, then, are some links for Third Trimester Emergencies.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

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." EM makes a strong push into bedside use of ultrasound sonography. EDNA->ENA.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

EB Medicine

NOVEMBER 1, 2018

Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. Thankfully, fatalities are declining, with just 565 in 2015. Pay attention to the entry and exit sites, as the pathway of the shock is predictive of the potential for myocardial injury and arrhythmia. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. You can also use the shock index, which as a reminder is simply the HR/SBP. Jeff: Indeed.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 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’. 2015; 19(2):e107-e109. Cardiovasculr Ultrasound. 2015; AID 953826. 2015; AID 905097. Pediatr Cardiol. 2013; 34(3):489-491. Liu Y, Miller BW.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. Jeff: Interestingly, the system I work in has prehospital physicians, who do carry US, but I can’t think of a major trauma where ultrasound changed any of the decisions we made.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

EB Medicine

JULY 8, 2019

Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. Nachi: If possible, obtain a view of the IVC also while doing your ultrasound to assess for volume status. Nachi: If possible, obtain a view of the IVC also while doing your ultrasound to assess for volume status.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EB Medicine

SEPTEMBER 1, 2018

As some background, from 2006-2015 there were almost 66,000 reported snake exposures and 31 deaths from snake envenomation in the US. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Andy Jagoda, who is also Chair of the Department of Emergency Medicine at Mount Sinai in New York City. Jeff: What a team!

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EB Medicine

AUGUST 1, 2018

It was peer-reviewed by Joseph Habboushe, assistant professor at NYU and Nadia Maria Shaukat, director of the emergency and critical care ultrasound at Coney Island Hospital in Brooklyn, New York. 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

EB Medicine

AUGUST 6, 2019

Jeff: Edoxaban is up next, approved by the FDA in 2015 for similar indications as the other Factor Xa inhibitors. But next we should talk about ultrasound. Jeff: That is simply shocking! It’s also been studied in acute ACS, with increased bleeding and no decrease in ischemic events. Jeff: And we’ll get to that in a few minutes.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EMDocs

JULY 15, 2023

A lower extremity radiograph does not reveal any gas formation and an ultrasound of the lower extremity is negative for DVT or cobblestoning, WBC is within normal limits and there are mild elevations in ESR and CRP. 2015, July 31). No fungal infections are identified on the feet. What is the most likely diagnosis? pneumoniae , S.

EMS 94

EMS Infectious Diseases Shock Ultrasounds 94

Pediatric Emergency Playbook

JANUARY 1, 2017

Intranasal (IN) medications offer the advantage of a fast onset for moderate-to-severe pain ( Graudins 2015 ), either as monotherapy or as a bridge to parenteral treatment (Table 4). Needleless lidocaine injectors may facilitate IV placement without obscuring the target vein ( Spanos 2008 , Lunoe 2015 ). 2015 Jun;33(6):791-5.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Intensive Blog

FEBRUARY 9, 2023

Other investigations to consider include imaging of the liver with ultrasound and computerised tomography (CT) to assess for any changes to the liver parenchyma or vasculature, such as portal vein thrombosis or Budd Chiari Syndrome (hepatic venous outflow obstruction). Disability- treat hypoglycaemia if present. Hepatology, 35 (3), 716-721.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

EB Medicine

JANUARY 2, 2019

So to get us all on the same page, the discriminatory zone is the b-HCG at which an IUP is expected to be seen on ultrasound. Nachi: Definitely concerning, but this is all the more reason you need to employ our favorite imaging modality… the ultrasound. For a threatened abortion, the os would be closed with an IUP seen on ultrasound.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

EMDocs

NOVEMBER 13, 2023

However, IgE-mediated or not, anaphylactic shock is possible in either case. Semin Ultrasound CT MR 2017, 38 (4), 345-356. DOI: 10.1136/neurintsurg-2015-012131 From NLM. (10) Bmj 2015, 351 , h5762. Journal of the American College of Surgeons 2015, 220 (6), 1027-1031. Acta Neurol Scand 2015, 131 (3), 164-168.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Mind The Bleep

JUNE 17, 2023

They may present in hypovalaemic shock On examination you may feel a sausage shaped mass in the right side of the abdomen which crosses the midline. Rosen MJ, 2015) IBD mostly presents with weight loss, crampy severe abdominal pain which may occur anywhere in the abdomen but frequently in the left lower quadrant and diarrhoea.

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

Mind The Bleep

JUNE 17, 2023

They may present in hypovalaemic shock On examination you may feel a sausage shaped mass in the right side of the abdomen which crosses the midline. Rosen MJ, 2015) IBD mostly presents with weight loss, crampy severe abdominal pain which may occur anywhere in the abdomen but frequently in the left lower quadrant and diarrhoea.

Shock 52

Shock Wellness Emergency Department Ultrasounds 52

Don't Forget the Bubbles

JULY 5, 2023

Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. The high blood flow velocities through these stenotic segments can be detected using transcranial doppler ultrasound (TCD). Anemia ; 2015.DOI:10.1155/2015/791498. DOI:10.1155/2015/791498.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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. Inwald et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Dr. Smith's ECG Blog

MARCH 3, 2025

Whenever there is tachycardia, I am skeptical of OMI unless it has led to severely compromised ejection fracction with cardiogenic shock. I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. Or I suspect that there is OMI simultaneous with another pathology.

EKG/ECG 74

EKG/ECG Emergency Department Hospitals Shock 74