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). Instead, IR performed pulmonary thrombectomy and the patient did well. As per Dr. Frick — sinus tachycardia is usually not seen with acute OMI unless the patient is in cardiogenic shock.

EKG/ECG 113

EKG/ECG Ultrasounds Shock EMS 113

Taming the SRU

JUNE 24, 2024

Follow this algorithm in patients with unstable bradycardia with acute heart failure, change in mental status, or concern for shock, physicians should start with atropine, 1 mg and may be continued every 3 to 5 minutes if effective. Bektas, Firat, and Secgin Soyuncu. The efficacy of transcutaneous cardiac pacing in ED.” Circulation , vol.

Advances Cardiac Life Support (ACLS) 88

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 88

RebelEM

APRIL 29, 2024

2016 PMID:27075364 13 Astasio-Picado Á et al. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation. Impact of intraosseous versus intravenous resuscitation during in-hospital cardiac arrest: A retrospective study. Resuscitation. 2021 PMID: 34273470 12 Petitpas F et al.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

RebelEM

JUNE 8, 2023

Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. 2016; PMID: 27720568 Guest Post By: Courney Knieriem, MD PGY-1, Emergency Medicine Resident RWJBH Community Medical Center, Toms River, NJ Courtneyknieriem.md@rutgers.edu Am J Emerg Med.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? Jeff : So get this -- one study showed that out-of-hospital shock index and respiratory rate were highly predictive of ICU admission.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

EMDocs

DECEMBER 23, 2024

Do we still shock? The most recent and well-known trial is the PROCAMIO trial (1). Well, the trial was a multicenter prospective open label trial. Well, lets look at some other trials. If the patient has a BP of 60/palp, its easy, right? Synchronized cardiovert and move on with your day. Are there any meds you can give?

EKG/ECG 64

EKG/ECG Wellness Shock EMS 64

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. Stredder et al, Archives of Disease in Childhood 2016 we see that 58% were not asked about triggers, 30% were not asked about duration and, importantly for risk stratification, 59% were not asked for a family history of cardiac disease.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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

Emergency Medicine Ireland

OCTOBER 30, 2023

Well, that time has come and it’s time to run through vasopressin. Well this is where the fun beings. A somewhat underwhelming start Second is the VANISH trial by Gordon et al, JAMA 2016. Vasopressin versus norepinephrine infusion in patients with septic shock. Jama 316 , 509–518 (2016). How does it work?

Shock 52

Shock Sepsis Wellness Outcomes 52

RebelEM

AUGUST 14, 2023

in both groups Mean APACHE II score was 12 in both groups Almost half of the patients had septic shock at enrollment Mean time from sepsis identification to randomization was 1.4 Demographics, severity of illness, and comorbidities were well balanced between groups and the intervention and control groups have the same prognosis.

Sepsis 98

Sepsis Outcomes Administration EMS 98

EMDocs

JUNE 25, 2024

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. American Burn Association Clinical Practice Guidelines on Burn Shock Resuscitation. 2016 Aug;42(5):953-1021. Chest burns/flank/back/abdominal burns may cause issues with ventilation.

Burns 74

Burns Fluid Resuscitation Resuscitation Poisoning 74

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 77

Poisoning Fluid Resuscitation Seizures Resuscitation 77

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." Committee on Shock. Accessed 2/29/2016. Mouth-to-Airway (adjunct).

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

Emergency Medicine Ireland

OCTOBER 16, 2023

The incidence of dynamic LVOTO in those with septic shock is remarkably high and is reported to be 20% in one study from ICU echo guru Michel Slama. Even if it’s not that common it’s yet another reason why the super shocked patient should get a timely echo. Current Opinion in Critical Care 22 , 260–266 (2016).

Sepsis 52

Sepsis Shock Wellness 52

EMDocs

NOVEMBER 19, 2024

1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. Low-dose lipid emulsion for pediatric vasoplegic shock due to quetiapine and fluvoxamine overdose: a case report.

Poisoning 91

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 91

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. You will be running the show today, and you want to use your preparation time well. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. Injury 2016; 47: 797– 804. The trauma call goes out. So, what are your key priorities?

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Resuscitation Operations Sepsis Pediatrics 139

EMDocs

JUNE 27, 2024

His medical history is significant for three prior admissions for vaso-occlusive crises that have responded well to appropriate therapy, including pain control with NSAIDs and opioids, blood transfusions, antibiotics, and intravenous (IV) crystalloids. 2016 Dec;91(12):1185-1190. Epub 2016 Oct 3. C or 100.4 mg/kg, max 0.4

Pediatrics 76

Pediatrics Dehydration EMS Hospitals 76

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. ”) A 2016 study by Lambert et al in The Journal of Pediatrics shows how variable death investigations can be.

CDC 66

CDC Sepsis Research Pediatrics 66

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. McGraw Hill; 2016. Neurologic and neuropsychological symptoms during the first year after an electric shock: results of a prospective multicenter study. Click to enlarge.) Accessed October 21, 2023.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Don't Forget the Bubbles

MAY 10, 2023

A shocked friend is being ushered out of the way. And then the debrief runs through STOP : Situation – a recap of the resuscitation, including the reasoning behind decisions made Things that went well Opportunities to improve Points of action – equipment issues, or whether a case review is needed And so after the hot debrief, you pause.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Pediatric Emergency Playbook

AUGUST 1, 2017

2016; 13:590-600. Eur J Pediatr Surg 2016; 26:192. 2016; 5(1):5-12. Necrotizing Enterocolitis. N Eng J Med. 2011; 364(3):255-264. Niño DF et al. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms. Walsh MC et al. Necrotizing Enterocolitis: A Practitioner’s Perspective. Pediatr Rev. 1988; 9(7):219-226.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

If doing what was called "the one-man-band resurrection shuffle" [single person CPR in the back of a moving ambulance], this worked very well, as the bag would stay hanging there on the patient's face. How useful these would have been to let us know how well the patient was oxygenating and ventilating! Intraosseous Infusion.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. Trends in the Incidence and Recurrence of Inpatient-Treated Spontaneous Pneumothorax, 1968-2016. J Emerg Trauma Shock. Eur Respir Rev. doi:10.1001/jama.2018.14299

Fractures 95

Fractures COPD Hospitals Emergency Department 95

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Pediatric Emergency Playbook

DECEMBER 1, 2015

Victims of electrical injuries present either in extremis or as the seeming well patient with insidious, developing disease. Most patients do well, and the burn heals by secondary intention. It’s a high-flow artery to the face, and if disrupted, the child may have significant bleeding and possibly hemorrhagic shock. Horeczko T.

Burns 40

Burns EKG/ECG Emergency Department Shock 40

AED Leader

OCTOBER 11, 2023

Thanksgiving Mains According to the National Grocers Association, for Thanksgiving 2016, Americans were stuffing their shopping carts with over 311 million pounds of turkey and over 213 million pounds of potatoes ! For a festive finishing touch to your board, sprinkle with toasted nuts and pomegranate seeds.

CPR 52

CPR Burns Hospitals Shock 52

AED Leader

OCTOBER 11, 2023

Thanksgiving Mains According to the National Grocers Association, for Thanksgiving 2016, Americans were stuffing their shopping carts with over 311 million pounds of turkey and over 213 million pounds of potatoes ! For a festive finishing touch to your board, sprinkle with toasted nuts and pomegranate seeds.

CPR 52

CPR Burns Hospitals Shock 52

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. 23 Pelvic binding remains a critical resuscitation step well within the purview of the ED physician, and can be reviewed here: [link].

Fractures 54

Fractures Resuscitation Operations EMS 54

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Many of these issues were described in a prior post by Dr. Angie Lobo ( @aloboMD ) (For open-access reviews of this literature, see Saw 2016 , Saw 2017 , or Hayes 2018.) On the other hand , high-risk lesions appear to do well with aggressive treatment. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock.

EKG/ECG 52

EKG/ECG Wellness Shock Ultrasounds 52

Don't Forget the Bubbles

JANUARY 10, 2024

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. Groups were well matched at baseline. 2016 Jan 7;4(1). Do you believe the results?

Blood Transfusions 78

Blood Transfusions Outcomes Research Hospitals 78

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. While it was < 15% in 1990, by 2016 it reached 40%. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. million adults!!

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

RebelEM

SEPTEMBER 26, 2022

What They Did Single-center randomized controlled study design performed by the Department of Hepatology & Liver transplantation in New Delhi Study participants, investigator clinicians, data collectors, and data analysts were blinded Investigators recruited participants from February 27, 2016 – March 3, 2018.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 52

Pediatric Emergency Playbook

JANUARY 1, 2017

Tachycardia, tachypnea, and a change in behavior can be indicators not only to the presence of pain, but possibly to its etiology as well. For children greater than one year who are preverbal, a well performing scale is the FLACC score: Face, Legs, Activity, Cry, Consolability ( Table 3 ).

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 2016 Dec;115(6):317-21. 2016 Aug 23;134(8):e113. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Bray C, Bell LN, Liang H, Haykal R, Kaiksow F, Mazza JJ, Yale SH. Brigden ML.

Infectious Diseases 87

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 87

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

Tachycardia is unusual in ACS unless there is cardiogenic shock or a second simultaneous pathology. There is an acute R V “ S train” p attern with ST depression/T wave inversion in both inferior and anterior leads ( Note dramatic ST-T wave changes in II, III and aVF — as well as V3,V4 ).

EKG/ECG 52

EKG/ECG COPD Documentation/Coding Shock 52