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. In both tracings — an exceedingly fast PMVT is documented. LAD — 100% proximal occlusion; with 70-89% mid-vessel narrowing. RCA — 100% proximal occlussion.

EKG/ECG 130

EKG/ECG Shock Hospitals Sepsis 130

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2. That’s where we’re at.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Don't Forget the Bubbles

JULY 26, 2023

For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. Typical features include: HR >220bpm Narrow complex regular tachycardia P waves difficult to identify In this case there is no shock present so we can proceed to the right branch of the ALSG guideline.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

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. Documentation with coronary arteriography within 12 1/2 hours of the onset of symptoms in two cases (three episodes). FIGURE 2: Traumatic amputation and electrical burn of the patient’s left arm.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

RebelEM

SEPTEMBER 26, 2022

A meta-analysis of fifteen RCTs comparing blood product transfusion rates of cardiothoracic and surgery patients found significantly lower transfusion rates of FFP in TEG/ROTEM guided group compared to traditional tests, with no difference in survival rates (Fahrendorff 2017). Published 2017 Apr 13. Article: Kumar M et al.

Resuscitation 52

Resuscitation Blood Transfusions Outcomes Hospitals 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. Low O2 protocol: 3.1% aOR 0.96, 95% CI 0.86 Low O2 protocol: 10.6%

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52

Pediatric Emergency Playbook

JUNE 1, 2017

The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. 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’. 2017; 15:47-50. 2009; 8:67-69.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Downeast Emergency Medicine

APRIL 26, 2021

Trauma patients between the ages of 18-90 years had to have either had one documented episode of hypotension (defined as a systolic BP <90 mmHg) or tachycardia (>100 beats/minute) to be included in the study. When looking at the subgroups with severe shock, there was an 18.5% MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

EB Medicine

JUNE 6, 2019

Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. You can also use the shock index, which as a reminder is simply the HR/SBP. The greatest value of a lactate level is to detect occult shock and sepsis. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EB Medicine

MAY 3, 2019

Jeff: And while it seems crass to even mention the financial impact, the number is shocking - suicide has an estimated economic burden of $5.4 Jeff: a 2017 ACEP clinical policy also recommends against routine lab testing in those with acute psychiatric complaints. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%.

Emergency Department 40

Emergency Department Psychiatric Documentation/Coding Outcomes 40

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). Trauma: In the trauma setting, metabolic acidosis often occurs secondary to hypoperfusion from hemorrhagic shock.

Emergency Department 98

Emergency Department Resuscitation COPD Shock 98

Downeast Emergency Medicine

OCTOBER 21, 2021

We chose this topic for Journal Club with the goals to raise awareness around these shocking statistics, discuss etiologies behind these high rates of suicide, and to normalize the discussion around physician mental health. October 2017; 92 (10): 1486-1493.[ December 2017, Volume 177, Number 12.[ Mayo Clin Proc. Pdf ] Sinah.

Documentation/Coding 52

Documentation/Coding Emergency Department Shock Research 52

EB Medicine

JANUARY 2, 2019

Nachi: This month’s issue was authored by Dr. Ryan Pedigo, you may remember him from the June 2017 episode on dental emergencies, though he is perhaps better known as the director of undergraduate medical education at Harbor-UCLA Medical center. This result was for the most part re-confirmed in a 2017 cochrane review.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Thus, Brugada is the likely diagnosis _ A very nice explanation of this is given in the document quoted below on current ECG criteria for Brugada pattern. This is based on the Sieira et al, 2017, risk calculator , which gives a borderline risk score (2). Bayes de Luna, A et al.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

RebelEM

NOVEMBER 11, 2024

compared cefepime to piperacillin-tazobactam in a cohort of 250 patients with septic shock and found a signal toward higher mortality in those receiving cefepime. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. 2017 Sep;279(1):70-89. In 2021, Buckley et. JAMA Intern Med.

Sepsis 108

Sepsis Outcomes Administration Shock 108

Dr. Smith's ECG Blog

MARCH 25, 2025

Documentation indicates that the patient was shocked 4 times (with no comment on energy level) and received amiodarone 300 mg IV and magnesium 2 g IV. In the second case, the patient never converted meaning the shock did not do its job at all. After CULPRIT SHOCK, many shied away from multivessel PCI in the acute setting.

EKG/ECG 62

EKG/ECG Shock Documentation/Coding Hospitals 62

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. However, there are documented adverse events such as haemorrhagic cerebrovascular accidents or recurrence of VOC after drug withdrawal, which represent a drawback in its regular use. Anemia ; 2015.DOI:10.1155/2015/791498.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EMDocs

JANUARY 6, 2025

Based on available hospital resources, the patient is treated for septic shock secondary to pneumonia and an infected wound using broad-spectrum antibiotics and IV crystalloid fluids. She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI.

Infectious Diseases 74

Infectious Diseases CDC PPE Rapid Diagnostic Testing 74