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. 3 Always get an EKG to assess for cardiotoxicity, including widened QRS and prolonged QTc, although this may not be evident right away. Eds (2017).

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

Don't Forget the Bubbles

OCTOBER 7, 2024

Was the patient thrown from the source (suggestive of DC shock and may result in further blunt force trauma)? Children, especially toddlers, may insert objects into outlets, leading to shocks or burns. Electrical devices used near water sources can cause severe shocks. Was the voltage high or low (as below)?

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

ACEP Now

JULY 7, 2023

However, between four and five percent of cases of VT or VF will be refractory to standard management, with nonperfusing arrhythmia persisting despite repeated shocks. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. amiodarone or lidocaine). Resuscitation. Sakai T, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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

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). During a short period of ROSC an ECG was performed. The findings of RV strain on the ECG also supported the POCUS echo findings in this case. EKG RV strain.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

He had a triage ECG at time 0 (ECG-1): Computer read, with Physician overread: Sinus rhythm. If you see this, you must very closely question the patient about any chest symptoms, and even if no relevant symptoms, to be certain to look for old ECG, and to do serial ECGs and troponins. A 3rd ECG was recorded at 3.5

EKG/ECG 52

EKG/ECG Emergency Department Wellness Shock 52

RebelEM

MARCH 30, 2023

However, there are no clear guidelines for management in post-cardiac arrest patients without ST-segment elevations on ECG. Clinical Question : In patients who suffer an OHCA without ST-segment elevation on the post-resuscitation ECG, will early coronary angiogram (CAG) vs. delayed CAG improve outcomes?

Hospitals 66

Hospitals Outcomes EKG/ECG Resuscitation 66

Dr. Smith's ECG Blog

OCTOBER 24, 2019

The ECGs An initial ECG was obtained as the pain was rapidly resolving: Minimal upsloping ST Elevation in III, with a steeply biphasic T wave, and with reciprocal ST depression in leads I and aVL. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock. Figure-1: The 2 ECGs in this case ( See text ).

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

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. 1,4-5 Thus, an electrocardiogram (ECG) and cardiac monitoring should be performed for unstable, electrical injury patients. 7 Thus, an ECG is recommended for all electrical injuries.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 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

Dr. Smith's ECG Blog

JULY 12, 2020

Why did she go from stable to shock in seconds? She had presented initially with 6 days of recurrent chest, back, and shoulder pain and was worked up with a reportedly normal ECG, CXR, and d-dimer. Here is her ECG at that first visit: There is the slightest STE in lead II and III. Prac 15(17), 2017.

EKG/ECG 40

EKG/ECG Hospitals Ultrasounds Wellness 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. 2017 Nov;35(4):525-537. Cardiac Tamponade. Cardiol Clin.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

Pediatric Emergency Playbook

JUNE 1, 2017

Electrocardiography (ECG) should be performed on any patient with significant blunt chest injury. A negative ECG is highly consistent with no significant blunt myocardial injury. Any patient with a new abnormality on ECG (dysrhythmia, heart block, or signs of ischemia) should be admitted for continuous ECG monitoring.

Pediatrics 52

Pediatrics EKG/ECG Wellness 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

JULY 8, 2019

Nachi: Taken all together, the rising rates of obesity and the rising success and availability of bariatric procedures has led to an increased number of bariatric procedures, with 228,000 performed in the US in 2017. In 2017, these were performed 60%, 18%, and 3% of the time. Finally, there is the roux-en-y gastric bypass.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

DECEMBER 16, 2023

A 12-lead EKG shows sinus tachycardia but is otherwise normal. Heat stroke can lead to end-organ dysfunction such as rhabdomyolysis, disseminated intravascular coagulation, cardiogenic shock, liver failure, and cerebral edema. The patient is agitated, not oriented, and becoming combative with ED staff. Temps greater than 41.5C

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

Dr. Smith's ECG Blog

DECEMBER 5, 2019

As part of the workup, she underwent an ECG. 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. We repeated the ECG: Brugada pattern is mostly resolved. Is this Type 2 Brugada syndrome/ECG pattern?

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

Dr. Smith's ECG Blog

FEBRUARY 10, 2025

normal glucose, and mild acute on chronic renal failure (Creatinine from 140 to 170 umol/L), and the following ECG, and they were sent to the ED. Theres no prior ECG to compare - but the bradycardia, prolonged PR and peaked T waves could all be from hyperkalemia. regardless of the ECG (when the repeat level came back).[1]

EKG/ECG 118

EKG/ECG Shock Operations Emergency Department 118

Dr. Smith's ECG Blog

MARCH 25, 2025

High enough that a bland ECG is not immediately reassuring. ECG 1 What do you think? To me, this ECG is not diagnostic. But if you call every ECG that looks like this OMI, you are going to have a lot of false positives. No further ECGs were obtained for the rest of the day. in absolute terms!

EKG/ECG 63

EKG/ECG Shock Documentation/Coding Hospitals 63

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Below is his presentation ECG. The above ECG was originally recorded with a paper speed of 50mm/sec. Interpretation: The ECG shows sinus rhythm at 94 beats per minute. This ECG shows a lot of "acuity". The ECG findings in isolation must be assumed to be acute MI until proven otherwise. What do you think?

EKG/ECG 89

EKG/ECG Shock COPD Wellness 89