Taming the SRU

JANUARY 10, 2024

Additionally, ED boarding is a now a larger factor than in 2018. Physicians believe the biggest factors contributing to ED violence are a lack of adequate punitive consequences toward the attacker and the absence of adequate protective mechanisms for staff. It usually takes 4-6 weeks for a coronary artery to heal from dissection.

EKG/ECG 92

EKG/ECG Shock Fractures Emergency Department 92

RebelEM

JUNE 26, 2023

J Trauma Acute Care Surg 2018. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03 Lancet Haematol 2017.

Administration 145

Administration Outcomes Resuscitation Radiology 145

RebelEM

JANUARY 29, 2024

Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. CHEST 2010.

Stroke 136

Stroke Outcomes Hospitals Administration 136

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

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. 2018, Kuttab, Lykins et al. 2018, Kuttab, Lykins et al. Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

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

EMDocs

JANUARY 16, 2024

VF/asystole), a pulse cannot be identified via Doppler ultrasound for a full minute, or if lack of organized cardiac activity is confirmed on bedside echocardiogram. This is a good time to utilize an arterial line or use the ultrasound to find a central pulse. Resuscitation 2018. doi.org/10.1016/j.resuscitation.2018.11.004

Hyperthermia / Hypothermia 85

Hyperthermia / Hypothermia Resuscitation CPR EMS 85

ACEP Now

MAY 9, 2024

1,2 You’ll also find the story of Sheila Powell, a woman who suffered a pneumothorax during her 2018 Miami BBL and whose 16-year-old daughter worried that in “just a blink of the eye, I could have lost my mom.” 6 Theoretically, ultrasound guidance should decrease this risk, which formed the basis for the 2022 Florida Medical Board regulation.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Can J of Cardiol 2018, 34: 132-145 Here are some other cases: LVH, LBBB, RBBB, and RVH may manifest ST depression without any ischemia! An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. A emergent cardiology consult can be helpful for equivocal cases. Left main? 3-vessel disease?

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

EMDocs

JULY 17, 2023

3 Point of care ultrasound (POCUS) can be highly sensitive for free fluid and pneumoperitoneum when used by a trained physician in the appropriate patient population. However, surgical consultation should not be delayed while waiting for imaging in a patient who is in shock, appears toxic, or has signs of peritonitis. -In 2018;13:36.

Operations 78

Operations EMS Fluid Resuscitation Resuscitation 78

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW. The January 30, 2018 post — for PTA.

EKG/ECG 67

EKG/ECG Wellness Point-of-Care Testing Shock 67

Taming the SRU

AUGUST 30, 2023

Notably, lung ultrasound for the diagnosis of bacterial CAP demonstrated exceptional stand-alone diagnostic accuracy in 33 studies including 4,901 adults and children in the emergency department, with a pooled sensitivity of 92% and specificity of 90%. 2018 Aug 1;10(8):a028456. Epub 2018 Oct 19. 2018 Jul 31;138(5):e78-e79.

Infectious Diseases 87

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

Dr. Smith's ECG Blog

MAY 13, 2020

This was a point of care ultrasound, not a bubble contrast echo. Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; shock/profound hypotension; GI bleeding; anemia; etc. ). What do you think the echocardiogram shows? First trop I returns at 1.5.

EKG/ECG 52

EKG/ECG EMS Shock Ultrasounds 52

Dr. Smith's ECG Blog

MAY 19, 2020

In this case, profound shock for 1 hour would result in the same degree of infarction. The Type 2 MI would then have been a result of the prolonged severe shock while in arrest. If the arrest had another etiology (such as old scar), and the ST elevation is due to severe shock, then it is a type II STEMI. Troponin I rose to 44.1

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

PulmCCM

JULY 10, 2023

A 2018 meta-analysis reviewed here suggested that prolonged infusion of antipseudomonal beta-lactams reduced mortality by 30% compared with shorter infusions, and more observational data has accumulated since that time. Many institutions have created protocols for extended infusions of beta lactam antibiotics, available online.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

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

Dr. Smith's ECG Blog

JUNE 17, 2018

I have always said that tachycardia should argue against acute MI unless there is cardiogenic shock or 2 simultaneous pathologies. My Comment, by KEN GRAUER, MD ( 6/17/2018 ): = Excellent case with insightful learning points explaining why these serial tracings are not indicative of acute inferior infarction.

EKG/ECG 52

EKG/ECG Documentation/Coding Shock Ultrasounds 52

EB Medicine

NOVEMBER 1, 2018

In total, they pulled references from 1966 until 2018. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. 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

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). J Hematol 2018; 93: 363-370 Rubin LG, Schaffner W. Macharia AW et al.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

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.) Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis. Lobo et al. The SCAD cases in Lobo et al.

EKG/ECG 52

EKG/ECG Wellness Shock Ultrasounds 52

Dr. Smith's ECG Blog

AUGUST 3, 2018

Here was his prehospital ECG, which I viewed immediately while the resident performed cardiac ultrasound: What do you think? Here is the cardiac ultrasound which the resident performed as I viewed the ECG: This shows a huge pericardial effusion. However, he was in shock and we had to take the risk of cardioversion. Is is sinus?

EKG/ECG 40

EKG/ECG Ultrasounds Stroke Shock 40

Dr. Smith's ECG Blog

MARCH 15, 2023

Her bedside cardiac ultrasound was normal We decided to cardiovert her since the time of onset was very recent. We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion. But when you see this, you should suspect that the AV node is not well.

EKG/ECG 52

EKG/ECG Dehydration Stroke Wellness 52

EB Medicine

SEPTEMBER 1, 2018

I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. First are pregnant patients.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EB Medicine

AUGUST 6, 2019

But next we should talk about ultrasound. Jeff: That is simply shocking! Nachi: Next up is recombinant coagulation factor Xa (brand name Andexxa), which was approved in 2018 for the FXa inhibitors. Jeff: Interestingly, though only a small retrospective study of 156 patients, one study found markedly reduced mortality, 4.9%

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

EMDocs

JANUARY 20, 2024

Bedside ultrasound shows hypokinesis of the basal portion of the left ventricle with an apparent sigmoid-shaped septum and a dilated inferior vena cava. Symptoms of heart failure and cardiogenic shock may develop in more severe cases. The oral mucosa is moist. Serum troponin and B-type natriuretic peptide are elevated.

EMS 75

EMS Fluid Resuscitation Shock EKG/ECG 75

EMDocs

JANUARY 6, 2024

A bedside cardiac ultrasound is performed which shows biventricular failure with a dilated inferior vena cava. 10 Dysrhythmias (more commonly ventricular), chest pain, dyspnea, acute CHF and shock are all possible. 10 Dysrhythmias (more commonly ventricular), chest pain, dyspnea, acute CHF and shock are all possible.

EMS 64

EMS Infectious Diseases Shock Emergency Department 64

EB Medicine

AUGUST 1, 2018

I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the August 2018 issue of Emergency Medicine Practice. 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.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

A bedside cardiac ultrasound revealed grossly normal to hyperdynamic systolic function with no obvious areas of wall motion abnormalities. Heart Rhythm 2018. Implantable Cardioverter-Defibrillator ), with long-term potential for device-related complications from the ICD, including inappropriate shocks? y (3 of 88, 43.6 ± 37.4

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

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. Stroke 2018, 49 (10), 2323-2329. Stroke 2018, 49 (3), e46-e99. Spine (Phila Pa 1976) 2018, 43 (9), E520-e524. J Stroke Cerebrovasc Dis 2018, 27 (4), 1077-1084. DOI: 10.1161/strokeaha.118.023173

Stroke 87

Stroke Radiology Radiology Emergency Department 87

EMDocs

OCTOBER 29, 2024

A 43-year-old male with a history of mitral valve regurgitation s/p valvular replacement, hypertension, hyperlipidemia was evaluated in the ED for septic shock secondary to a pyelonephritis with a renal abscess. This series provides evidence-based updates to previous posts so you can stay current with what you need to know.

Shock 87

Shock EMS Sepsis Resuscitation 87