Dr. Smith's ECG Blog

OCTOBER 20, 2024

sepsis, anemia, hypoxemia, severe hypotension etc., Figure-1: Reasons for the varied ECG presentation of acute LMain occlusion — excerpted from Dr. Smith’s 8/9/2019 post ( This Table from My Comment in the January 16, 2020 post ). The patient was given aspirin and heparin. There is now some flow in the LMCA!

EKG/ECG 131

EKG/ECG Shock Emergency Department Ambulance Services 131

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. “Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. RR 28, SpO2 89% on 6L NC. link] j.ajog.2016.03.012

EMS 107

EMS Resuscitation Blood Transfusions Seizures 107

The Skeptics' Guide to EM

SEPTEMBER 28, 2019

Date: September 11th, 2019 Reference: Putzu et al. Date: September 11th, 2019 Reference: Putzu et al. But you remember seeing in the news there was a study claiming vitamin C could cure sepsis. This was because of a well-known critical care physician Dr. Paul Marik. Critical Care Medicine. Critical Care Medicine.

Sepsis 52

Sepsis Shock Outcomes Stroke 52

Dr. Smith's ECG Blog

JULY 21, 2024

The stay in the cardiac intensive care unit (CICU) was further complicated by sepsis, delirium, GI bleeding, and anuric renal failure with need for renal replacement therapy. Unfortunately, he required re-intubation a few days later due to respiratory distress from severe bilateral pneumonia. What About Procainamide?

EKG/ECG 134

EKG/ECG Shock Hospitals Sepsis 134

EMDocs

AUGUST 22, 2023

Capnography has several novel uses in other disease states commonly seen in the ED such as trauma, DKA, sepsis and obstructive lung disease. In cardiac arrest, EtCO 2 is dependent on compressions AND the underlying cause. Other organ system involvement & hypotension/low perfusion affect EtCO 2. Ann Emerg Med. 2017;70(5):758.

Emergency Department 79

Emergency Department Blood Transfusions Resuscitation Sepsis 79

Taming the SRU

MARCH 30, 2023

10.1186/s13613-020-00658-8 P: A total of 761 patients from two separate cohorts found to have septic shock I: Diastolic shock index C: Comparison to a variety of well adopted markers of morbidity and mortality, including systolic shock index, SOFA score, APACHE II score, lactate, etc. Ann Intensive Care 2020;10(1):41. decreased DSI values).

Shock 52

Shock Outcomes Sepsis Resuscitation 52

EMDocs

OCTOBER 8, 2024

The full differential diagnosis of sinus tachycardia in isolation is extensive ranging from benign etiologies such as anxiety to severely life threatening etiologies such as sepsis. Tachycardia may be present both from many medications or drugs, as well as withdrawal. The Mental Model: A mental model for sinus tachycardia can assist.

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Shock Emergency Department Pediatrics EKG/ECG 103

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. This sort of sepsis would produce many of the common autopsy findings. What do we know about SIDS and how effective back sleep is at reducing it?

CDC 96

CDC Sepsis Research Pediatrics 96

Emergency Medicine Ireland

JULY 3, 2023

Type 5 is the big bucket where they put all the left over disease that cause both kidney and heart failure eg things like amyloid, or sepsis or cirrhosis. There are of course much more complex neurohumoral, inflammatory type cytokiney thingies going on but as you can tell they are well over my head so I’ve skipped them for now.

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

Taming the SRU

AUGUST 27, 2024

This differential is broad and reflects the clinical diversity of their presentations - in this post we will parse through the specifics of bullous lesions as well as what there is to do for them acutely. Bacteremia and sepsis occur in 30-50% of patients, with a 3-4x increase in mortality rates. J Am Acad Dermatol 2019; 81:686.

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

Emergency Medicine Ireland

DECEMBER 3, 2020

All that being said it’s worth being aware that there are some major pieces of guidance out there and you would do well to have a passing correspondence with them. 2019 Feb;38(1):48-79. I would highly recommend attending an excellent lecture given by your ICU dietician which is just possibly where this entire summary came from.

Burns 52

Burns Sepsis EMS Wellness 52

The Skeptics' Guide to EM

DECEMBER 11, 2021

Back in 2019 we were talking about Vitamin C for sepsis ( SGEM#268 ). There have been at least two randomized control trials published that do not support the use of Vitamin C in sepsis. It was Dr. Paul Marik who has been a big advocate for Vitamin C sepsis. Not much has changed over the last two years.

Sepsis 40

Sepsis Shock Outcomes Research 40

The Skeptics' Guide to EM

FEBRUARY 2, 2019

Date: January 28th, 2019 Reference: Chu DK et al. Date: January 28th, 2019 Reference: Chu DK et al. Their workup reveals a multifocal pneumonia with signs of sepsis. This study expands upon that investigation to patients with other conditions as well. The Lancet 2018. This is Bob’s ninth visit to the SGEM.

Poisoning 52

Poisoning Administration Hospitals Outcomes 52

EMDocs

JULY 26, 2023

Updated October 8, 2019. McGraw-Hill; 2019. Mother states that the rash started as flat spots but then became raised bumps. The patient has been itching at the rash. He is otherwise normally healthy and was born at term with an uncomplicated birth history. 3 Incubation period is about 12 days (range 7-19 days). 2020;12(2):138.

CDC 80

CDC Research Pediatrics Wellness 80

Emergency Medicine Ireland

OCTOBER 30, 2023

Well, that time has come and it’s time to run through vasopressin. As such vasopresin exhibits the same ADH effects but this maxes out at very low doses, much lower than what we use in sepsis. Well this is where the fun beings. Nagendran 2019 in CCM. Intens Care Med 45 , 844–855 (2019). How does it work?

Shock 52

Shock Sepsis Wellness Outcomes 52

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. 2019 Nov 1;179(11):1528-1536. Twice-Daily Oral Zinc in the Treatment of Patients With Coronavirus Disease 2019: A Randomized Double-Blind Controlled Trial. N Engl J Med. 2023 Jan 21. doi: 10.1056/NEJMoa2212663. Epub ahead of print. doi: 10.1503/cmaj.091974.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

Don't Forget the Bubbles

JULY 22, 2024

Using a score that’s not used in clinical practice may seem like it reduces the applicability of the findings, but ultimately, the authors have translated the studies to the well-established PRAM score. References BTS_SIGN Guideline for the management of asthma 2019.pdf. 2019 Aug;9(8):e028511.

Outcomes 105

Outcomes Research Pediatrics Hospitals 105

PulmCCM

APRIL 8, 2024

Read in Journal of Palliative Medicine New-onset atrial fibrillation provoked by sepsis: anticoagulate or not? Your elderly patient with sepsis develops new-onset atrial fibrillation that spontaneously converts to normal sinus rhythm. If so, maybe we should allow more patients to experience it.

Sepsis 40

Sepsis Stroke Hospitals Wellness 40

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability.

Outcomes 81

Outcomes Hospitals Operations Shock 81

Taming the SRU

JULY 21, 2023

In infants, this can represent a medical emergency as it can quickly lead to orbital cellulitis and sepsis. Patients will often have objective visual acuity impairment as well as a fever or leukocytosis. Corneal ulcers are most frequently caused by Pseudomonas (especially if they wear contact lens), as well as S. Dacryocystitis.

Emergency Department 87

Emergency Department EMS Burns Wellness 87

Ken Grauer, MD

OCTOBER 10, 2024

This is not to say that sinus tachycardia will never go faster than 170/minute — but rather to suggest that when the rate of the regular SVT rhythm you are assessing is well over this rate range — then the rhythm is less likely to be sinus tachycardia. Today's C ASE C ontinues: The patient was treated for sepsis. What has happened?

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EKG/ECG Sepsis Wellness 420

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Am J Med 2019, 132(5):622-630. Now there is a paper published in 2019 that proves the point beyond doubt, though makes it clear that this pattern is associated with very high mortality. American Journal of Medicine 132(5):622-630; May 2019. J Electrocardiol 2013;46:240-8 2. Harhash AA, Huang JJ, Reddy S, et al.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

PulmCCM

NOVEMBER 11, 2021

Notably, they observed that while phenylephrine rectified hypotension, it significantly reduced heart rate [HR], SV – and, therefore, total cardiac output [CO] – as well as cerebral oxygenation [SctO2]. evaluated phenylephrine in 7 critically-ill patients with ‘hyperdynamic’ sepsis [defined as sepsis with CO above 6.0

Stroke 40

Stroke Sepsis Administration Wellness 40

Dr. Smith's ECG Blog

APRIL 15, 2019

Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. QTc was 374, and the formula value was quite high, consistent with LAD occlusion. It is prudent to treat the other conditions, get the heart rate controlled, and repeat the ECG.

EKG/ECG 40

EKG/ECG Sepsis Documentation/Coding Shock 40

Northwestern EM Blog

MAY 16, 2022

The above study was well summarized and bears repeating that, in this multicenter randomized study assessing CT vs POCUS vs radiology performed US in patients with suspected renal colic in the ED setting, initial US reduced radiation exposure without adversely affecting patient-centered outcomes. J Urol 2019. Thanks again toDr.’s

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

RebelEM

MARCH 27, 2023

2019 Aug; PMID: 30954692 Clinical Question: What is the impact of system factors in the implementation of standard-of-care LPV in critically ill ED patients admitted to the ICU? 4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. Paper: Owyang CG, et al. J Crit Care.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Don't Forget the Bubbles

JULY 5, 2023

SCD, therefore, is not only a mechanical disease but there are also many other cellular and plasma factors as well as endothelial interaction that generate chronic inflammation. Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis.

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Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

JUNE 30, 2023

You will be running the show today, and you want to use your preparation time well. Importantly, there were no differences between the groups regarding complications, including acute respiratory distress syndrome, multiple organ failure, venous thromboembolism, sepsis, and transfusion-related complications. 2019 Aug;31(4):683-687.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. 3) Farkas J.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. A 2019 French multi-center prospective RCT involving 370 ED patients published in Annals of Emergency Medicine similarly found no difference in antibiotic exposure between PCT-guided versus usual care groups [50].

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

Don't Forget the Bubbles

JULY 17, 2023

Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. Prenatal opioid exposure and well-child care in the first 2 years of life: population-based cohort study. 2023 Jun 14;46:8-23 One-year survival and outcomes of infants born at 22 and 23 weeks of gestation in Sweden 2004-2007, 2014-2016 and 2017-2019.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

EM Updates

JUNE 15, 2021

had DNR/DNI orders), 5 patients were transferred from an outside institution, and 6 were determined not to have COVID-19; these 21 patients were excluded from this analysis, as well as a single patient who at the time of this writing was still in ICU after over two months of mechanical ventilation and ECMO, leaving a cohort of 68 patients.

Emergency Department 52

Emergency Department Hospitals Outcomes Wellness 52

Don't Forget the Bubbles

MAY 31, 2023

The DIMPLES study by PERUKI sought to investigate the incidence of new-onset diabetes in the paediatric population across the UK and Ireland, as well as the characteristics of these ED presentations, and to determine if SARS-CoV2 infection was involved. Which patients were involved? How good was this paper? Do you believe the results?

Emergency Department 135

Emergency Department Research Documentation/Coding Outcomes 135

Don't Forget the Bubbles

MAY 15, 2023

Previously well child? “ Pregnancy was uncomplicated and he was well after birth. Physical examination: Joey is well-grown. It usually affects children between 18 months and five years old, who are otherwise well with average growth, development and physical exam. Pregnancy was uncomplicated, and he was well after birth.

Wellness 103

Wellness Seizures Hospitals Dehydration 103

EMDocs

JULY 15, 2023

sepsis), immunocompromised patients, IV drug users, patients with prosthetic heart valves or any intravascular device Clinical features may not abe enough to differentiate erysipelas from cellulitis, and in such cases the treatment should be targeted towards cellulitis Labs No laboratory evaluation is required for the diagnosis of erysipelas.

EMS 76

EMS Infectious Diseases Shock Ultrasounds 76

Taming the SRU

MAY 5, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. 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. 2019, Bauer, Gerlach et al. 2019, Evans, Rhodes et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Don't Forget the Bubbles

AUGUST 21, 2023

The baby’s parents tell you that the baby hasn’t been feeding well for a few days and today has been very sleepy. Infection/sepsis? The ED team helpfully did a gas while you headed down to review, and as you scan the numbers, you see that the baby has a severe mixed respiratory/lactic acidosis. What are your differentials?

Pediatrics 98

Pediatrics Outcomes Research Sepsis 98