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. Another approach is sympathetic chain (stellate ganglion) blockade if you have the skills to do it: it requires some expertise and ultrasound guidance. RCA — 100% proximal occlussion.

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

RebelEM

JUNE 26, 2023

J Trauma Acute Care Surg 2019. 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

Administration 145

Administration Outcomes Resuscitation Radiology 145

EMDocs

APRIL 22, 2024

Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. Multiorgan POCUS The diagnostic power of POCUS often resides in combining multiple ultrasound exams. 1-3 As many as 25% of acute PE cases present as sudden cardiac death.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 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. 2019, Bauer, Gerlach et al. 2019, Evans, Rhodes et al. 2019, Evans, Rhodes et al. N Engl J Med. 2023;388(6):499-510.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

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. doi.org/10.1016/j.resuscitation.2018.11.004

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

She arrives in the emergency department (ED) with decreased level of consciousness and shock. Her point-of-care ultrasound (POCUS) shows appropriate-appearing global ejection fraction and no marked wall motion abnormalities. Lemke et al 2019 published a multicentre RCT done in the Netherlands looking at patients without ST se.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

ACEP Now

MAY 9, 2024

Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation. 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 Shock 52

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. He was shocked when the hospital CEO took him up on it, but a year later, volumes increased 30 percent with his emphasis on quality rather than cost-cutting. Published September 5, 2019. Published July 22, 2019.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Am J Med 2019, 132(5):622-630. An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g., A emergent cardiology consult can be helpful for equivocal cases. Left main?

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Taming the SRU

AUGUST 30, 2023

The 2019 Journal of Arthroplasty practice guidelines to screen for periprosthetic joint infections recommend using ESR at 30mm/hr and CRP at 10mg/L, citing pooled sensitivities and specificities ranging from 75%-86% and 70-72.3%, respectively, for ESR and 88% and 73-74%, respectively, for CRP [32]. 2019 Feb;34(2S):S187-S195.

Infectious Diseases 89

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 89

Taming the SRU

OCTOBER 1, 2023

Possibly more useful in trauma patients during e-FAST to determine presence or absence of PTX and less helpful in spontaneous PTX where management is partially based on size, which is difficult to quantify on ultrasound and may be falsely positive in the setting of emphysematous blebs. J Emerg Trauma Shock. Published 2019 Dec 3.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

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 September 22, 2019 post — intermittent ST-T wave artifact.

EKG/ECG 64

EKG/ECG Point-of-Care Testing Wellness Shock 64

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

PulmCCM

JULY 10, 2023

In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours). However, the practice has not been supported by randomized trials.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram. As for the ECG, it could represent OMI, but RBBB is also a clue that it may be PE. There is sinus tachycardia at ~100/minute.

EKG/ECG 73

EKG/ECG EMS Shock Ultrasounds 73

Dr. Smith's ECG Blog

OCTOBER 7, 2019

When the physicians approached him, he was ashen, diaphoretic, and appeared in shock. Why is the patient in shock? He was in profound cardiogenic shock. Although the shock is no doubt partly a result of poor pump function, with low stroke volume, especially of the RV, it should be compensated for by tachycardia.

Seizures 40

Seizures EKG/ECG Shock EMS 40

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock. JACC 2019 Sep 10;74(10):1290-1300. Type 2 is more difficult to appreciate on angiography than type 1. Lobo et al.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

Dr. Smith's ECG Blog

APRIL 24, 2020

Just prior to transport, the patient became confused and agitated and, although blood pressure and pulse were OK, I was worried about cardiogenic shock. Diagnosis : Posterior MI, right? We intubated him. Cath lab The BP was 70/40 on arrival to the cath lab and received a balloon pump and norepinephrine.

EKG/ECG 52

EKG/ECG Shock Ultrasounds 52

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 Shock 52

Downeast Emergency Medicine

APRIL 26, 2021

Lancet 2019; Vol 394, Iss 10210, P 1713-1723[ Full Text ]. When looking at the subgroups with severe shock, there was an 18.5% When stratifying TXA administration time after injury and qualifying shock incidence, there appeared to be a lower 30 d mortality if TXA was given within 1 hour of the incident. MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

EB Medicine

JULY 8, 2019

I’m Jeff Nusbaum and I’m back with Nachi Gupta for the 30 th episode of EMplify and the first Post-Ponte Vedra Episode of 2019. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. Jeff: Next up is ultrasound. I hope everybody enjoyed a fantastic conference.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Dr. Smith's ECG Blog

JULY 12, 2020

So I immediately left the room to get an ultrasound machine. While calling for some help and arranging to have her transported to our critical care zone, I got this quick ultrasound which confirmed my suspicion: This quick view was all I was able to obtain in the circumstances. Why did she go from stable to shock in seconds?

EKG/ECG 40

EKG/ECG Hospitals Ultrasounds Wellness 40

EB Medicine

AUGUST 1, 2018

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. Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 million, and cocaine at 1.9

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 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 101

EMS Fluid Resuscitation Shock EKG/ECG 101

EMDocs

JULY 15, 2023

A lower extremity radiograph does not reveal any gas formation and an ultrasound of the lower extremity is negative for DVT or cobblestoning, WBC is within normal limits and there are mild elevations in ESR and CRP. No fungal infections are identified on the feet. Given the patient’s comorbidities laboratory and imaging studies are ordered.

EMS 92

EMS Infectious Diseases Shock Ultrasounds 92

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. Annals of Noninvasive Electrocardiology 2019. 8, 2019 ) — ( Jan. 30, 2019 ) — many others. This was recorded about 30 minutes later: Same A previous ECG was obtained and was normal.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

EB Medicine

JANUARY 2, 2019

Jeff: With that, let’s get into the first episode of 2019 – the topic this month is first trimester pregnancy emergencies: recognition and management. So to get us all on the same page, the discriminatory zone is the b-HCG at which an IUP is expected to be seen on ultrasound. Generally 1500 is used as the cutoff.

Ultrasounds 40

Ultrasounds Radiology Radiology Infectious Diseases 40

Mind The Bleep

JUNE 17, 2023

Leung AKC, 2019) Parents may say the urine is offensive smelling In older children they may complain of urinary symptoms + fever and suprapubic pain By the age of 16 years, 11.3% Leung AKC, 2019) There may be generalised abdominal tenderness or tenderness localised to the suprapubic region. of girls and 3.6% Paediatric Appendicitis.

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

EMDocs

NOVEMBER 13, 2023

2019) argue against a minimum NIHSS score to trigger the use of CTA, instead purporting that clinical suspicion of acute ischemic stroke presenting within 24 hours of the last known well was sufficient evidence to order the study. However, IgE-mediated or not, anaphylactic shock is possible in either case. Stroke 2019, 50 (2), 365-372.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Mind The Bleep

JUNE 17, 2023

Leung AKC, 2019) Parents may say the urine is offensive smelling In older children they may complain of urinary symptoms + fever and suprapubic pain By the age of 16 years, 11.3% Leung AKC, 2019) There may be generalised abdominal tenderness or tenderness localised to the suprapubic region. of girls and 3.6% Paediatric Appendicitis.

Shock 52

Shock Wellness Emergency Department Ultrasounds 52

EMDocs

JANUARY 20, 2025

Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. 13 While there is good data that early antibiotics for patients in septic shock reduce mortality 18-19 the role of early and aggressive volume resuscitation and its impacts on patient-centered outcomes remain unclear. Inwald et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

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). 2019, 3 rd edition. coli and Staphylococcus aureus.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126