Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. The patient was in clinical shock with a lactate of 8. This confirms inferior, posterior, lateral, and RV MI RV MI often leads to shock and (systolic) hypotension. RVMI explains part of the shock. The February 11, 2020 post ( LA-RA reversal ).

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Shock EKG/ECG Academics Stroke 97

Pediatric EM Morsels

NOVEMBER 3, 2023

falciparum accounts for >70% of cases of imported malaria , primarily seen in those returning from travel in Sub-Saharan Africa (Mischlinger 2020) Other species include P. 2020 Mar 11;33(2):e00104-19. vivax , P. malariae , and the less common P. knowlesi and P. simium (Forgie 2022) P. vivax and P. vivax , P. knowlesi and P.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

Pediatric EM Morsels

JULY 21, 2023

Orso 2020] One pediatric study in this systematic review, and the intubated patients had worse outcome than non-intubated Early airway protection = lower rates of complications (in TRAUMA), but this is not always true with medical patients. 2020 Dec 10;28(1):116. Fun fact for animal lovers! BMJ Open 2021; 11: e053619. 107.498345.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

EMDocs

MARCH 4, 2025

A 2020 Cochrane review found the pooled sensitivity was 65%. Bacterial Meningitis Mimics: Other flu-like illnesses: COVID, influenza, toxic shock syndrome, myocarditis, endocarditis, spinal epidural abscess, pneumonia. Published 2020 Jun 11. A 1991 study found a sensitivity >97% and a specificity of 60%. 2020;6(6):CD012824.

Infectious Diseases 74

Infectious Diseases Seizures Poisoning Sepsis 74

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4%

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Resuscitation Fluid Resuscitation Head Injuries Shock 145

JournalFeed

MARCH 28, 2020

Here is the JournalFeed Podcast for the week of March 23-27, 2020. We cover cast vs walking boot for Achilles tendon rupture; treating toddler's fracture - boot, cast, or nothing; digital distractors for painful pediatric procedures; WEST’s c-spine clearance algorithm; and RAFF2 - drug-shock or just shock a-fib.

Shock 52

Shock Fractures Pediatrics 52

EMDocs

APRIL 6, 2024

. #1: Phoenix Criteria – New Pediatric Sepsis Score Spoon Feed The Phoenix Sepsis Score, which is a novel clinical criterion for pediatric sepsis and septic shock developed using measures of organ dysfunction, outperforms existing IPSCC criteria for the diagnosis of pediatric sepsis and septic shock. 2024 Feb 27;331(8):675-686.

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Sepsis Pediatrics Shock 94

The Trauma Pro

JUNE 18, 2024

The ABC score and the shock index are two of the more common methods. The Shock Index (SI) uses the initial vital signs to perform a quick and dirty calculation by dividing the heart rate by the systolic blood pressure. Combining the ABC score with an age-adjusted Shock Index improved the accuracy only slightly. J Pediatr Surg.

Pediatrics 113

Pediatrics Blood Transfusions Resuscitation Shock 113

PulmCCM

OCTOBER 7, 2024

Midodrine A 75-year-old woman seems to have recovered from septic shock, but each time her norepinephrine infusion is reduced from 0.05 It was reported to improve blood pressure in children with septic shock in 1979, and in the treatment of orthostatic hypotension in 1981. mcg/kg/min, her mean arterial pressure falls below 65 mm Hg.

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Shock Outcomes 98

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Assessment was severe sudden cardiogenic shock. He remained hypotensive and in shock. JAMA Cardiol [Internet] 2020;Available from: [link] 4. He was intubated and then went pulseless.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Either approach in severe sepsis with shock seems reasonable.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

EMDocs

JANUARY 23, 2024

Episode 93: BRASH syndrome Background: Brash syndrome has 5 components: bradycardia, renal failure, AV nodal blocker, shock, hyperkalemia. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. 2020 Aug;59(2):216-223. BRASH syndrome: Bradycardia, Renal failure, Av blocker, Shock, and Hyperkalemia.

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Shock Dehydration Sepsis EKG/ECG 106

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. Referring to Figure-1 — this 53-year old woman who presented in extremis with cardiogenic shock and an initial pH = 6.9, This was sent by a reader. and K was normal. Here was the ECG: There is sinus tachycardia.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

EMDocs

NOVEMBER 19, 2024

Published 2020. Low-dose lipid emulsion for pediatric vasoplegic shock due to quetiapine and fluvoxamine overdose: a case report. Psychol Res Behav Manag. 2022;15:3915-3929. Published 2019. Accessed October 23, 2023. Stiff and Twisted. Life In The Fast Lane. Accessed October 23, 2023. Movement Disorder Emergencies. Published 2022.

Poisoning 108

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 108

Ken Grauer, MD

OCTOBER 21, 2023

Subendocardial Ischemia from another Cause ( ie, sustained tachyarrhythmia; cardiac arrest; shock or profound hypotension; GI bleeding; anemia; "sick patient" , etc. ). The August 22, 2020 post in Dr. Smith's ECG Blog — which illustrates another case of dynamic ST-T wave changes that resulted from a repolarization variant.

EKG/ECG 245

EKG/ECG Shock Wellness 245

EB Medicine

NOVEMBER 17, 2020

Write us at emplify@ebmedicine.net.

Emergency Department 40

Emergency Department Shock Resuscitation CPR 40

ALiEM

MAY 29, 2023

If left untreated, it can lead to significant blood loss, shock, airway obstruction, and even death. Symptoms of massive epistaxis include sudden and heavy bleeding from the nose, difficulty breathing, dizziness, and a rapid heartbeat. For our case, this dual catheter compression technique succeeded in halting the bleed.

Blood Transfusions 98

Blood Transfusions Emergency Department Shock Hospitals 98

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

EMDocs

SEPTEMBER 7, 2024

Clinical features include abdominal or flank pain; ecchymosis to the flank, periumbilical region, proximal thighs, or scrotum; and hemorrhagic shock early in the disease course. 2020 May;13(5):545-555. Epub 2020 Mar 3. 2020 Jun;13(6):i. angioembolization). Expert Rev Hematol. doi: 10.1080/17474086.2020.1733963.

EMS 93

EMS Fluid Resuscitation Resuscitation Radiology 93

Ken Grauer, MD

FEBRUARY 28, 2023

These 2 settings are: i ) In patients with severe , often longstanding pulmonary disease ; and / or , ii ) In acutely ill patients with multi-system disease ( ie, sepsis, shock, electrolyte and/or acid-base disorders ). These cases provide insight to assessment for MAT: The January 5, 2020 post in Dr. Smith’s ECG Blog — for an example of MAT.

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

RebelEM

NOVEMBER 30, 2023

Current SSC guidelines recommend fluid resuscitation with at least 30mL/kg IV crystalloid in patients with sepsis induced hypoperfusion or septic shock within the first three hours of resuscitation, regardless of comorbidities. Published 2020 Aug 19. Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. 2020;4(5):537-541.

Sepsis 118

Sepsis Fluid Resuscitation Resuscitation Administration 118

EMDocs

OCTOBER 8, 2024

POCUS: RUSH exam (Rapid Ultrasound for Shock and Hypotension) While derived to help identify unexplained hypotension, if we accept that sinus tachycardia may be an early indicator of shock, we can utilize this general approach to help reevaluate as clinically indicated. 2020 Nov 21;41(44):4258]. Do they have edema? Eur Heart J.

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

RebelEM

JANUARY 18, 2024

septic shock) earlier antibiotics most likely makes a difference in morbidity and mortality, however earlier antibiotics in all patients who meet SIRS criteria may not be a good thing and potentially cause more harms than good. to 0.97; p = 0.02 to 2.07; p = 0.91 to 12.33; p = 0.26

Sepsis 130

Sepsis Hospitals Administration Outcomes 130

Dr. Smith's ECG Blog

AUGUST 28, 2020

Now appears to be in cardiogenic shock." However, cardiogenic shock usually takes some time to develop, so it is probably subacute." A fixed stenosis in that other artery, especially in the context of hypotension from the occlusion of the first coronary artery, can lead to ischemia and very poor LV function and worsening shock.

Shock 40

Shock EKG/ECG Wellness Outcomes 40

The Skeptics' Guide to EM

AUGUST 14, 2021

Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Circulation 2020 Guest Skeptic: Missy Carter is a PA practicing in emergency medicine in the Seattle area and an adjunct faculty member with the Tacoma Community College paramedic program.

Shock 52

Shock CPR Hyperthermia / Hypothermia EMS 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

AslangerE A 65-year-old gentleman presented to the emergency department after experiencing two recent ICD shocks in the preceding hours. The subsequent ECG, taken 5-10 minutes post-shock, depicted a soothing of ST deviation. See My Comment at the bottom of the page in the May 19, 2020 post in Dr. Smith's Blog ).

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EKG/ECG Shock Emergency Department Administration 114

The Skeptics' Guide to EM

JUNE 6, 2020

Date: June 2nd, 2020 Reference: Permpikul et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Date: June 2nd, 2020 Reference: Permpikul et al. Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Respir Crit Care Med 2019.

Sepsis 52

Sepsis Shock Resuscitation Administration 52

JournalFeed

DECEMBER 26, 2020

It’s the JournalFeed Podcast for the week of Dec 21-25, 2020. We cover the pros and cons of NSAIDs for adult fractures, the accuracy of COVID-19 antibody testing, angiotensin II for refractory shock, and a Merry Christmas song!

Fractures 52

Fractures Shock 52

JournalFeed

SEPTEMBER 5, 2020

We cover a review of acute ischemic stroke, ACP/AAFP musculoskeletal pain guidelines, antibiotics for cirrhosis with upper GI bleed, early norepinephrine for septic shock, and the best way to tape an ETT so it won’t come out. It’s the JournalFeed Podcast for the week of Aug. 31 - Sept.

Stroke 52

Stroke Shock 52

JournalFeed

OCTOBER 3, 2020

28- Oct 2, 2020. We cover the new ACEP opioid policy statement, PE response teams during COVID-19, a SMART balanced fluid trial spin-off in septic shock, an AHA statement on drug-induced arrhythmia, and use of POCUS for shoulder dislocation. It’s the JournalFeed Podcast for the week of Sept.

Dislocations 52

Dislocations Sepsis Shock 52

Taming the SRU

JANUARY 10, 2024

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. Additionally, ED boarding is a now a larger factor than in 2018.

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

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. As I review in My Comment in the January 16, 2020 post of Dr. Smith's ECG Blog ( and have reproduced in Figure-2 below ) — the ECG of patients with acute LMCA occlusion may be varied.

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EKG/ECG Shock Hospitals Sepsis 132

Ken Grauer, MD

JULY 15, 2023

Synchronized shock successfully converted the rhythm to sinus — but there was marked ST depression on the 12-lead ( Figure-2 ). Since the patient was hemodynamically stable — brief trial with Amiodarone is reasonable and was attempted, but when this did not convert the rhythm — synchronized cardioversion was applied.

EKG/ECG 195

EKG/ECG Shock EMS 195

Mind The Bleep

OCTOBER 29, 2024

Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. PMID: 31795625; PMCID: PMC6895471 Emergency Management of Severe Burns Course Manual, 18th Edition, January 2020, UK Version for The British Burn Association, Australia and New Zealand Burn Association Ltd 1996. Check temperature and blood glucose levels.

Burns 52

Burns Fluid Resuscitation PPE Hyperthermia / Hypothermia 52

EMDocs

MARCH 9, 2025

2020 Jun;8(6):e19.00202-e19.00202. Pediatric osteomyelitis treatment algorithm. 4 Adapted from: Gornitzky AL, Kim AE, ODonnell JM, Swarup I. Diagnosis and Management of Osteomyelitis in Children: A Critical Analysis Review. JBJS Reviews.

Pediatrics 52

Pediatrics EMS Infectious Diseases Fractures 52

Thinking Critical Care

JUNE 5, 2024

while the R side will deep-dive bedside hemodynamics and our 4-interface model of shock management. Day 2 – The R “Fluids and Shock Hemodynamics” 0800-0830 – Intro to the circuit & interfaces – CRAGER 0830-0900 – What is Coupling?

Shock 59

Shock Hospitals Wellness Resuscitation 59

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. J Crit Care 2020. Many of these patients are started on vasopressor and inopressor medications to assist in efforts to normalize blood pressure to help improve organ perfusion.

Resuscitation 117

Resuscitation Outcomes EMS Sepsis 117