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?

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

RebelEM

APRIL 29, 2024

The current standard of practice has moved away from landmark-based central line placement given the efficacy and safety of ultrasound-based techniques. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation. This study also showed the median time for IO placement was only 1.2 Resuscitation.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

JANUARY 10, 2024

R4 Case Follow-up: SCAD WITH dr. Martella Spontaneous Coronary Artery Dissection (SCAD) is a diagnosis confirmed via imaging: Coronary Angiography, Optical Coherence Tomography, Intravascular Ultrasound Therefore, treatment in the ED is the same as atherosclerotic ACS: ASA, heparin gtt and possible statin.

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

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 97

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 97

Taming the SRU

JUNE 24, 2024

Follow this algorithm in patients with unstable bradycardia with acute heart failure, change in mental status, or concern for shock, physicians should start with atropine, 1 mg and may be continued every 3 to 5 minutes if effective.

Advances Cardiac Life Support (ACLS) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

PulmCCM

NOVEMBER 11, 2023

Diagnosis because P ra is non-invasively transduced with ultrasound, for instance via the size and collapsibility of the inferior vena cava [1] and/or the Venous Excess Ultrasound Score [VExUS] [2-4]. If changes in P ra cause changes in CO, shouldn’t we then know the etiology of shock with certainty?

Ultrasounds 87

Ultrasounds Operations Shock 87

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 132

EKG/ECG Shock Hospitals Sepsis 132

EMDocs

NOVEMBER 4, 2023

An ultrasound of the testes reveals the following: What is the diagnosis? doi:10.1186/1757-1626-1-165 Hackett B, Sletten Z, Bridwell R E (July 03, 2020) Testicular Abscess and Ischemia Secondary to Epididymo-orchitis. J Emerg Trauma Shock. 2008;1(1):165. Published 2008 Sep 19. Cureus 12(7): e8991. doi:10.7759/cureus.8991

EMS 87

EMS Ultrasounds Emergency Department Infectious Diseases 87

ACEP Now

MAY 9, 2024

6 The increasing mortality rate led to an additional emergency regulation in 2022 requiring the consenting physician to perform the critical steps of the case, limiting surgeons to three cases per day, and mandating continuous, recorded ultrasound guidance for gluteal AFT procedures. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

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 2020 Jul 23.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation. were more likely to respond.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

ACEP Now

SEPTEMBER 3, 2024

During the legislative fight to pass the federal No Surprises Act of 2020, it was asserted that most balance billing in the U.S. 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 March 15, 2020. The New Yorker.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

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. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Dr. Smith's ECG Blog

MAY 13, 2020

This was a point of care ultrasound, not a bubble contrast echo. On echo, OMI has a wall motion abnormality, but SI usually does not. == MY Comment by K EN G RAUER, MD ( 5/13/2020 ): == It’s good to periodically review the differential diagnosis of the diffuse subendocardial ischemia. What do you think the echocardiogram shows?

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

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 November 10, 2020 post — for PTA.

EKG/ECG 65

EKG/ECG Point-of-Care Testing Wellness Shock 65

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 75

EKG/ECG EMS Shock Ultrasounds 75

Taming the SRU

AUGUST 30, 2023

Pneumonia A 2020 meta-analysis of 8 studies including 2,215 adults with confirmed community acquired pneumonia in different settings found PCT with a cutoff of 0.5 Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. 2020 Nov 20;99(47):e23315. J Med Virol. 2021; 93: 4358–4369.

Infectious Diseases 89

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

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. Only that it need not! == MY Comment by K EN G RAUER, MD ( 4/24/2020 ): == Prediction of a “culprit lesion” is an imperfect science. Diagnosis : Posterior MI, right? We intubated him.

EKG/ECG 52

EKG/ECG Shock Ultrasounds 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

ALiEM

OCTOBER 30, 2024

Clinical impact: The patient’s DVT ultrasounds were negative. Microdosing Methods Help, 2020. Evaluation for nephrotic syndrome due to viral hepatitis, endocarditis, venous thromboembolism or other cause of chronic lymphedema is reasonable. Clonidine is often added back to their regimens inpatient as their vital signs tolerate.

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

PulmCCM

SEPTEMBER 23, 2021

With the explosion of bedside ultrasound and automated methods to capture LVEF, the ejection fraction will grow in clinical prominence and affect decisions for the acutely-ill. Annals of Translational Medicine 2020, 8(12). Jon-Emile S. Download his free textbook here. Critical Care 2013, 17(2):213. Critical Care 2014, 18(2):R80.

Stroke 40

Stroke Sepsis Shock Ultrasounds 40

Intensive Blog

FEBRUARY 9, 2023

Other investigations to consider include imaging of the liver with ultrasound and computerised tomography (CT) to assess for any changes to the liver parenchyma or vasculature, such as portal vein thrombosis or Budd Chiari Syndrome (hepatic venous outflow obstruction). Disability- treat hypoglycaemia if present. Alexander, G. Hayllar, K.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

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 93

EMS Fluid Resuscitation Shock EKG/ECG 93

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 2020, 51 (1), 331-334. World Neurosurg 2020, 137 , e315-e320. J Trauma Acute Care Surg 2020, 88 (6), 875-887. IgE-mediated reactions to contrast do exist, but they are very rare.

Stroke 103

Stroke Radiology Radiology Emergency Department 103

Don't Forget the Bubbles

FEBRUARY 17, 2025

Before considering a further fluid bolus, you do a point-of-care ultrasound (POCUS). Volume resuscitation has historically been the first-line therapy for patients in septic shock. Taken together, the adult critical care community has shifted towards assessing for venous congestion at the organ level with Doppler ultrasound.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

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 73

Dehydration Fluid Resuscitation Sepsis Resuscitation 73

Mind The Bleep

JUNE 17, 2023

Azmy DJ, 2020) Diagnosis can only be made after recurrent presentations. They may present in hypovalaemic shock On examination you may feel a sausage shaped mass in the right side of the abdomen which crosses the midline. Ultrasound (USS) should be urgently requested for suspected appendicitis, or ovarian torsion. of children.

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

Mind The Bleep

JUNE 17, 2023

Azmy DJ, 2020) Diagnosis can only be made after recurrent presentations. They may present in hypovalaemic shock On examination you may feel a sausage shaped mass in the right side of the abdomen which crosses the midline. Ultrasound (USS) should be urgently requested for suspected appendicitis, or ovarian torsion. of children.

Shock 52

Shock Wellness Emergency Department Ultrasounds 52