RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . 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.

Sepsis 132

Sepsis Hospitals Administration Outcomes 132

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? 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.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. 6 What Can I Do Outside of Repeated Shocks and Standard ACLS? amiodarone or lidocaine).

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Acute Crit Care.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

EMDocs

MARCH 9, 2025

Well keep it short, while you keep that EM brain sharp. 2020 Jun;8(6):e19.00202-e19.00202. Infectious disease expertise is useful as the optimum duration of treatment is not well established. A 2-year-old female with a past medical history of failure to thrive presents to the ED with her mother for evaluation of right arm pain.

Pediatrics 52

Pediatrics EMS Infectious Diseases Fractures 52

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

Thinking Critical Care

JUNE 5, 2024

while the R side will deep-dive bedside hemodynamics and our 4-interface model of shock management. Bookmark this page as the registration link (november 1) will appear as well as developing programme information! So the most important thing for you to do is to mark your calendars and make sure you don’t miss being a part of it!

Shock 59

Shock Hospitals Wellness Resuscitation 59

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. Bektas, Firat, and Secgin Soyuncu. The efficacy of transcutaneous cardiac pacing in ED.”

Advances Cardiac Life Support (ACLS) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC? Reference: Grunau et al.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

EMDocs

NOVEMBER 1, 2023

ECG – May show tachycardia or rate related ST depressions Laboratory evaluation: CBC w/ differential – may reveal leukocytosis with left shift CMP, Lipase – can reveal alternative intra-abdominal diagnoses as well as show findings of end-organ hypoperfusion (elevated serum creatinine, transaminitis, etc.) McGraw-Hill Education; 2020.

Operations 93

Operations Radiology Radiology Fluid Resuscitation 93

RebelEM

APRIL 29, 2024

Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation. Resuscitation. 2012 PMID: 21893125. 9 Zhang W et al. Intravenous vs intraosseous adrenaline administration in cardiac arrest: A protocol for systematic review and meta-analysis. Medicine (Baltimore). PMID: 33350794 10 Meilandt C. Resusc Plus.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. 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. Eur J Heart Fail 22, 584–603 (2020).

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

RebelEM

DECEMBER 19, 2022

This procedure involves applying another set of pads attached to a second defibrillator to a patient and shocking them in hopes of terminating the rhythm. That write up was for the DOSE-VF pilot trial done in March 2020 and can be found here. Now that same group has published the results of their full randomized control trial.

EMS 52

EMS CPR Shock Resuscitation 52

Don't Forget the Bubbles

JUNE 26, 2023

But, they may present postnatally with cyanosis/hypoxaemia due to insufficient pulmonary blood flow, cardiogenic shock due to insufficient systemic blood flow, or both. Resistance provided by this pathway will have a marked bearing on how well-balanced the circulation is – it is the primary determinant of PVR. 2014;129(20):2013-2020.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

ALiEM

OCTOBER 30, 2024

The Wounds Common among patients who use xylazine, the necrotic and exudative wounds are still not fully understood [5-8], but are likely due in part to direct cytotoxic effects of the drug and its impurities, as well as possible nutritional deficiencies common in those with dependence. Microdosing Methods Help, 2020. J Addict Med.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

PulmCCM

NOVEMBER 27, 2023

Beta-blockers for septic shock (STRESS-L trial) Septic shock deranges multiple complex signaling systems in the body. A meta-analysis of 7 randomized trials (n=503) previously suggested that co-administration of esmolol to blunt vasopressor-induced tachycardia and arrhythmias could reduce mortality in septic shock by one-third.

Sepsis 52

Sepsis Shock Administration Leadership 52

The Skeptics' Guide to EM

FEBRUARY 25, 2023

He is found to be in hypoxic respiratory failure and septic shock. 4] This association seems to hold true in the pediatric literature as well. [5-6] 4] This association seems to hold true in the pediatric literature as well. [5-6] Parents note that he has been progressively more tired and difficult to arouse.

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

Mind The Bleep

JULY 15, 2023

As well as synthesising more albumin, the liver also increases its production of LDL and VDL and lipoprotein which causes hypercholesterolaemia and hypertriglyceridaemia. Moroni G, 2020) Congenital nephrotic syndrome is extremely rare and presents within 3 months of birth. Paediatric Nephrology , 1409-1418. Daehn IS, D. Goyal S, D.

Allergic Reactions 52

Allergic Reactions Shock Hospitals Wellness 52

Dr. Smith's ECG Blog

JANUARY 8, 2024

Since that moment, she had had shortness of breath as well as pressure-like chest pain. Patient was given aspirin, sublingual nitro as well as heparin. She had been sitting doing work when she experienced "waves of chest tightness". Any kind of exertion made the shortness of breath considerably worse.

EKG/ECG 71

EKG/ECG Resuscitation Hospitals EMS 71

Dr. Smith's ECG Blog

JULY 3, 2020

She had multiple rib fractures as well as serious hemorrhage and underwent massive transfusion. It presents on the ECG as a long ST segment with resultant long QT == MY Comment by K EN G RAUER, MD ( 7/3/2020 ): == The patient in today’s case is a middle-aged woman who was brought to the ED following a motor vehicle accident.

Blood Transfusions 52

Blood Transfusions EKG/ECG Shock Fractures 52

Dr. Smith's ECG Blog

DECEMBER 10, 2022

Seen together, these 2 ECG findings suggest possible RVH ( For review on "My Take" for the ECG diagnosis of RVH — Please see My Comment at the bottom of the page in the March 6, 2022 post and in the September 1, 2020 post of Dr. Smith's ECG Blog ).

EKG/ECG 52

EKG/ECG Operations Shock EMS 52

Dr. Smith's ECG Blog

OCTOBER 28, 2022

I believed this met modified Sgarbossa in II, III and aVF with excessive discordance as well as reciprocal in aVL. He went into cardiogenic shock and is intubated in the cardiac ICU. That said — I favor beginning with a qualitative approach , which has served me well over a period of decades.

EKG/ECG 52

EKG/ECG EMS Shock Wellness 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

Because of the tachcardia, I would expect her to be very poor left ventricular function and maybe Cardiogenic shock. It looks like he has an old anterior lateral MI as well. Still Irregular Blood pressure during these rhythms was adequate; there was no shock. It does not show RBBB but does show Left anterior fascicular block.

EKG/ECG 52

EKG/ECG Shock Stroke Seizures 52

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. 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 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

ALiEM

JULY 17, 2023

as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4]. Match Data The unprecedented numbers of unfilled PGY-1 EM residency training positions in the NRMP Match results shocked the specialty these last two years. However, the decrease in applicants to EM programs may not be the whole story.

EMS 52

EMS Burns Emergency Department Shock 52

Dr. Smith's ECG Blog

JUNE 1, 2020

== MY Comment by K EN G RAUER, MD ( 6/1 /2020 ): == YOU are asked to interpret the ECG shown in Figure-1. When PMVT is associated with a long QT interval — the rhythm is then defined as Torsades de Pointes ( Please SEE My Comment at the bottom of the April 29, 2020 post in Dr. Smith’s ECG Blog ). Figure-1: The initial ECG in the ED.

EKG/ECG 52

EKG/ECG Resuscitation Shock Outcomes 52

Dr. Smith's ECG Blog

APRIL 8, 2022

You must be the one who knows the ECG and indications for angiography, and who knows it well enough to be confident to push for angiography. 21, 2020 post — Optimal Use of Lead aVL for predicting the "culprit" artery ). 21, 2020 post — Optimal Use of Lead aVL for predicting the "culprit" artery ).

EKG/ECG 52

EKG/ECG Outcomes Wellness Shock 52

PulmCCM

JANUARY 2, 2022

.” -Julia Child Background Early observational studies and the RECOVERY collaborative group initially demonstrated the benefit of corticosteroid therapy in oxygen-requiring, COVID-19-patients; additional randomized studies as well as a meta-analysis of these reports corroborated this. invasive mechanical ventilation. versus 27.1%

Outcomes 40

Outcomes Hospitals Shock Wellness 40

Dr. Smith's ECG Blog

JANUARY 5, 2020

Thus, both overdiagnosis and underdiagnosis of AF are well-recognized problems in computer interpreted electrocardiograms, and they adversely affect patient management with either inappropriate anticoagulation and/or antidysrhythmics or undertreatment [ 1 , 14 ]. Poon et al. sensitivity and 98.9%

EKG/ECG 52

EKG/ECG COPD Wellness Sepsis 52

Mind The Bleep

APRIL 20, 2024

Cyanosis can be peripheral, central or both and it can be seen in cases of shock and cyanotic congenital heart disease. [see Figure 2] Colour: Observe for any cyanosis, pallor, or mottling Cyanosis is when there is a blue discolouration of the skin and mucous membranes either due to poor circulation or poor oxygenation of the blood.

Shock 52

Shock Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. There appears to be some ST elevation in leads II and aVF, as well as to a lesser extent in the lateral chest leads. Thus, there is diffuse low voltage.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

Tachycardia is unusual in ACS unless there is cardiogenic shock or a second simultaneous pathology. There is an acute R V “ S train” p attern with ST depression/T wave inversion in both inferior and anterior leads ( Note dramatic ST-T wave changes in II, III and aVF — as well as V3,V4 ).

EKG/ECG 52

EKG/ECG COPD Documentation/Coding Shock 52

Dr. Smith's ECG Blog

JULY 12, 2020

I found a well appearing young lady in the room with her parents who witnessed the event. Why did she go from stable to shock in seconds? In contrast, in ECG #5 ( done when the patient felt well ) normal sinus rhythm is seen, because the P wave is clearly upright in lead II, and the PR interval is normal.

EKG/ECG 40

EKG/ECG Hospitals Ultrasounds Wellness 40

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

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Figure B At this point, with the ECG changing from diffuse ST depression to widespread ST elevation and the patient presenting in cardiogenic shock, left main coronary artery (LMCA) occlusion is the likely diagnosis. Complete LMCA occlusion is associated with clinical shock and/or cardiac arrest. This is an ominous sign.

EKG/ECG 128

EKG/ECG Shock Emergency Department Ambulance Services 128

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