Dr. Smith's ECG Blog

MAY 26, 2023

A 20-something presented after a huge verapamil overdose in cardiogenic shock. He was admitted to the ICU and was unstable, in shock, overnight. Today's patient is a young male who presented in cardiogenic shock following a massive verapamil overdose. The initial K was 3.0 mEq/L and ionized calcium was 5.5 What is going on here?

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Shock EKG/ECG Documentation/Coding Resuscitation 98

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 November 27, 2021 post ( LA-RA reversal ).

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Shock EKG/ECG Academics Stroke 97

EMDocs

NOVEMBER 19, 2024

of exposures reported to poison control centers in 2021 were related to antipsychotics or sedative-hypnotics with the majority of those exposures occurring in patients 20 years of age or older. 2021 Annual Report of the National Poison Data System © (NPDS) from America’s Poison Centers: 39th Annual Report. Front Psychiatry.

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Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

Pediatric EM Morsels

MARCH 17, 2023

In the US, the venomous snakes include rattlesnakes , copperheads, cottonmouths/water moccasins , and coral snakes [ CDC, 2021 ] Rattlesnakes live all across the United State s Copperheads inhabit the eastern U.S. If you are managing a snake bite from a snake that does not typically reside in the U.S.,

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CDC Poisoning Pediatrics Shock 130

RebelEM

FEBRUARY 19, 2024

Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. The 2021 Surviving Sepsis Campaign Guidelines suggest starting vasopressors peripherally rather than delaying infusion until a CVC is placed [2]. Crit Care Med 2021. CHEST 2024.

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Administration Sepsis EMS Shock 137

Pediatric EM Morsels

NOVEMBER 3, 2023

Travel Medicine and Infectious Disease 44 (2021) 102196. falciparum parasitemia , and no other defined cause of AMS (WHO 2023). falciparum parasitemia , and no other defined cause of AMS (WHO 2023). PMID: 36209409 Comelli A, Guarner ME, Tomasoni LR, Zamboni AF, Pavo BM, Zanotti P, Caligaris S, Matteeli A, Soriano-Arandes A, Castelli F.

Seizures 281

Seizures Pediatrics CDC Infectious Diseases 281

ED ECMO

JANUARY 1, 2021

January 1, 2021: The year following COVID19 Global Pandemic brings us a new horizon – lets appreciate what has happened, learn from our mistakes and begin to look forward. Amazing patient who had an Iliac pseudo-aneurysm causing hemorrhagic shock through the urinary tract, resuscitated using REBOA.

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Shock Resuscitation Radiology Radiology 52

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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Northwestern EM Blog

DECEMBER 27, 2021

Congratulations to all of the authors with the most popular posts of 2021! Marc Sala, summarize the current literature on the peripheral infusion of vasopressors, which is becoming more and more commonplace as the evidence evolves to support earlier initiation of pressors and more judicious use of crystalloid for many forms of shock.

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Dislocations Emergency Department Burns Shock 52

JournalFeed

FEBRUARY 20, 2021

It’s the JournalFeed Podcast for the week of Feb 15-19, 2021. We cover the longstanding controversy around epinephrine for arrest, esmolol for septic shock, TXA for TBI, TXA for SAH, and ECG abnormalities in COVID-19.

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Shock EKG/ECG 52

RebelEM

SEPTEMBER 27, 2023

While ACLS will recommend shocking these patients, as with everything else in medicine, clinical context is essential. Mohan 2021 ) Recall that the subsequently alkalemia will shift potassium intracellular. 2021 Sep;61(3):259-264. Epub 2021 Jun 17. As a result, it is essential to replete potassium simultaneously.

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Poisoning Seizures Administration EKG/ECG 105

Don't Forget the Bubbles

MARCH 31, 2025

The primary outcome was to evaluate the impact of % FO in paediatric patients with sepsis or septic shock at any time after PICU admission. 41% of patients with septic shock had MODS. Reviewed by Dr Sadia Irshad Article 3: Updates on the management of sepsis and shock Long B, Gottlieb M. Am J Emerg Med. 2025 Apr;90:179-191.

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Sepsis Fluid Resuscitation Shock Resuscitation 59

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. ). To EMPHASIZE: This pattern of diffuse Subendocardial Ischemia does not suggest acute coronary occlusion ( ie, it is not the pattern of an acute MI ).

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EKG/ECG Shock Wellness 248

Dr. Smith's ECG Blog

APRIL 2, 2024

He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. Angiogram in 2021 was normal. Patient received 11 shocks by ICD and was in V-fib when EMS arrived. Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. Initial trop ~200.

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EKG/ECG Shock CPR Stroke 133

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

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Sepsis Hospitals Administration Outcomes 132

Mind The Bleep

DECEMBER 19, 2023

Majority of DKA patients are in a fluid deficit and present acutely with shock. Signs of shock to be mindful for are tachycardia, hypotension, prolonged CRT, pallor, and a weak thready pulse. Fluid boluses are given according to local guidelines, but generally shocked patients should receive a 10ml/kg 0.9% References (2021).

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Dehydration Fluid Resuscitation Shock Resuscitation 98

JournalFeed

JANUARY 16, 2021

It’s the JournalFeed Podcast for the week of Jan 11-15, 2021. We cover non-invasive ventilation for severe asthma, prognostication in near-hanging patients, push-dose phenylephrine for septic shock, safety bundles for critical pediatric intubation, and when to intubate patients with ACE inhibitor angioedema.

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Taming the SRU

JANUARY 10, 2024

Therefore this should remain high on the differential if a patient with history of SCAD presents with similar symptoms. della porta & Hajdu Alcohol withdrawal syndrome is a highly prevalent and morbid condition.

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EKG/ECG Shock Fractures Dislocations 93

The Skeptics' Guide to EM

AUGUST 14, 2021

Date: August 12th, 2021 Reference: Daya et al. Survival After Intravenous Versus Intraosseous Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Shock-Refractory Cardiac Arrest. Date: August 12th, 2021 Reference: Daya et al. Missy is also now the director […] The post SGEM#340: Andale, Andale Get An IO, IO for Adult OHCA?

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Shock CPR Hyperthermia / Hypothermia EMS 52

PEMBlog

OCTOBER 18, 2023

Neonatal Toxic Shock Syndrome C. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease E. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease The patient was diagnosed with Neonatal Toxic Shock Syndrome-Like Exanthematous Disease (NTED). Neonatal toxic shock syndrome-like exanthematous disease (NTED).

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Infectious Diseases Shock Pediatrics Wellness 59

RebelEM

FEBRUARY 8, 2024

Background: Patients with shock frequently present with hypotension. Many of these patients are started on vasopressor and inopressor medications to assist in efforts to normalize blood pressure to help improve organ perfusion. In shocky patients, arterial lines are often used to monitor hemodynamic parameters and inform treatment decisions.

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Resuscitation Outcomes EMS Sepsis 125

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. 2021, Jarczak, Kluge et al. 2021, Im, Kang et al. 2021, Im, Kang et al. N Engl J Med. 2023;388(6):499-510. 2019, Bauer, Gerlach et al.

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Sepsis Shock Administration Resuscitation 52

EMDocs

MARCH 9, 2025

Clinical Practice Guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 Guideline on Diagnosis and Management of Acute Hematogenous Osteomyelitis in Pediatrics. Pediatr Emerg Care. 2022;38(1):e209-e213. doi:10.1097/PEC.0000000000002217 J Pediatr Infect Dis Soc. 2021;10(8):801-844.

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Pediatrics EMS Infectious Diseases Fractures 52

Don't Forget the Bubbles

FEBRUARY 5, 2025

In trauma patients, the primary sources of bleeding are external haemorrhage (blood on the floor), chest, abdomen, pelvis, and long bones in paediatrics brain is also included (infants with open sutures can bleed a significant amount intracranially) Shock The most common cause in trauma is haemorrhage. Don’t Forget the Bubbles, 2021.

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

EMDocs

MAY 24, 2023

He and his physician are shocked at the report and the lack of follow-up. Medscape eMedicine, August 2, 2021. A new chest CTA reveals a mass surrounding the vena cava. The patient recalls his prior CTA – which is requested for comparison and mailed directly to the patient. References: Anterior mediastinal mass. Mueller DK.

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Radiology Radiology EKG/ECG Patient Safety 91

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. Published on November 4, 2021. EMCrit 310 – Transvenous Pacemakers. EMCrit Blog. Available at [[link]

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Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. In 2021, Evans and colleagues (1) compared adolescent mortality rates in adult, children’s and mixed major trauma centres across the UK. 2021 Jul;38(7):488-494. 2021 Nov 1;91(5):809-813. 2021 Nov;37(11):1613-1620. Right now, though, Ranulf’s’ Mum looks whiter than he does. “Is

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Resuscitation Operations Sepsis Pediatrics 139

Sensible Medicine

FEBRUARY 15, 2024

I think that the most important article for leaning about Galleri was published in Annals of Oncology in 2021: Clinical validation of a targeted methylation-based multi-cancer early detection test using an independent validation set. The purpose of a cancer screening test is not to find cancer, I would say, but to save lives.

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University of Maryland CC Project

MAY 19, 2021

About the AuthorJim Lantry Twitter Google+Just your average critical care doc: wandering the ED and ICUs of Maryland, dedicating time to the USAF to travel the globe to cannulate for ECLS wherever the need arises, and trying to keep up with great minds of today. E: JlantryMD@gmail.com Just your average.

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Sepsis Shock 40

EMDocs

JANUARY 16, 2024

However, consideration of infection, endocrine shock (adrenal, thyroid disease), electrolyte abnormalities, hypoglycemia or central nervous system (CNS) disasters is important. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Accidental Hypothermia: 2021 Update. 2009;338:b2085.

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Hyperthermia / Hypothermia Resuscitation CPR EMS 109

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Date: September 8th, 2021 Reference: Desch et al. She arrives in the emergency department (ED) with decreased level of consciousness and shock. The TOMAHAWK Investigators. Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. The TOMAHAWK Investigators.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

The Skeptics' Guide to EM

JANUARY 15, 2022

Intensive Care Med 2021 Guest Skeptic: Missy Carter, former City of Bremerton Firefighter/Paramedic, currently a professor of Emergency Medical Services at Tacoma Community College’s paramedic program. Both agents are considered hemodynamically stable, but any induction agent may precipitate shock in the critically ill.

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Sepsis Shock Emergency Department Outcomes 43

Taming the SRU

APRIL 17, 2024

Surviving sepsis campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Ultimately, this article is unlikely to significantly change my practice pattern in the ED, where patients tend to be undifferentiated with rapidly evolving clinical presentations. References Evans L, Rhodes A, Alhazzani W, et al.

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Sepsis Research Stroke Academics 94

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. LAD — 100% proximal occlusion; with 70-89% mid-vessel narrowing. LCx — 50-69% stenosis of the 1st marginal branch; with 100% distal LCx occlusion. RCA — 100% proximal occlussion.

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EKG/ECG Shock Hospitals Sepsis 131

RebelEM

APRIL 29, 2024

2021 PMID: 34273470 12 Petitpas F et al. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation. Resusc Plus. 2023 PMID: 37502742 11 Schwalbach KT et al. Impact of intraosseous versus intravenous resuscitation during in-hospital cardiac arrest: A retrospective study. Resuscitation.

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Resuscitation Administration Emergency Department Ultrasounds 105

EB Medicine

DECEMBER 1, 2021

EMplify – December 2021 Announcements: The EB Medicine app is live and available for free in the Apple Store. Imaging CXR Echo CT MRI Aortogram Treatment BP management Heart Rate Shock Surgery – Who goes and when? Coming to Google Play soon. It is in Beta and your feedback is welcome.

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EKG/ECG Emergency Department EMS Shock 52

Emergency Medicine Journal

NOVEMBER 28, 2023

Aims and Objectives In 2021, the Surviving Sepsis Campaign International Guidelines advised clinicians to administer antimicrobials within 1h and 3h to sepsis patients with and without shock respectively. We aim to evaluate whether the timing of antibiotic administration in admitted sepsis patients affects mortality. 1.01) and 0.77(0.84-1.11)

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