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]

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

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. Her point-of-care ultrasound (POCUS) shows appropriate-appearing global ejection fraction and no marked wall motion abnormalities.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

ALiEM

OCTOBER 30, 2024

Clinical impact: The patient’s DVT ultrasounds were negative. 2021 Aug 1;94:103086. 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

Taming the SRU

FEBRUARY 19, 2024

A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. In general, radial artery readings in patients with shock likely underestimate central pressure which can lead to increasing vasopressor dosing. Cite As: Snyder, B. Broadstock, A.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Taming the SRU

AUGUST 30, 2023

Notably, lung ultrasound for the diagnosis of bacterial CAP demonstrated exceptional stand-alone diagnostic accuracy in 33 studies including 4,901 adults and children in the emergency department, with a pooled sensitivity of 92% and specificity of 90%. 2021; 93: 4358–4369. 2021 Jan;25(1):466-479. Epub 2021 Oct 1.

Infectious Diseases 89

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

Dr. Smith's ECG Blog

JANUARY 23, 2023

2021 Dec 7;10(23):e022866. Epub 2021 Nov 15. PMID: 34775811; PMCID: PMC9075358 A bedside ultrasound was performed, shown here: Parasternal short axis view demonstrating inferior LV wall motion akinesis Apical 2 chamber view again demonstrating inferior LV wall akinesis The cath lab was not activated based on the ECG and bedside echo.

EKG/ECG 52

EKG/ECG Shock Emergency Department Ultrasounds 52

EMDocs

NOVEMBER 13, 2024

Ultrasound can assist: confirm ascites, evaluate for best site, abdominal wall thickness, blood vessels along needle track. Management: Patients can rapidly progress to septic shock and multiorgan failure. 2021 Aug;74(2):1014-1048. 2021 Jan;70(1):9-29 Marciano S, Díaz JM, Dirchwolf M, Gadano A. Hepatology. Ann Hepatol.

Hyperthermia / Hypothermia 105

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 105

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. What are the most up-to-date guidelines for managing this patient?

Sepsis 91

Sepsis Fluid Resuscitation Resuscitation Shock 91

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

EMDocs

NOVEMBER 4, 2023

An ultrasound of the testes reveals the following: What is the diagnosis? McGraw Hill; 2021. J Emerg Trauma Shock. He reports approximately one month of dysuria, and around two weeks ago noticed a dull aching sensation in his testicles that has progressively gotten worse. Radiographics. 2013;33(3):721-740. doi:10.1148/rg.333125158

EMS 94

EMS Ultrasounds Emergency Department Infectious Diseases 94

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.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

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. 2021, May 18). No fungal infections are identified on the feet. What is the most likely diagnosis? pneumoniae , S.

EMS 92

EMS Infectious Diseases Shock Ultrasounds 92

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. Accidental Hypothermia: 2021 Update. 2009;338:b2085. Resuscitation.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

EMDocs

JULY 17, 2023

3 Point of care ultrasound (POCUS) can be highly sensitive for free fluid and pneumoperitoneum when used by a trained physician in the appropriate patient population. However, surgical consultation should not be delayed while waiting for imaging in a patient who is in shock, appears toxic, or has signs of peritonitis. -In 2018;13:36.

Operations 98

Operations EMS Fluid Resuscitation Resuscitation 98

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 2021 Jun 24.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

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

ACEP Now

MAY 9, 2024

The procedure has soared in popularity as beauty standards have shifted and cosmetic surgery has become increasingly transparent on social media platforms, with reported cases in the United States increasing from 614 in 2002 to 61,387 by 2021, a nearly 10,000 percent increase. References Garcia SE. Butt Lifts Are Booming. Healing Is No Joke.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

ACEP Now

SEPTEMBER 3, 2024

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. Her primary interests are in ultrasound, machine learning, and health justice. Published May 31, 2021. References Pomorski C. The death of Hahnemann Hospital.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

Downeast Emergency Medicine

APRIL 26, 2021

2021 Jan 1;32(1):37-43. 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. Rivas L, Estroff J, Sparks A, et al. MI or stroke).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

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. Bellomo, R. 2014, Jan).

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

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

NOVEMBER 13, 2023

2021) found that the top 5 reasons for ordering a CTA head/neck were suspected stroke, neurologic problem, dizziness, headache with new/concerning symptoms, and altered mental status. However, IgE-mediated or not, anaphylactic shock is possible in either case. Semin Ultrasound CT MR 2017, 38 (4), 345-356. DOI: 10.1161/strokeaha.118.023173

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Mind The Bleep

JUNE 17, 2023

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. Classically they have redcurrant jelly stools but this is often a late sign. Brott NR, L.

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

Mind The Bleep

JUNE 17, 2023

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. Classically they have redcurrant jelly stools but this is often a late sign. Brott NR, L.

Shock 52

Shock Wellness Emergency Department Ultrasounds 52

EMDocs

JANUARY 20, 2025

The latest Society of Critical Care Medicine (SCCM) sepsis guidelines from 2021 recommend giving patients with signs of hypoperfusion an initial 30 ml/kg bolus as a best practice statement 13 based on the PROCESS, 14 ARISE, 15 and PROMISE 16 trials. Similar to Andrews et al., For children in well-resourced settings, the data is less clear.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75