Dr. Smith's ECG Blog

JANUARY 13, 2025

Drug toxicity , especially diphenhydramine , which has sodium channel blocking effects, and also anticholinergic effects which may result in sinus tachycardia, hyperthermia, delirium, and dry skin. Hypothermia. Hyperkalemia 2. Other drugs with sodium channel blockade: Tricyclic antidepressants. Ischemia or infarction. Cardiac arrest.

Hyperthermia / Hypothermia 74

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 74

The Skeptics' Guide to EM

OCTOBER 22, 2022

Date: October 18th, 2022 Reference: Moore et al. Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN). Date: October 18th, 2022 Reference: Moore et al. Resuscitation 2022 Guest Skeptic: Clay Odell is a Paramedic, Firefighter, and registered nurse (RN).

CPR 52

CPR Hyperthermia / Hypothermia Resuscitation EMS 52

Don't Forget the Bubbles

JUNE 19, 2023

Hypothermia should be prevented both directly after birth (this includes considering the use of polythene bags in very small neonates born >32 weeks) and during admission. Up To Date, [link] Accessed on: 11 August 2022. Treatment Preventing growth restriction is hard and depends on the cause. Acta Pediatrica 2018;107:981-9.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

PulmCCM

JANUARY 24, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival. Read on for details.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

The Skeptics' Guide to EM

FEBRUARY 11, 2023

NEJM 2022 Guest Skeptic: Dr. Sean Moore is an emergency physician working in Kenora Ontario, where he is Chief of Staff at Lake of the Woods District Hospital, Northern Medical Director for the Ornge air medical transport program and associate medical director with CritiCall Ontario. Date: February 7, 2023 Reference: Cheskes et al.

Shock 55

Shock CPR Hyperthermia / Hypothermia Hospitals 55

Taming the SRU

APRIL 13, 2023

Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C 2022 Pre-AeRATE Trial: use of HFNC for preoxygenation and apneic oxygenation showed no difference in lowest SpO2 during first intubation attempt when compared with usual care.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Don't Forget the Bubbles

MAY 17, 2023

2023 Apr 20:fetalneonatal-2022-324835. 2023 Apr 4:archdischild-2022-325281. To feed or not to feed during therapeutic hypothermia in asphyxiated neonates: a systematic review and meta-analysis. Effect of initial and subsequent mask applications on breathing and heart rate in preterm infants at birth. Kuypers KLAM, et al.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

EMDocs

MAY 28, 2024

Hypothermia, hypotension, and vasoconstriction may affect pulse oximetry reading, which is based on light absorption from fingertip blood flow. 2022 Aug;58:235-244. Epub 2022 Jun 11. Based onavailable literature, pulse oximetry readings are up to three times less accurate in Black patients. Am J Emerg Med. PMID: 35717760.

Blood Transfusions 88

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 88

ACEP Now

OCTOBER 11, 2024

3 Hypothermia is commonly encountered in submersion episodes, regardless of geographic location and season, although case reports have hypothesized improved neurologic outcomes, possibly due to the protective effects of the lower body temperatures. 2022;17(11):e0276374. Siddiqui SA, Singh MV, Mishra N, et al. 2023;53(4):416-418.

Pediatrics 52

Pediatrics Hyperthermia / Hypothermia Emergency Department Resuscitation 52

ACEP Now

OCTOBER 3, 2023

Accessed 2022, [link]. Blood oxygen saturation should be continuously measured in the prehospital setting with a pulse oximeter and supplemental oxygen administered to maintain blood oxygen saturation above 90%. Prehospital Guidelines for the management of traumatic brain injury – 3rd edition. Prehosp Emerg Care. J Safety Res.

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

Don't Forget the Bubbles

FEBRUARY 5, 2025

According to the latest figures (2022), there were approximately 6,000 recorded offences where a child was a victim of violence, including physical assault, sexual abuse, and homicide. In the bleeding trauma patient, fluid resuscitation aims to avoid the diamond of death (acidosis, coagulopathy, hypothermia and hypocalcaemia).

Domestic Violence 59

Domestic Violence Fluid Resuscitation Head Injuries Sexual Assault 59

Mind The Bleep

OCTOBER 29, 2024

Exposure Expose the patient in a systematic manner while keeping remaining body areas covered e.g. 1 limb at a time, to reduce the risk of hypothermia. 2022 Mar 2;83(3):1-12. Epub 2022 Mar 4. Assess pupillary reaction to light. Keep the patient warm using force air warmers such as Bairhugger. Kirkpatrick JJ, Enion DS, Burd DA.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Don't Forget the Bubbles

AUGUST 12, 2024

There is weak evidence to suggest that moderate hypothermia (32-33 o C) can be used for ICP control in specialist settings. Published 2022 Nov 20. Published 2022 Mar 1. This may involve prophylactic anticonvulsants, avoiding low or excessively high glucose levels, avoiding fever and maintaining a normal temperature.

Seizures 75

Seizures Pediatrics Emergency Department Ambulance Services 75

Pediatric Education

DECEMBER 15, 2024

We have to order the nurses to use an isolette so hypothermia doesn’t become an issue. However it caries risk of dehydration, sunburn, and hypothermia. Even with sunlight filters hypothermia continues to be a major issues. The nurses still monitor the temperature closely though in the isolette.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Pediatrics Dehydration Wellness 40

PulmCCM

JUNE 19, 2023

That was in NEJM Aug 18 2022. Sepsis was a main trigger, and hypothermia and shock were as common (>50%) as coma. No drug or combination improved the primary outcome (a composite outcome of hypoxemia, visit to the emergency department, hospitalization, or death). Very high TSH levels (17-100 mIU/L) and very low FT3 (0-2.2)

Infectious Diseases 52

Infectious Diseases Hyperthermia / Hypothermia Outcomes Sepsis 52

Mind The Bleep

DECEMBER 19, 2023

In cases of hypothermia, re-warming can be done passively (with blankets), or active techniques can be implemented in severe cases. Similarly, body temperature should be assessed as this can reveal exposure to infections which may have precipitated DKA, or some patients may be hypothermic if they have been unconscious for some time.

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

RebelEM

MARCH 30, 2023

Published online June 08, 2022. For More on This Topic, Checkout: MIRACLE2 Risk Score for Early Prediction of Neurologic Outcome in Out-of-Hospital Cardiac Arrest TTM2: Hypothermia vs Normothermia for Out-of-Hospital Cardiac Arrest References: Geri, G., JAMA Cardiol. Bougouin, W., Varenne, O., Daviaud, F., Lamhaut, L., Chiche, J.-D.,

Hospitals 57

Hospitals Outcomes EKG/ECG Resuscitation 57

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

These are Osborn waves usually associated with hypothermia. See our other blog posts of hypothermia and Osborn waves -- Massive Osborn Waves of Severe Hypothermia (23.6 Presumably, this is the result of body shivering , that so often accompanies hypothermia once temperatures drop below 30-32°C ( = 86-90°F ).

Hyperthermia / Hypothermia 140

Hyperthermia / Hypothermia EKG/ECG Wellness 140

EMDocs

JANUARY 16, 2024

Some authors recommend not starting chest compressions in hypothermia unless there is no organized cardiac activity (e.g., 2 In reality you may start compressions before you confirm that hypothermia was the primary cause of cardiac arrest. Obtaining a core temperature early in any arrest suspected to be from hypothermia is key.

Hyperthermia / Hypothermia 97

Hyperthermia / Hypothermia Resuscitation CPR EMS 97

EMDocs

NOVEMBER 19, 2024

1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. Rigidity and hyperthermia should raise concerns for NMS. Published 2022. Accessed October 23, 2023.

Poisoning 102

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 102

EMDocs

NOVEMBER 6, 2024

StatPearls Publishing; 2022. Accessed April 27, 2022. 2022 Annual Report of the National Poison Data System ® (NPDS) from America’s Poison Centers ® : 40th Annual Report. Recovery from profound lactic acidosis, hyperthermia, and rhabdomyolysis. Accessed April 27, 2022. Accessed April 27, 2022.

Poisoning 90

Poisoning Airway Management Dislocations Forensics 90

Taming the SRU

APRIL 26, 2023

First aid cooling techniques for heat stroke and exertional hyperthermia: A systematic review and meta-analysis. N Engl J Med 2022. April 26, 2023) Acute Hyperthermia in the Emergency Department. References Chiha M, Samarasinghe S, Kabaker AS. Thyroid storm: an updated review. J Intensive Care Med 2015. Resuscitation 2020.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Emergency Department Stroke Sepsis 52

Don't Forget the Bubbles

JUNE 30, 2023

Traditionally thought to result from the dilutional effects of massive transfusion, acidaemia or hypothermia, trauma-induced coagulopathy is now known to be triggered at the time of injury, long before these factors have developed or any medical intervention has taken place. 2022 Dec;57(12):986-993. Trials 23, 384 (2022).

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

Broome Docs

OCTOBER 31, 2022

2022 Jan;48(1):78-91. 2022 Sep;21(9):781-791. 2022 Sep 15;387(11):989-1000. 2022 Sep 18. 2022 Aug;41(4):101096. Epub 2022 Apr 28. 2022 Aug 3;11:100284. 2022 Jul 26:emermed-2021-211540. Etomidate versus ketamine for emergency endotracheal intubation: a randomized clinical trial. Lancet Neurol.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Seizures Emergency Department 52

EMDocs

NOVEMBER 13, 2024

Mild hypothermia is normal in patients with advanced cirrhosis; consider lowering threshold for fever to 37.8 Marked hypothermia is specific for SBP (> 90%), and it’s a poor prognostic finding. 2022 Mar-Apr;12(2):519-532. 2022 Oct;106(4):Online. 2022 Dec 30;14(12):e33124. J Clin Exp Hepatol. Am Fam Physician.

Hyperthermia / Hypothermia 99

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 99

Don't Forget the Bubbles

NOVEMBER 18, 2024

Hypothermia: Newborns, particularly preterm infants, are prone to hypothermia. In these situations, it’s crucial to focus on treating the underlying respiratory issue—ensuring adequate oxygenation and ventilation and possibly using inhaled nitric oxide for pulmonary hypertension—rather than just addressing the low blood pressure.

Sepsis 59

Sepsis Shock Hyperthermia / Hypothermia Administration 59

Dr. Smith's ECG Blog

JULY 22, 2023

This discussion comes from this previous post: Hyperthermia and ST Elevation Discussion Brugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias. Syncope and weakness were attributed to acute illness from influenza. The patient did well and was ultimately discharged home.

EKG/ECG 92

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 92

Don't Forget the Bubbles

OCTOBER 28, 2024

How do we prevent hypothermia? Hypothermia is another part of the ‘ diamond of death ’. Care must be taken to avoid the ‘diamond of death’ (coagulopathy, acidosis, hypothermia, and hypocalcemia). Published 2022 May 4. 2022 Apr 22;8(1):25. Am J Emerg Med. 2021;49:404-405. doi:10.1016/j.ajem.2021.02.009 2021;7(1):30.

Blood Transfusions 72

Blood Transfusions Hyperthermia / Hypothermia Shock Pediatrics 72

EMDocs

JUNE 27, 2024

2022 Jul 5;328(1):57-68. 2022 Aug;58:235244. Epub 2022 Jun 11. 2022 Aug;58:235-244. Epub 2022 Jun 11. 2022 Aug 29;13:796837. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 0.4 PMID: 35788790.

Pediatrics 88

Pediatrics Dehydration EMS Hospitals 88

Dr. Smith's ECG Blog

MAY 5, 2022

Bradycardia, SOB, in a Dialysis Patient == MY Comment by K EN G RAUER, MD ( 5/5/2022 ): == If I was allowed to ask 2 Questions , with use of a single ECG to assess the ECG interpretation astuteness of emergency providers — I would select the initial ECG in today's case ( Figure-1 ). The April 17, 2022 post ( Leads V1,V2 placed too high ).

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

Blunt Trauma in a Child 40-something male in a head-on Motor Vehicle Collision and Splenic Injury == MY Comment, by K EN G RAUER, MD ( 10/10 /2022 ): == Highly interesting post by Dr. Smith regarding a 30-something male with multiple injuries from a motor vehicle accident. What are the ECG Findings of Cardiac Contusion?

EKG/ECG 52

EKG/ECG Fractures Hyperthermia / Hypothermia Wellness 52

The Skeptics' Guide to EM

MARCH 5, 2022

Date: February 24th, 2022 Reference: Parish et al. Date: February 24th, 2022 Reference: Parish et al. This includes therapeutic hypothermia for out-of-hospital cardiac arrest (OHCA), tranexamic acid (TXA) for epistaxis and electrolyte solutions for mild pediatric gastroenteritis.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Research Pediatrics Outcomes 40

Northwestern EM Blog

JANUARY 24, 2022

While the diagnosis of hypothyroidism can be delayed by lab results, clues to the diagnosis include thyroidectomy scar, non-pitting edema of the extremities, macroglossia, altered mental status, hypoglycemia and hypothermia. 2022, Jan 24). Wibberly, A. Vasopressor Nonresponse. Expert Commentary by Zimmerman, J].

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Intensive Blog

FEBRUARY 9, 2023

It refers to hypernatraemia, hyperventilation, haemodialysis, and induced hypothermia. Hypothermia Aiming for a lower core temp (35 o C) reduces cerebral metabolic rate and cerebral blood flow. The exact pathophysiology is complex, but an important factor is the accumulation of metabolic toxins such as ammonia. link] Nickson, C.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

EMDocs

DECEMBER 16, 2023

Broad-spectrum antibiotics (A) for septic shock are not inappropriate given the hyperthermia, tachycardia, and hypotension. Hyperthermia. As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. What is your diagnosis, and what are your next steps in evaluation and management? 1 Fever is usually < 40C.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia EMS Stroke Seizures 80

RebelEM

DECEMBER 19, 2022

2022 Nov 6 PMID: 36342151 Clinical Question: How does double defibrillation and vector change defibrillation compare to standard therapy in OHCA patients with refractory ventricular fibrillation? 2022 Nov 6 PMID: 36342151 Cheskes S, et al. Defibrillation Strategies for Refractory Ventricular Fibrillation. N Engl J Med. N Engl J Med.

EMS 52

EMS CPR Shock Resuscitation 52

Dr. Smith's ECG Blog

MAY 23, 2022

In today's post Dr. NOTE: Early repolarization is included among the "J Wave Syndromes" ( JWS ) which are a phenotypic spectrum of disorders including individuals with ERS, Brugada Syndrome and/or malignant arrhythmias linked to STEMIs or the J-point accentuation ( Osborn wave ) of hypothermia.

EKG/ECG 52

EKG/ECG Documentation/Coding Hyperthermia / Hypothermia Research 52