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 April 17, 2022 post ( Leads V1,V2 misplacement ).

Shock 79

Shock EKG/ECG Academics Stroke 79

Emergency Medicine Cases

JANUARY 2, 2023

Based on a blend of number of listens, feedback from listeners, website visits and my personal faves, here is EM Cases Top 10 of 2022. The post Top 10 of 2022 – EM Cases Podcasts & Blogs Highlights of the Year appeared first on Emergency Medicine Cases.

EMS 52

EMS Stroke Shock 52

Pediatric EM Morsels

MARCH 17, 2023

Ahmed 2008, Meyers 2022) Of course, treat any other systemic symptoms (like respiratory failure, hypotension) as you typically would. If you are managing a snake bite from a snake that does not typically reside in the U.S., please utilize other resources and local Toxicology experts for help with management protocols.

CDC 130

CDC Poisoning Pediatrics Shock 130

Dr. Smith's ECG Blog

JULY 9, 2024

Here is the Queen of Hearts (version 1) interpretation: Click here to sign up for Queen of Hearts Access Angiogram images before and after intervention: Another view (before and after intervention): The patient was confirmed to be in cardiogenic shock, placed on ECMO, also with impella assist device. 15, 2022 post).

EKG/ECG 101

EKG/ECG Resuscitation Shock CPR 101

Pediatric EM Morsels

APRIL 5, 2024

CDC 2022) Testing for many of these illnessess can take time during the acute phase as many are ELISA or PCR tests. CDC 2022) Divided into Soft tick relapsing fever and Hard tick relapsing fever , depending on what type of ticks carry the Borrelia sp (CDC 2022) There is also a louse which carries a Borrelia sp.

CDC 161

CDC Infectious Diseases Pediatrics Wellness 161

RebelEM

JUNE 12, 2024

Background and Physiology Shock secondary to beta-blocker (BB) or calcium-channel blocker (CCB) toxicity bears a tremendous degree of morbidity and mortality. 2022 Annual Report of the National Poison Data System ® (NPDS) from America’s Poison Centers ® : 40th Annual Report. References Gummin DD, Mowry JB, Beuhler MC, et al.

Poisoning 84

Poisoning Stroke Shock Administration 84

EB Medicine

AUGUST 6, 2022

In this episode, Sam Ashoo, MD interviews Adam Sigal, MD and Stephanie Costa, MD - the authors of the August 2022 EMP article on Managing Acute Cardiac Valvular Emergencies in the Emergency Department. Managing Acute Cardiac Valvular Emergencies in the Emergency Department EMplify - August 2022 Episode Outline: Why Valvular disease?

COPD 52

COPD Emergency Department Shock EKG/ECG 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. Method and Design Studies published up to 19 May 2022 in PubMed, Ovid EMBASE, Web of Science, and Cochrane were included.

Sepsis 40

Sepsis Administration Shock 40

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Shocked x 2 without effect. Warning: if this is VT, a calcium channel blocker can result in shock and death. Today's case is insightful in many ways — especially since despite prompt electrical cardioversion, we are told that this patient "was shocked X 2 without effect". However, this is not SVT. What to do now? K returned 3.6

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EKG/ECG Shock Documentation/Coding Academics 136

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. 2022), ideally with antibiotics administered within one hour of sepsis recognition by the treating provider (Evans, Rhodes et al. N Engl J Med.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

ALiEM

JUNE 5, 2023

Glucocorticoid therapy should be considered in anthrax meningitis, cutaneous anthrax with extensive tissue edema involving the head and neck, or anthrax with vasopressor-resistant shock [9]. Updated 2022 Jul 26]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Updated 2022 Aug 8]. Simonsen KA, Chatterjee K.

Infectious Diseases 102

Infectious Diseases CDC PPE Military 102

RebelEM

JANUARY 18, 2024

Health Sci Rep 2022. 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. Health Sci Rep 2022. Paper: Varney J et al. References: Varney J et al.

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Sepsis Hospitals Administration Outcomes 121

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. 2022 Jul;45(7):1183-1192.

Shock 59

Shock Resuscitation Ultrasounds Research 59

Pediatric EM Morsels

FEBRUARY 2, 2024

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk. 2022 Jun:56:113-116.

Infectious Diseases 161

Infectious Diseases Pediatrics Sepsis Documentation/Coding 161

ACEP Now

MAY 9, 2024

Unfortunately, at least 13 deaths were subsequently reported in Miami-Dade County from 2019–2022, the three years immediately following the implementation of the subcutaneous injection regulation. 6 Theoretically, ultrasound guidance should decrease this risk, which formed the basis for the 2022 Florida Medical Board regulation.

Emergency Department 52

Emergency Department Operations Ultrasounds Hospitals 52

EM Literature of Note

MARCH 2, 2023

Data Dredging Coming Through: Heads Up Cardiopulmonary Resuscitation Does Not Improve Outcomes Are Two Shocks Better Than One? Finally, a Twitter thread with slides illustrating some of the top articles of 2022: 20 Papers in 20 Minutes from ACEM Spring Symposium Enjoy!

Emergency Department 52

Emergency Department Resuscitation Shock EMS 52

The Skeptics' Guide to EM

NOVEMBER 12, 2022

Date: November 10th, 2022 Reference: de-Madaria E et al. Date: November 10th, 2022 Reference: de-Madaria E et al. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Guest Skeptic: Dr. Salim R. Aggressive or Moderate Fluid Resuscitation in Acute Pancreatitis (WATERFALL). Guest Skeptic: Dr. Salim R.

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Emergency Department Shock 52

Pediatric EM Morsels

MARCH 29, 2024

Pediatr Rev (2022) 43 (7): 371–383. Incidence of inborn errors of metabolism in British Columbia, 1969–1996. Pediatrics. 2000; 105:e 10. Inborn Errors of Metabolism: Becoming Ready for Rare. Samantha A. Schrier Vergano. link] The post Rebaked: Inborn Errors of Metabolism presenting in the ED appeared first on Pediatric EM Morsels.

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Dehydration Pediatrics Sepsis EMS 289

EMDocs

OCTOBER 9, 2023

6 However, due to the vasoconstrictive effects, hydrocortisone may be useful in refractory shock. Treasure Island (FL): StatPearls Publishing; July 26, 2022. Corticosteroids in septic shock: a systematic review and network meta-analysis. Treasure Island (FL): StatPearls Publishing; October 17, 2022. 2014;14(2):203-207.

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Basic Life Support CPR Fractures Emergency Department 81

Dr. Smith's ECG Blog

JUNE 23, 2024

They shocked him twice before return of spontaneous circulation. The above said — it may prove insightful to take another look at the Wellens' Syndrome case instantly recognized by Dr. Smith in the August 12, 2022 post in Dr. Smith’s ECG Blog. His daughter immediately started CPR and another family member called EMS.

EKG/ECG 107

EKG/ECG EMS CPR Hospitals 107

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% Marcdante, R.

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Dehydration Fluid Resuscitation Shock Resuscitation 98

EMDocs

AUGUST 15, 2023

Published April 15, 2022. Accessed May 7, 2022. StatPearls Publishing; 2022. Accessed May 17, 2022. Accessed May 7, 2022. Accessed May 7, 2022. Accessed May 7, 2022. Accessed May 7, 2022. Treatment of snakebite poisoning. Am J Hosp Pharm. 1991;48(10):2190-2196. Venomous Snakes | NIOSH | CDC.

Poisoning 81

Poisoning Administration CDC EMS 81

EMDocs

JULY 1, 2023

UpToDate;2022. Accessed December 31, 2022. Accessed December 31, 2022. UpToDate;2022. Accessed December 31, 2022. UpToDate;2022. Accessed December 31, 2022. UpToDate;2022. Accessed December 31, 2022. In: Post TW, ed. link] Ramphul, K., Kawasaki disease: a comprehensive review.

EMS 65

EMS Infectious Diseases Pediatrics Research 65

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 Outcomes 52

JournalFeed

MARCH 26, 2022

The JournalFeed podcast for the week of March 21-25, 2022. For continued access to all the JournalFeed has to offer will require you to be a member as of April 4th, 2022. Check out journalfeed.org for details.

Documentation/Coding 40

Documentation/Coding Stroke Emergency Department Resuscitation 40

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. The American Journal of Emergency Medicine , vol. 2090–2093, [link] Moayedi, Siamak, et al. Circulation , vol.

Advances Cardiac Life Support (ACLS) 83

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 83

RebelEM

APRIL 29, 2024

2022 PMID: 35206981 2. Healthcare 2022 PMID: 35206981 Post Peer Reviewed By: Frank Lodeserto, MD & Salim R. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation. . Labs can be drawn from an IO to help with rapid diagnosis in emergencies. References: 1 Astasio-Picado Á et al.

Resuscitation 102

Resuscitation Administration Emergency Department Hospitals 102

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 Outcomes Fluid Resuscitation 52

Stop and Think

MARCH 31, 2024

Our main finding was that industry paid doctors more than $12 billion dollars between 2013-2022. His list of device approvals despite dodgy evidence is shocking. The influential Journal of the American Medical Association published our data this week. The numbers surprised me. B as in billions. Let me make two points. We use devices.

Research 138

Research Hospitals Shock 138

ALiEM

JULY 17, 2023

Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., In 2022, unfilled PGY-1 positions totaled 219 (7.9%), and 554 (18.4%) positions were unfilled in 2023 [2,5]. Published May 2022.

EMS 52

EMS Burns Emergency Department Shock 52

RebelEM

MAY 29, 2023

septic shock). Limited, small studies on its use in septic shock do not make a clear argument for use. Early Adjunctive Methylene Blue in Patients with Septic Shock: A Randomized Controlled Trial. Background: Sepsis can induce numerous physiologic derangements. Paper: Ibarra-Estrada, M et al. Crit Care 2023. 95% CI 15.4

Shock 144

Shock Fluid Resuscitation Sepsis Resuscitation 144

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. Sickle Cell Disease: A Review. PMID: 35788790. Farooq S, Abu Omar M, Salzman GA. Acute chest syndrome in sickle cell disease. Hosp Pract (1995). 2018 Aug;46(3):144-151. PMID: 29648482.

Pediatrics 75

Pediatrics Dehydration EMS Hospitals 75

The Skeptics' Guide to EM

FEBRUARY 25, 2023

2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Pediatric Crit Care Med.

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

EMDocs

FEBRUARY 12, 2024

First, there can be a poor correlation between venous and arterial gases in states of shock, hemodynamic instability, or extremes of acid-base disturbances, due to poor cardiac output/circulatory failure impairing venous and arterial flow, with associated poor gas exchange as well as hypercapnia and acidemia at the tissue level (8).

Emergency Department 94

Emergency Department Resuscitation COPD Shock 94

The Skeptics' Guide to EM

FEBRUARY 3, 2023

September 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You are working an overnight shift at a small rural hospital. The patient is in ventricular fibrillation, and you achieve return of spontaneous circulation (ROSC) on the second shock.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Outcomes Documentation/Coding 52

Medical Law

MARCH 20, 2024

After the initial shock and trauma caused by a brain injury and the early medical treatment that the victim receives comes the realization that TBI patients are likely to require a lifetime of medical, psychological, and assisted living care. Call (805) 962-2022 to schedule a FREE consultation today. In fact, more than 5.3

Shock 52

Shock Hospitals 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. Routine STEMI activation in STE-aVR for emergent revascularization is not warranted, although urgent, rather than emergent, catheterization appears to be important. == MY Comment, by K EN G RAUER, MD ( 11/4 /2022 ): == Our thanks to Drs.

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EKG/ECG Shock Sepsis Emergency Department 52