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

RebelEM

APRIL 29, 2024

The current standard of practice has moved away from landmark-based central line placement given the efficacy and safety of ultrasound-based techniques. 2022 PMID: 35206981 2. Healthcare 2022 PMID: 35206981 Post Peer Reviewed By: Frank Lodeserto, MD & Salim R. minutes compared to a mean placement time of 10.7 Healthcare.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

JANUARY 10, 2024

R4 Case Follow-up: SCAD WITH dr. Martella Spontaneous Coronary Artery Dissection (SCAD) is a diagnosis confirmed via imaging: Coronary Angiography, Optical Coherence Tomography, Intravascular Ultrasound Therefore, treatment in the ED is the same as atherosclerotic ACS: ASA, heparin gtt and possible statin.

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

EMDocs

OCTOBER 8, 2024

POCUS: RUSH exam (Rapid Ultrasound for Shock and Hypotension) While derived to help identify unexplained hypotension, if we accept that sinus tachycardia may be an early indicator of shock, we can utilize this general approach to help reevaluate as clinically indicated. Axilla, Sacral, GU Overall Volume Status? In: StatPearls.

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

ALiEM

OCTOBER 30, 2024

Clinical impact: The patient’s DVT ultrasounds were negative. Drug Checking Quarterly Report (Q3 2022). 2022; 06/26/2023. 2022 May;14(5). Evaluation for nephrotic syndrome due to viral hepatitis, endocarditis, venous thromboembolism or other cause of chronic lymphedema is reasonable. 2011 Dec;6:1-4.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

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. Published 2022 Jan 3. doi.org/10.1016/j.resuscitation.2018.11.004

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

Don't Forget the Bubbles

MARCH 4, 2024

International Consensus Criteria for Pediatric Sepsis and Septic Shock. The aim of this paper was to update and evaluate the criteria for sepsis and septic shock in children. Check out DFTB’s module on SIRS, Sepsis and Shock Module – Don’t Forget the Bubbles (dontforgetthebubbles.com) Why does it matter?

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

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) 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

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 Shock 52

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

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

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

ACEP Now

SEPTEMBER 3, 2024

As of 2022, 1 in 4 emergency departments in the United States were staffed by a private equity-owned physician group. 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. 2022:3(9):e222886. Published December 14, 2022.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

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 Fluid Resuscitation Sepsis 52

Mind The Bleep

AUGUST 5, 2023

Example of pneumoperitoneum following perforated NEC Other Investigations Blood tests and abdominal ultrasound. Abdominal ultrasound may show bowel wall thickening, altered vascular state and free fluid. Updated 2022 Aug 8]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Necrotizing Enterocolitis. Lakhoo, K. &

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

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. Ann Emerg Med. Can Respir J.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Dr. Smith's ECG Blog

OCTOBER 10, 2022

A 30-something woman with chest pain and h/o pulmonary hypertension due to chronic pulmonary emboli A 30-something with 8 hours of chest pain and an elevated troponin Syncope, Shock, AV block, Large RV, "Anterior" ST Elevation. Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism.

EKG/ECG 52

EKG/ECG Resuscitation Ultrasounds CPR 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.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

It was notable for a normal cardiac ultrasound with no pericardial fluid, normal LV and RV function (though the quality was not sufficient to evaluate for wall motion abnormalities) and normal IVC dynamics. Bedside ultrasound is another very important piece. Ultrasound can be very helpful to distinguish causes of hypotension.

Ultrasounds 40

Ultrasounds EKG/ECG EMS Radiology 40

Dr. Smith's ECG Blog

JANUARY 23, 2023

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. J Am Heart Assoc. 2021 Dec 7;10(23):e022866.

EKG/ECG 52

EKG/ECG Shock Emergency Department Ultrasounds 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram. As for the ECG, it could represent OMI, but RBBB is also a clue that it may be PE. There is sinus tachycardia at ~100/minute.

EKG/ECG 73

EKG/ECG EMS Shock Ultrasounds 73

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW. The October 21, 2022 post — for " artifactual VT".

EKG/ECG 64

EKG/ECG Wellness Point-of-Care Testing Shock 64

Stop and Think

OCTOBER 2, 2024

Their argument required high levels of trust in measurements from ultrasound images. The first ORBITA trial shocked the cardiology world when it failed to find a placebo-resistant effect of stenting substantial coronary lesions. In 2022, I authored an opinion on AF screening in the New England Journal of Medicine.

Stroke 44

Stroke Academics Shock Ultrasounds 44

Taming the SRU

AUGUST 30, 2023

A larger 2022 meta-analysis in the journal of Clinical Microbiology and Infection examined different test modalities for diagnosing pneumonia in the setting of clinical suspicion for acute community-acquired lower RTI in outpatient clinics, LTACs, and the emergency department. 2022 Jul 11;11(14):2163. 2022 Jan;28(1):13-22.

Infectious Diseases 89

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

Dr. Smith's ECG Blog

MARCH 15, 2023

Her bedside cardiac ultrasound was normal We decided to cardiovert her since the time of onset was very recent. We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion. 25, 2022 ). But when you see this, you should suspect that the AV node is not well.

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

EMDocs

JANUARY 20, 2024

Bedside ultrasound shows hypokinesis of the basal portion of the left ventricle with an apparent sigmoid-shaped septum and a dilated inferior vena cava. Symptoms of heart failure and cardiogenic shock may develop in more severe cases. The oral mucosa is moist. Serum troponin and B-type natriuretic peptide are elevated.

EMS 101

EMS Fluid Resuscitation Shock EKG/ECG 101

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

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. Updated 2022 Aug 8]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. What is the most likely diagnosis?

EMS 92

EMS Infectious Diseases Shock Ultrasounds 92

EMDocs

JANUARY 6, 2024

A bedside cardiac ultrasound is performed which shows biventricular failure with a dilated inferior vena cava. 10 Dysrhythmias (more commonly ventricular), chest pain, dyspnea, acute CHF and shock are all possible. 10 Dysrhythmias (more commonly ventricular), chest pain, dyspnea, acute CHF and shock are all possible.

EMS 89

EMS Infectious Diseases Shock Emergency Department 89

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. link] Nickson, C.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

Mind The Bleep

JUNE 17, 2023

Frontino G, 2022) There may be kussmal breathing, impaired consciousness level, vomiting The abdomen will be generally tender with no focal area for the tenderness and the child may look very poorly. E, 2022) Presents with sudden onset acute severe pelvic/ lower abdominal pain, nausea and vomiting. The incidence in paediatrics is 4.9

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

EMDocs

NOVEMBER 13, 2023

However, IgE-mediated or not, anaphylactic shock is possible in either case. American Journal of Roentgenology 2022, 218 (3), 544-551. Semin Ultrasound CT MR 2017, 38 (4), 345-356. Emerg Radiol 2022, 29 (2), 291-298. Front Neurol 2022, 13 , 956888. JAMA Netw Open 2022, 5 (11), e2242805. DOI: 10.2214/ajr.21.26543.

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Mind The Bleep

JUNE 17, 2023

Frontino G, 2022) There may be kussmal breathing, impaired consciousness level, vomiting The abdomen will be generally tender with no focal area for the tenderness and the child may look very poorly. E, 2022) Presents with sudden onset acute severe pelvic/ lower abdominal pain, nausea and vomiting. The incidence in paediatrics is 4.9

Shock 52

Shock Wellness Emergency Department Ultrasounds 52

EMDocs

JANUARY 20, 2025

Patients were enrolled in these trials if they had signs of shock, with mortality ranging from 18-29%. 13 While there is good data that early antibiotics for patients in septic shock reduce mortality 18-19 the role of early and aggressive volume resuscitation and its impacts on patient-centered outcomes remain unclear. Inwald et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Dr. Smith's ECG Blog

DECEMBER 3, 2024

I put this through the Queen of Hearts and was shocked that she did not see it. Case continued A bedside cardiac ultrasound revealed grossly preserved left ventricular function, no appreciable wall motion abnormality, pericardial effusion, or obvious valvular abnormality.

EKG/ECG 110

EKG/ECG Burns Wellness Shock 110