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

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . Health Sci Rep 2022. Health Sci Rep 2022. Background: Sepsis remains one of the leading causes of morbidity and mortality. Paper: Varney J et al. More evidence is needed before this becomes mainstream practice.

Sepsis 129

Sepsis Hospitals Administration Outcomes 129

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. 6 What Can I Do Outside of Repeated Shocks and Standard ACLS? amiodarone or lidocaine).

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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

EMDocs

OCTOBER 8, 2024

Tachycardia may be present both from many medications or drugs, as well as withdrawal. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? Does the patient require blood, a procedure to address obstructive shock, or other source control? Do they have edema? Sinus Tachycardia.

Shock 103

Shock Emergency Department Pediatrics EKG/ECG 103

Taming the SRU

DECEMBER 17, 2024

Out of 18 patients receiving ORT, 4 failed to respond well and were escalated to IV therapy. Other contraindications include those who are unable to drink liquid (respiratory problems or impaired unconsciousness) and patients in shock, persistent vomiting, or with an ileus. 2022 Sep 11;5(5):e827. AtherlyJohn et al.

Dehydration 83

Dehydration Fluid Resuscitation Administration Resuscitation 83

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenic shock). Instead, IR performed pulmonary thrombectomy and the patient did well. As per Dr. Frick — sinus tachycardia is usually not seen with acute OMI unless the patient is in cardiogenic shock.

EKG/ECG 131

EKG/ECG Ultrasounds Shock EMS 131

RebelEM

JUNE 8, 2023

2022 Sep 5. 2022 2022 Sep 5. Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. Paper: Singer S, et al. The safety and efficacy of push dose vasopressors in critically ill adults. Am J Emerg Med. Am J Emerg Med.

Administration 97

Administration Emergency Department Outcomes Documentation/Coding 97

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 105

Resuscitation Administration Emergency Department Ultrasounds 105

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. 2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. 2-4 Any patient with evidence of complications or septic shock may need surgical management or a higher level of care. Stercoral Colitis.

EMS 88

EMS Sepsis Shock Fluid Resuscitation 88

Dr. Smith's ECG Blog

OCTOBER 8, 2024

A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. For more on Precordial Swirl — See the October 15, 2022 post in Dr. Smith's ECG Blog ). She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD. She could not be resuscitated.

EKG/ECG 126

EKG/ECG Documentation/Coding Resuscitation Shock 126

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) 89

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 89

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. In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ).

EKG/ECG 134

EKG/ECG Shock Hospitals Sepsis 134

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 76

EMS Infectious Diseases Pediatrics Research 76

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. Recent evidence has challenged the routine use of aggressive large volume fluid resuscitation with the potential to increase the severity of pancreatitis as well as fluid overload. Guest Skeptic: Dr. Salim R.

Fluid Resuscitation 52

Fluid Resuscitation Resuscitation Emergency Department Shock 52

RebelEM

AUGUST 12, 2024

Epub 2022 Aug 28. Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability. Epub 2022 Aug 28. The PROTECTION trial. Contemp Clin Trials. The PROTECTION trial.

Outcomes 81

Outcomes Hospitals Operations Shock 81

RebelEM

JANUARY 25, 2024

CHF, in particular, lends itself well to diagnosis and treatment with PoCUS, as it readily reveals the presence of B lines. POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence. 2022 Dec;106:9-38. Epub 2022 Aug 1. Published on February 28, 2022. vs. 18.3%). PMID: 24998674.

Ultrasounds 122

Ultrasounds Outcomes COPD Hospitals 122

AED Leader

JULY 19, 2023

The importance of having an up-to-date, well-maintained system shouldn’t be underestimated. According to 2022 statistics from the American Heart Association, there are more than 356,000 out-of-hospital cardiac arrests in the United States every year and just over 10% of EMS-treated victims survive to hospital discharge.

CPR 52

CPR Shock EKG/ECG Hospitals 52

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. The RCA was stented successfully with TIMI III flow noted post-procedure and the patient has done well with a post-PCI TTE demonstrating good LVEF and no wall motion abnormality. There is minimal STE in lead III with reciprocal STD in aVL. Mobitz II is not.

EKG/ECG 113

EKG/ECG Burns Wellness Shock 113

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

RebelEM

AUGUST 14, 2023

in both groups Mean APACHE II score was 12 in both groups Almost half of the patients had septic shock at enrollment Mean time from sepsis identification to randomization was 1.4 Demographics, severity of illness, and comorbidities were well balanced between groups and the intervention and control groups have the same prognosis.

Sepsis 96

Sepsis Outcomes Administration EMS 96

Dr. Smith's ECG Blog

JANUARY 8, 2024

Since that moment, she had had shortness of breath as well as pressure-like chest pain. Patient was given aspirin, sublingual nitro as well as heparin. She had been sitting doing work when she experienced "waves of chest tightness". Any kind of exertion made the shortness of breath considerably worse.

EKG/ECG 74

EKG/ECG Resuscitation Hospitals EMS 74

ALiEM

JULY 17, 2023

Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., as well as an analysis of the 2023 Match by Pupazan and Cook in Emergency Medicine News [3,4]. Many of these findings were similar to a study of the 2022 EM Match results by Murano et al., 2022 Main Residency Match: Results and Data.

EMS 52

EMS Burns Emergency Department Shock 52

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. 2022 Mar 2;83(3):1-12. Epub 2022 Mar 4. Check temperature and blood glucose levels.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

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 Leadership 52

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). While awaiting transfer to the cath lab, STAT echocardiogram was performed and showed LVEF 30-35%, as well as anterior, inferior, and apical hypokinesis, and apical thrombus. There are also diagonal branches which are not well visualized.

EKG/ECG 66

EKG/ECG Wellness Point-of-Care Testing Shock 66

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

Northwestern EM Blog

FEBRUARY 21, 2022

Emergency doctors know intuitively what trajectory patients are on, a chronically ill elderly patient presenting with shock requiring pressors have an extremely high mortality risk and we should be clear with families about that. Anticipatory guidance is not just for well-child checks ! 2022, Feb 21). End of Life Care in the ED.

Dehydration 52

Dehydration Shock Hospitals Wellness 52

Medical Law

JULY 19, 2024

However, the influx of cyclists also highlights the pressing need for well-maintained infrastructure to ensure safety. Unlike vehicles, bicycles have less stability and shock absorption, making them more susceptible to road imperfections. Moreover, these issues often go unrepaired for extended periods, exacerbating the risk.

Documentation/Coding 52

Documentation/Coding Shock Wellness 52

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Infectious Diseases 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He had history of prior MIs and CABG, as well as diabetes, hypertension, and hyperlipidemia. He underwent CPR and then was shocked out of VF. He was in cardiogenic shock requiring an impella for several days after cath. The pain was still ongoing at arrival. He also noted a bilateral "odd feeling" in his arms.

EKG/ECG 52

EKG/ECG Shock CPR Outcomes 52

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. There may have very well been a policy where only RTs can make changes to a ventilator after an order was placed to ensure accurate documentation. 2022 Feb 8; PMID: 35156050 Higgins TL et al. 2022 Feb 24;7(1):29603.

Emergency Department 52

Emergency Department Operations Academics Documentation/Coding 52

Stop and Think

OCTOBER 2, 2024

Well known is the fact that procedures put out a much stronger placebo effect than tablets. 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

Dr. Smith's ECG Blog

MAY 8, 2023

There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessively discordant TE in V2-V4. This was several months after the 2022 ACC Guidelines adding modified Sgarbossa criteria as a STEMI equivalent in ventricular paced rhythm). Modified Sgarbossa Criteria Refresher!

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Importantly, there is also STE in aVL, as well as V1. A 50-something with severe chest pain and a normal ECG 30 Year Old with Cardiac Arrest, PEA, then Cardiac Ultrasound = Comment by K EN G RAUER, MD ( 12/18 /2022 ): = I thought the initial ECG in today's case ( which I've reproduced in Figure-1 ) — to be "eye-catching".

Ultrasounds 40

Ultrasounds EKG/ECG EMS Radiology 40

Taming the SRU

APRIL 13, 2023

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. cuffed ETT) preloaded and intubate through the stoma if PPV needed Infection (i.e. This showed no difference in Cormack-Lehane score.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. Comment by K EN G RAUER, MD ( 11/28 /2022 ): = Today's case is remarkable for the presence of 2 important ECG findings: i ) Low Voltage ; and , ii ) Electrical Alternans.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40