Dr. Smith's ECG Blog

JULY 25, 2024

For clarity in Figure-1 — I've reproduced today's ECG — obtained following successful resuscitation of out-of-hospital cardiac arrest. As we have often emphasized on Dr. Smith's ECG Blog ( See My Comment in the March 1, 2023 post) — DSI does not indicate acute coronary occlusion! Figure-1: The initial ECG in today's case. —

Resuscitation 124

Resuscitation EKG/ECG CPR Shock 124

EMDocs

JANUARY 11, 2025

2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. If sepsis or septic shock is present, aggressive fluid resuscitation and empiric antibiotics covering intra-abdominal flora should be administered. Abdominal pain may be absent in up to 60%.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

EMDocs

JANUARY 8, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline Updates for 2023 were just published. 2023 Dec 18. The post 2023 AHA Update on ACLS appeared first on emDOCs.net - Emergency Medicine Education. o C recommended (Level 1: strong). Circulation.

Seizures 98

Seizures Shock CPR Hyperthermia / Hypothermia 98

RebelEM

FEBRUARY 24, 2025

13 That is to say nothing of the effect that the type and response to shock has on the individual patients involved in these studies. As seen in the Andromeda Shock Trial, and multiple other trials involving shocked patients, capillary return also reigns supreme regarding physical examination. Apr 2023; PMID: 37009935.

Ultrasounds 74

Ultrasounds Shock Fluid Resuscitation Resuscitation 74

EMDocs

NOVEMBER 6, 2023

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association 2023 Guideline for managing cardiac arrest or life-threatening toxicity due to poisoning was recently released. The usefulness of administering methylene blue for refractory vasodilatory shock due to CCB poisoning is uncertain.

Poisoning 115

Poisoning Hyperthermia / Hypothermia Seizures Administration 115

PulmCCM

DECEMBER 11, 2023

Sepsis, infectious disease Managing septic shock with a restrictive-fluids approach (preferentially using vasopressors after a single liter crystalloid bolus) led to similar outcomes as the usual practice of bolusing large volumes of fluids first. Either approach in severe sepsis with shock seems reasonable.

Sepsis 94

Sepsis Stroke Shock Infectious Diseases 94

Dr. Smith's ECG Blog

MAY 26, 2023

A 20-something presented after a huge verapamil overdose in cardiogenic shock. He was admitted to the ICU and was unstable, in shock, overnight. This was a very complex case and the details are too much for an ECG Blog, but suffice it to say that, s hortly thereafter, the patient had an asystolic arrest and was resuscitated.

Shock 98

Shock EKG/ECG Documentation/Coding Resuscitation 98

Don't Forget the Bubbles

MARCH 31, 2025

2023 Nov;7(1):e002094. doi: 10.1136/bmjpo-2023-002094. Sepsis is a significant cause of mortality in children, and fluid resuscitation is a key treatment strategy. It also emphasizes the need for better fluid management strategies, including early de-resuscitation in high-risk patients. BMJ Paediatr Open. Whats it about?

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

RebelEM

NOVEMBER 30, 2023

This systematic review and meta-analysis attempts to elucidate whether a more conservative fluid resuscitation approach is warranted in volume sensitive sepsis patients, such as those with congestive heart failure (CHF). Am J Emerg Med. 2023;73:34-39. What They Did: Researchers performed a systematic review and meta-analysis.

Sepsis 121

Sepsis Fluid Resuscitation Resuscitation Administration 121

ACEP Now

JULY 7, 2023

However, between four and five percent of cases of VT or VF will be refractory to standard management, with nonperfusing arrhythmia persisting despite repeated shocks. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. Resuscitation. Resuscitation. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9% Liberal: 14.9%

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

RebelEM

APRIL 29, 2024

Critically ill patients requiring resuscitation often present with many challenges including the ability to secure safe, sterile, fast, and reliable intravenous (IV) access. This can often lead to significant delays in proper resuscitation. Studies reviewed landmark-based CVC compared to IO; using IJ, subclavian, and femoral CVC sites.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

EMDocs

JANUARY 13, 2024

2023 Nov 28:emermed-2023-213285. doi: 10.1136/emermed-2023-213285. sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock. sodium chloride) reduced acute kidney injury and improved other outcomes in these pediatric patients with septic shock.

Stroke 86

Stroke Shock Pediatrics Resuscitation 86

EMDocs

MARCH 4, 2025

Bacterial Meningitis Mimics: Other flu-like illnesses: COVID, influenza, toxic shock syndrome, myocarditis, endocarditis, spinal epidural abscess, pneumonia. Start resuscitating with fluids, and add a vasopressor like norepinephrine. 2023 Mar;65:76-83. A 2020 Cochrane review found the pooled sensitivity was 65%. Am J Emerg Med.

Infectious Diseases 83

Infectious Diseases Seizures Poisoning Sepsis 83

Don't Forget the Bubbles

FEBRUARY 5, 2025

This should include early identification of life-threatening injuries, targeted fluid resuscitation using blood products, pain management, then eventual safeguarding and psychological support. Establish IV access for potential fluid resuscitation. You feel the patient needs fluid resuscitation. Administer O2 if necessary.

Fluid Resuscitation 59

Fluid Resuscitation Domestic Violence Head Injuries Sexual Assault 59

PulmCCM

NOVEMBER 17, 2023

Operating point guided resuscitation How do we make sense of this? The trick, I believe, lies in ‘operating point guided resuscitation’ [OPGR]. Put another way, because the OP is comprised of both P ra and CO/SV, both values are quantified or qualified at each step of resuscitation. Front Physiol 2023, 14:1230654.

Operations 132

Operations Ultrasounds Resuscitation Blood Transfusions 132

RebelEM

JUNE 26, 2023

Clinical Take Home Point: In adult patients with trauma at risk of massive transfusion, receiving standard trauma resuscitation management, the addition of 4F-PCC did not result in a decrease in blood product consumption over 24 hours compared to placebo. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03

Administration 145

Administration Outcomes Resuscitation Radiology 145

EMDocs

JANUARY 16, 2024

Hypothermic Arrest In general, hypothermic patients in cardiac arrest should be aggressively resuscitated. Patients can have excellent outcomes despite prolonged resuscitation. 2,3 If the patient meets criteria for resuscitation, they generally are not declared dead until their core temperature is above 32℃ (“warm and dead”).

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

Mind The Bleep

OCTOBER 29, 2024

Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications. Updated 2023 Jul 17]. Updated 2023 Jul 17]. PMID: 7077702.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Don't Forget the Bubbles

OCTOBER 7, 2024

Was the patient thrown from the source (suggestive of DC shock and may result in further blunt force trauma)? Children, especially toddlers, may insert objects into outlets, leading to shocks or burns. Electrical devices used near water sources can cause severe shocks. Was the voltage high or low (as below)?

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

EMDocs

SEPTEMBER 7, 2024

Laborator evaluation: CBC, CMP, lipase, type and screen, coagulation panel Treatment: 1-3 Resuscitation with blood products as necessary for hemodynamic stability. Clinical features include abdominal or flank pain; ecchymosis to the flank, periumbilical region, proximal thighs, or scrotum; and hemorrhagic shock early in the disease course.

EMS 97

EMS Fluid Resuscitation Resuscitation Radiology 97

Greater Sydney Area HEMS

FEBRUARY 20, 2024

Obtaining access in shocked trauma patients can be notoriously difficult due to circulatory collapse. Those who are shocked, shut down with limited or no other options for peripheral access require central access. Right Brachiocephalic Vein Origin Access for the Resuscitation of Shocked Adult Trauma Patients. Green et al.

Ultrasounds 98

Ultrasounds Shock Research Operations 98

Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

Resuscitation efforts were undertaken. ECG#3 Resuscitation efforts were ongoing. link] == MY Comment , by K EN G RAUER, MD ( 9/27 /2023 ): == Fascinating series of tracings by Dr. Nossen — that illustrate dramatic shark fin morphology from acute LAD OMI. The patient went in and out of ROSC. Is there OMI?

EKG/ECG 133

EKG/ECG Resuscitation Academics EMS 133

PulmCCM

JUNE 5, 2023

Corticosteroids for community-acquired pneumonia have been studied with inconclusive results, and expert guidelines currently advise against their use except in patients with refractory septic shock. Patients with septic shock or influenza were excluded. standards of care. makes me long for an adequately powered randomized trial.

Advances Cardiac Life Support (ACLS) 96

Advances Cardiac Life Support (ACLS) Documentation/Coding CPR Shock 96

PulmCCM

JANUARY 29, 2024

AHA Updates its Cardiac Arrest Guidelines In December 2023, the American Heart Association published a “focused update” to its landmark guidelines for the management of cardiac arrest. three shocks with 2 minutes CPR in between) have been performed. PulmCCM is not affiliated with the American Heart Association.

Seizures 115

Seizures CPR Documentation/Coding Hyperthermia / Hypothermia 115

Stop and Think

JANUARY 10, 2024

Let’s do two topics on the RCT that I covered in my Top Ten Stories of 2023 piece. In January, Dutch investigators published results of the INCEPTION trial, in which extracorporeal cardiopulmonary resuscitation (CPR) or conventional CPR (standard advanced cardiac life support) were compared. These two RCTs show that it does not.

CPR 44

CPR Shock Outcomes Resuscitation 44

Don't Forget the Bubbles

JUNE 30, 2023

Ranulf went white with the shock. In addition, a flimsy cannula is easily dislodged during ongoing resuscitation and easily clots off. This was a randomised controlled multisite study comparing resuscitation of trauma patients requiring massive transfusion using either 1:1::1 or 1:1:2 ratios of platelets to plasma to red blood cells.

Resuscitation 139

Resuscitation Operations Sepsis Pediatrics 139

RebelEM

NOVEMBER 20, 2023

Early expeditious definitive hemorrhage control is a major focus in trauma resuscitation. Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial [published online ahead of print, 2023 Oct 12]. 2023;e2320850.

Resuscitation 91

Resuscitation Operations Outcomes Hospitals 91

EMDocs

NOVEMBER 1, 2023

6 Treatment : Airway Definitive airway management should be performed in those with respiratory distress with attention to appropriate resuscitation started beforehand in the setting of potential distributive shock from mediastinitis. 4 Fluid resuscitation and vasopressor use as appropriate. Accessed September 30, 2023.

Operations 93

Operations Radiology Radiology Fluid Resuscitation 93

AED Leader

DECEMBER 6, 2023

Omaha resident Greg Schraeder suffered a cardiac arrest on a social bike ride on June 20, 2023. The group performed cardiopulmonary resuscitation on Schraeder for around 11 to 13 minutes before an ambulance arrived and shocked him with an AED before taking him away.

CPR 52

CPR Resuscitation Shock 52

AED Leader

DECEMBER 6, 2023

Omaha resident Greg Schraeder suffered a cardiac arrest on a social bike ride on June 20, 2023. The group performed cardiopulmonary resuscitation on Schraeder for around 11 to 13 minutes before an ambulance arrived and shocked him with an AED before taking him away.

CPR 52

CPR Resuscitation Shock 52

Don't Forget the Bubbles

NOVEMBER 15, 2023

In a PICU setting, sodium can come from various sources (resuscitation fluids, IV drugs and infusions, enteral feed), not just the maintenance fluids we prescribe. There is growing interest in giving no maintenance fluid and using the input from drug infusions and resuscitative boluses only. Most drugs are chosen to be dissolved in 0.9%

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

The Skeptics' Guide to EM

FEBRUARY 25, 2023

Sodium bicarbonate use during pediatric cardiopulmonary resuscitation: a secondary analysis of the icu-resuscitation project trial. 2022 Date: February 15, 2023 Guest Skeptic: Dr. Carlie Myers is Pediatric Critical Care Attending at Cincinnati Children’s Hospital Medical Center. Reference: Cashen K, Reeder RW, Ahmed T, et al.

Pediatrics 52

Pediatrics Hospitals CPR Resuscitation 52

Critical Care Now

JULY 7, 2024

Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta in Trauma Patients With Exsanguinating Hemorrhage: The UK-REBOA Randomized Clinical Trial. 2023;e2320850. Reading Time: 3 minutes Jansen JO, Hudson J, Cochran C, et al.

Resuscitation 52

Resuscitation Military Outcomes Hospitals 52

PEMBlog

OCTOBER 26, 2023

Other complications include obstruction due to intussusception or volvulus, leading to bowel ischemia and shock. STAT Pearls, 2023 Wrap Up Meckel diverticulum is a congenital anomaly of the small intestine that can present with various clinical manifestations, including rectal bleeding and obstruction. Updated 2023 Jan 30].

Radiology 64

Radiology Radiology Resuscitation Administration 64

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. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

Sepsis 52

Sepsis Shock Administration Resuscitation 52