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). Answer : Bedside ultrasound! Smith : RV infarct may also have this appearance on ultrasound. So hypoxia without B lines on lung ultrasound strongly weights toward PE. Both were wrong.

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EKG/ECG Ultrasounds Shock EMS 128

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Shocked x 2 without effect. Pads were placed with ultrasound guidance, so they were in the correct position. Warning: if this is VT, a calcium channel blocker can result in shock and death. No adenosine was given (if you believe it is SVT, this is worth a try). However, this is not SVT. What to do now? K returned 3.6

EKG/ECG 139

EKG/ECG Shock Academics Documentation/Coding 139

ALiEM

OCTOBER 30, 2024

Clinical impact: The patient’s DVT ultrasounds were negative. 2023 Jan 1;53(1):140-2. 2022; 06/26/2023. 2023 Jun 1;36:89-91. This month in JAAD Case Reports: August 2023: Xylazine and skin necrosis. 2023 Aug 1;89(2):231. 2023 [book]. 2023 Jun 1;36:113-5. 2023 Aug 1;89(2):e99-102.

Emergency Department 64

Emergency Department Operations Psychiatric EMS 64

Dr. Smith's ECG Blog

JUNE 17, 2024

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 139

EKG/ECG Emergency Department Shock Ultrasounds 139

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. World J Emerg Surg 2023 PMID: 36918947 3. 2023 PMID: 37502742 11 Schwalbach KT et al. This study also showed the median time for IO placement was only 1.2 minutes CVC group.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

RebelEM

JUNE 26, 2023

Efficacy and Safety of Early Administration of 4-Factor Prothrombin Complex Concentrate in Patients with Trauma at Risk of Massive Transfusion: The PROCOAG Randomized Clinical Trial. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 to 2.10; P = 0.03 PMID: 36942533 Innerhofer P et al.

Administration 145

Administration Outcomes Resuscitation Radiology 145

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

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. link] Published February 12, 2023. Accessed September 30, 2023.

Hyperthermia / Hypothermia 110

Hyperthermia / Hypothermia Resuscitation CPR EMS 110

Taming the SRU

JUNE 3, 2024

Knowing the capabilities of your system BEFORE disaster strikes is crucial top 10 air care cases of 2023-2024 with drs. Get a blood gas when possible to help guide your ventilation.

Shock 91

Shock Seizures Airway Management Stroke 91

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

RebelEM

JANUARY 29, 2024

Clin Exp Emerg Med 2023. Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. Clin Exp Emerg Med 2023. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE? Click here for Direct Download of the Podcast Paper: Aykan AC et al.

Stroke 136

Stroke Outcomes Hospitals Administration 136

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

EMDocs

NOVEMBER 4, 2023

An ultrasound of the testes reveals the following: What is the diagnosis? Accessed April 26, 2023. Accessed May 2, 2023. J Emerg Trauma Shock. He reports approximately one month of dysuria, and around two weeks ago noticed a dull aching sensation in his testicles that has progressively gotten worse. Radiographics.

EMS 96

EMS Ultrasounds Emergency Department Infectious Diseases 96

Taming the SRU

JANUARY 10, 2024

2768 aka the SAVE act (introduced for the 3rd time 9/12/2023) which establishes a new criminal offense for knowingly assaulting or intimidating hospital personnel during the performance of their official duties in a manner that interferes with their performance of the duties or limits their ability to perform the duties. 2663 & S.1176

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

ACEP Now

SEPTEMBER 3, 2024

6,17-18 In a 2023 systematic review, no studies showed decreased costs to patients or payors, and the effect of PE ownership on quality of care measures was “mixed to harmful,” a pattern that has continued in subsequent studies. Her primary interests are in ultrasound, machine learning, and health justice. Published July 10, 2023.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

PEMBlog

OCTOBER 26, 2023

Other complications include obstruction due to intussusception or volvulus, leading to bowel ischemia and shock. Ultrasound and CT may not differentiate it from normal bowel. Reference article, Radiopaedia.org (Accessed on 26 Oct 2023) [link] Sagar J, Kumar V, Shah DK. Updated 2023 Jan 30]. ” An et. J R Soc Med.

Radiology 64

Radiology Radiology Resuscitation Administration 64

EMDocs

JANUARY 11, 2024

Author: Brit Long, MD (@long_brit) // Reviewed by Alex Koyfman, MD (@EMHighAK) The American Heart Association (AHA) and Neurocritical Care Society (NCS) released their 2023 Scientific Statement on the critical care management of post ROSC patients. 2023 Dec 1. Neurocrit Care. doi: 10.1007/s12028-023-01871-6. Epub ahead of print.

Seizures 98

Seizures Shock Infectious Diseases CPR 98

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. 2/19/2023 REFERENCES Sharman, J.E.,

Shock 59

Shock Resuscitation Ultrasounds Research 59

ACEP Now

MAY 9, 2024

6 The increasing mortality rate led to an additional emergency regulation in 2022 requiring the consenting physician to perform the critical steps of the case, limiting surgeons to three cases per day, and mandating continuous, recorded ultrasound guidance for gluteal AFT procedures. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 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. Reference article, Radiopaedia.org (Accessed on 13 Mar 2023) [link]. Necrotizing Enterocolitis. Updated 2022 Aug 8].

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 52

Taming the SRU

AUGUST 30, 2023

Specific Evidence: Septic arthritis: According to the European Journal of Bone and Joint Infection’s 2023 guidelines for septic arthritis of native joints (SANJO), no blood tests have adequate sensitivity or specificity to either diagnose or exclude SANJO. 2023 Feb 2;388(5):439-452. Updated 2023 Apr 24]. 2023 Jul 10.

Infectious Diseases 89

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

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

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 September 15, 2023 post — for PTA ( Pulse-Tap Artifact ).

EKG/ECG 64

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

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. 10/2/2023

Fractures 96

Fractures COPD Hospitals Emergency Department 96

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

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. But when you see this, you should suspect that the AV node is not well.

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

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 102

EMS Fluid Resuscitation Shock EKG/ECG 102

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 93

Sepsis Fluid Resuscitation Resuscitation Shock 93

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. Retrieved March 2, 2023, from [link] Levine, B. 2023, February 14). Retrieved March 2, 2023, from [link] Smith, J.

EMS 94

EMS Infectious Diseases Shock Ultrasounds 94

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). link] [Accessed 10 February 2023] Yartsev, A. link] Nickson, C.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

Mind The Bleep

JUNE 17, 2023

Gadiparthi R, 2023) Presents typically with suprapubic / umbilical pain which then migrates to the RIF. Brott NR, 2023) The child will look otherwise well and the abdomen will be soft with only mild tenderness to palpation in the lower abdomen with no guarding. Tends to be sharp stabbing pain. Associated with nausea, lack of appetite.

Shock 93

Shock Wellness Emergency Department Ultrasounds 93

EMDocs

NOVEMBER 13, 2023

However, IgE-mediated or not, anaphylactic shock is possible in either case. Emerg Radiol 2023. Semin Ultrasound CT MR 2017, 38 (4), 345-356. Neuroradiology 2023, 65 (1), 97-103. Stroke 2023, 54 (7), e314-e370. Intern Med 2023, 62 (7), 1067-1071. References (1) Barkovich, E. Batheja, V.; Malhotra, A.;

Stroke 105

Stroke Radiology Radiology Emergency Department 105

Mind The Bleep

JUNE 17, 2023

Gadiparthi R, 2023) Presents typically with suprapubic / umbilical pain which then migrates to the RIF. Brott NR, 2023) The child will look otherwise well and the abdomen will be soft with only mild tenderness to palpation in the lower abdomen with no guarding. Tends to be sharp stabbing pain. Associated with nausea, lack of appetite.

Shock 52

Shock Wellness Emergency Department Ultrasounds 52

Don't Forget the Bubbles

FEBRUARY 17, 2025

Before considering a further fluid bolus, you do a point-of-care ultrasound (POCUS). Volume resuscitation has historically been the first-line therapy for patients in septic shock. Taken together, the adult critical care community has shifted towards assessing for venous congestion at the organ level with Doppler ultrasound.

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78

EMDocs

JANUARY 20, 2025

2023 10 found that clinicians were 56% accurate in their assessments of patients admitted for heart failure when compared to the gold standard of blood volume measurement – a nuclear study utilizing radiolabeled red blood cells and albumin. 9 In terms of assessing volume status in general, Joseph et al. 11 A study by Stephan et al.

Dehydration 75

Dehydration Fluid Resuscitation Sepsis Resuscitation 75

Dr. Smith's ECG Blog

MARCH 3, 2025

Whenever there is tachycardia, I am skeptical of OMI unless it has led to severely compromised ejection fracction with cardiogenic shock. I suspect pulmonary edema, but we are not given information on presence of B-lines on bedside ultrasound, or CXR findings. Or I suspect that there is OMI simultaneous with another pathology.

EKG/ECG 74

EKG/ECG Emergency Department Hospitals Shock 74