The Skeptics' Guide to EM

SEPTEMBER 11, 2021

He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP). She arrives in the emergency department (ED) with decreased level of consciousness and shock.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Pediatric Emergency Playbook

AUGUST 1, 2017

Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. J Ultrasound. The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study? Utility of MRI After Inconclusive Ultrasound in Pediatric Patients with Suspected Appendicitis. Semin Pedaitr Surg. Dias SC et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Dr. Smith's ECG Blog

MAY 19, 2020

In this case, profound shock for 1 hour would result in the same degree of infarction. The Type 2 MI would then have been a result of the prolonged severe shock while in arrest. If the arrest had another etiology (such as old scar), and the ST elevation is due to severe shock, then it is a type II STEMI. Troponin I rose to 44.1

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

RebelEM

JANUARY 25, 2023

2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

PulmCCM

OCTOBER 16, 2023

Most central lines in the ICU are placed under ultrasound guidance in the internal jugular vein, representing a perceived middle ground of risk for pneumothorax and infection prevention. Peripherally-inserted central catheters (PICCs) are inserted through the skin into an arm vein, and advanced under ultrasound into large central veins.

CDC 52

CDC Hospitals Ultrasounds Documentation/Coding 52

EB Medicine

AUGUST 6, 2019

Make sure to get the name, dose, and time of last administration of any DOAC. But next we should talk about ultrasound. Jeff: That is simply shocking! High dose infusions for those on rivaroxaban doses of >10 mg or apixaban doses >5 mg within the last 8 hours and for unknown doses and unknown time of administration.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

RebelEM

JUNE 26, 2023

Interventions such as early application of hemorrhage control, tranexamic acid, reduction of crystalloid fluid administration and balanced ratio blood product transfusion have improved many patients’ outcomes. However, mortality still remains high due to trauma-induced coagulopathy. Severe acute traumatic coagulopathy = PT >1.5

Administration 145

Administration Outcomes Resuscitation Radiology 145

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

Taming the SRU

FEBRUARY 7, 2024

Ultrasound: Make “windows of access”. For blood product administration, PROPPR showed that 1:1:1 platelet, plasma, and pRBC administration led to earlier hemostasis along with less death due to blood loss and whole blood compared to separate blood product administration led to decreased death at 24 hours.

PPE 98

PPE Administration Ultrasounds Poisoning 98

EMDocs

NOVEMBER 4, 2023

An ultrasound of the testes reveals the following: What is the diagnosis? 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. Based on the presentation above, what is the best next step in management?

EMS 95

EMS Ultrasounds Emergency Department Infectious Diseases 95

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

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. The Accu-Chek was 214, and there was no response to empiric Narcan administration. 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

JANUARY 29, 2024

PMID: 37188358 Clinical Question: What is the efficacy and safety of low-dose (25mg) prolonged administration (over 6hrs) of alteplase in patients with massive PE? Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. Clin Exp Emerg Med 2023. CHEST 2010.

Stroke 136

Stroke Outcomes Hospitals Administration 136

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. Be careful with excessive medication administration.

Hyperthermia / Hypothermia 110

Hyperthermia / Hypothermia Resuscitation CPR EMS 110

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. And sepsis-3 redefined septic shock as “hypotension not responsive to fluid resuscitation” with the added requirement of vasopressors to maintain a MAP greater than or equal to 65 and with a lactate > 2. That’s where we’re at.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Dr. Smith's ECG Blog

AUGUST 9, 2024

However the patient continued to have chest pain and bedside ultrasound showed hypokinesis of the septum with significantly reduced LVEF. Although recognition of OMI was not affected by administration of morphine in this case, use caution with analgesia in ongoing ACS without a definitive plan for angiography. Leave it alone.

EKG/ECG 107

EKG/ECG EMS Emergency Department Wellness 107

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

EMDocs

JULY 17, 2023

3,14 There are currently no good studies of enteric or rectal contrast administration in the evaluation of LBO and there are no society recommendations for its use. 3 Point of care ultrasound (POCUS) can be highly sensitive for free fluid and pneumoperitoneum when used by a trained physician in the appropriate patient population.

Operations 98

Operations EMS Fluid Resuscitation Resuscitation 98

ACEP Now

SEPTEMBER 3, 2024

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. The AMA found that administrative burden of reimbursement and low rates were the most frequent factors in physicians’ decisions to sell their practices. References Pomorski C.

Hospitals 113

Hospitals Radiology Radiology Emergency Department 113

PulmCCM

JULY 10, 2023

In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours). However, the practice has not been supported by randomized trials.

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Downeast Emergency Medicine

APRIL 26, 2021

2][3] If earlier treatment with TXA is better, would there be benefit in its administration in the prehospital setting? Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. When looking at the subgroups with severe shock, there was an 18.5% JAMA Neurol. 2021;78(3):338–345.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Dr. Smith's ECG Blog

APRIL 8, 2016

He appeared to be in shock. Bedside ultrasound showed no effusion and moderately decreased LV function, with B-lines of pulmonary edema. IV administration of potassium is indicated when arrhythmias are present or hypokalemia is severe (potassium level of less than 2.5 He was managed medically with Clopidogrel.

Resuscitation 52

Resuscitation EKG/ECG Hospitals Administration 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Perhaps, not insignificantly, they were accustomed to receiving systematized government-supplied medical and trauma care, with "shock rooms" receiving an influx of victims, as contrasted to those later who opposed "socialized medicine." EM makes a strong push into bedside use of ultrasound sonography. EDNA->ENA.

Emergency Nursing 40

Emergency Nursing EMS Resuscitation Military 40

EB Medicine

SEPTEMBER 1, 2018

Unfortunately, this myokymia may not respond to antivenom administration and myokymia of the chest well and torso can necessitate intubation in extreme cases. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Nachi: In terms of respiratory effects of envenomations – they aren’t common.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EB Medicine

AUGUST 1, 2018

It was peer-reviewed by Joseph Habboushe, assistant professor at NYU and Nadia Maria Shaukat, director of the emergency and critical care ultrasound at Coney Island Hospital in Brooklyn, New York. Jeff: There are a shocking 22 million past-month users of marijuana in the US, followed by pain relievers at 3.8 million, and cocaine at 1.9

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Pediatric Emergency Playbook

JANUARY 1, 2017

CRIES is a 10-point scale, using a physiologic basis similar to APGAR: Crying; Requires increased oxygen administration (distress and breath-holding); Increased vital signs; Expression; and Sleeplessness ( Krechel 1995 ). Once the pain is controlled, less frequent administration of medications, with frequent reassessments, are indicated.

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

EMDocs

JANUARY 4, 2025

PMID: 39480221 #2: Albumin for AKI in Septic Shockor Not Spoon Feed Administration of early albumin to patients in septic shock with acute kidney injury (AKI) was associated with worse outcomes. 2024 Oct 18:S0012-3692(24)05315-7. doi: 10.1016/j.chest.2024.10.012. 2024.10.012. 2024 Oct 18:S0012-3692(24)05315-7. doi: 10.1016/j.chest.2024.10.012.

Shock 98

Shock Ultrasounds Pediatrics Administration 98

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.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Fluid Resuscitation Resuscitation 52

Dr. Smith's ECG Blog

APRIL 9, 2025

On arrival in the ED, a bedside ultrasound showed poor LV function (as predicted by the Queen of Hearts) with diffuse B-lines. Primary VF in this study refers to fibrillation occurring in the absence of shock or pulmonary edema. Following PSM, lidocaine administration was associated with greater odds of prehospital ROSC (36.0

EKG/ECG 63

EKG/ECG Resuscitation Administration Shock 63

EMDocs

NOVEMBER 13, 2023

However, IgE-mediated or not, anaphylactic shock is possible in either case. Semin Ultrasound CT MR 2017, 38 (4), 345-356. Frequency of acute kidney injury following intravenous contrast medium administration: a systematic review and meta-analysis. IgE-mediated reactions to contrast do exist, but they are very rare. Kallmes, D.

Stroke 106

Stroke Radiology Radiology Emergency Department 106

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

Don't Forget the Bubbles

JULY 5, 2023

Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. The high blood flow velocities through these stenotic segments can be detected using transcranial doppler ultrasound (TCD). coli and Staphylococcus aureus.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126