RebelEM

JUNE 1, 2023

Background: Achieving ROSC in out of hospital cardiac arrest (OHCA) is no easy feat but, care doesn’t end with ROSC. Excluded: Obvious cause for OHCA prior to SDCT or on hospital arrival. Bystander CPR, a known predictor of good outcomes, was more common in the SDCT cohort than in the standard care cohort. IQR 2.2 – 69.5)

Outcomes 144

Outcomes Resuscitation Hospitals CPR 144

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

Resuscitation 98

Resuscitation EKG/ECG CPR Outcomes 98

ACEP Now

DECEMBER 6, 2024

During initial assessment, an ECG was obtained and revealed ST-segment elevation (STE) in the inferior leads with ST depression anteriorly. Initial ECG demonstrating inferolateral ST segment elevation and anteroseptal depression, just prior to cardiac arrest. The ECG showed ST-segment elevation without obstructive coronary disease.

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

RebelEM

MARCH 30, 2023

Background: Previous observational studies published in 2015 (Geri 2015)(Vyas 2015) indicated that early cardiac catheterization in patients with out-of-hospital cardiac arrest (OHCA) might improve mortality and result in more favorable neurological outcomes. Article: How-Berlemont C, Lamhaut L, Diehl J, et al. 1.15; P= 0.32 1.15; P= 0.31

Hospitals 59

Hospitals Outcomes EKG/ECG Resuscitation 59

Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. Initial ROSC was obtained, during which this ECG was obtained: What do you think? I sent it to 2 of my ECG nerd colleagues with no clinical information whatsoever, who instantly said: "Looks like afib with subendocardial ischemia and right heart strain pattern." "I

EKG/ECG 52

EKG/ECG Resuscitation Ultrasounds CPR 52

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. The paramedics achieve return of spontaneous circulation (ROSC) after CPR, advanced cardiac life support (ALCS), and Intubation. The TOMAHAWK Investigators.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Taming the SRU

OCTOBER 5, 2023

morbidity and mortality - quality improvement - research grand rounds - r1 clinical knowledge: pres/rcvs - r4 case follow-up: compartment syndrome Morbidity and Mortality WITH dr. finney Takotsubo Cardiomyopathy with COVID-19 Increasing incidence of Takotsubo Cardiomyopathy with the COVID-19 pandemic Morbidity and mortality is similar to that of ACS (..)

Stroke 91

Stroke EKG/ECG Seizures CPR 91

The Skeptics' Guide to EM

FEBRUARY 3, 2023

Temperature Control After In-Hospital Cardiac Arrest: A Randomized Clinical Trial. September 2022 Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the creator of the #FOAMed project called www.First10EM.com Case: You are working an overnight shift at a small rural hospital. Circulation. Circulation.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Documentation/Coding CPR 52

Thinking Critical Care

MAY 20, 2023

Montreal – both at the Heart Institute (core days) and my shop, Santa Cabrini Hospital (pre/post courses). If you’re not personalizing your CPR, here’s the place to learn! Doc Procedure Course , aimed at trainees but truly good for anyone entering the hospital arena, regardless of age or training status.

Airway Management 95

Airway Management Resuscitation EKG/ECG CPR 95

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. Two prehospital 12-lead ECGs looked similar to this ED ECG: This shows diffuse ST depression (I, II, III, aVL, aVF, V3-V6) with reciprocal ST elevation in lead aVR. This ECG is diagnostic of diffuse subendocardial ischemia.

Resuscitation 52

Resuscitation EKG/ECG Hospitals Emergency Department 52

EMDocs

JANUARY 8, 2024

For patients with OHCA, use of steroids during CPR is of uncertain benefit. Extracorporeal CPR Use of ECPR for patients with cardiac arrest refractory to standard ACLS is reasonable in select patients when provided within an appropriately trained and equipped system of care. COR 2b, LOE B-R. COR 2b, LOE C-LD. COR 1, LOE B-NR.

Seizures 97

Seizures Shock CPR Hyperthermia / Hypothermia 97

AED Leader

JULY 19, 2023

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. What Are the Benefits of a WiFi AED? cprINSIGHT Analysis. cprINSIGHT Analysis. LIFELINKcentral.

CPR 52

CPR Shock EKG/ECG Hospitals 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

It was witnessed, and CPR was performed by trained individuals. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. The following 12-lead ECG was recorded at 11 minutes after ROSC. at the time of the ECG. at the time of the ECG. Here is the annotated ECG from above, with lines drawn.

EKG/ECG 52

EKG/ECG CPR Resuscitation Research 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

Some total LAD occlusion manifest on the ECG similarly to some left main occlusions. Depending on where the STE vector of the LM occlusion shows up on the ECG, there may be either STE, or STD, or neither in aVR, and lead aVR will not be the important part of the ECG interpretation in these cases.

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

Dr. Smith's ECG Blog

MARCH 9, 2017

This was her ECG (it is unclear if this was with or without pain): Computerized ECG Read: “Normal sinus rhythm. Normal ECG.” Overall this is a very quiet ECG. link] A repeat ECG was performed 1.5 hrs after the initial ECG) she develops severe, crushing chest pain. Don’t trust the computerized ECG reading.

EKG/ECG 52

EKG/ECG CPR Shock Hospitals 52

AED Leader

DECEMBER 2, 2024

Furthermore, regular maintenance and training in cardiopulmonary resuscitation (CPR) techniques significantly enhance the potential effectiveness of AEDs in emergencies. Proper placement and accessibility are key factors in enabling quick response times necessary for survival to hospital discharge.

CPR 52

CPR Basic Life Support Resuscitation Hospitals 52

Don't Forget the Bubbles

OCTOBER 7, 2024

Suspected low voltage injuries (<1000v) should still be approached with an A-E assessment, but if 12 lead ECG and urinalysis are normal, it’s reasonable to discharge the patient. If the ECG is abnormal, the patient should be managed as if exposed to a high voltage (>1000v). Electrical Injuries. Chen P, Bukhman AK.

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

A prehospital ECG was recorded: Limb leads: Precordial Leads What is the therapy? What does a heart look like on ultrasound when the EKG looks like that? The followup ECG is here: Now the QRS is only slightly prolonged. Hospital admission had been recommended, but she left that ED against medical advice.

Shock 40

Shock EKG/ECG Resuscitation Ultrasounds 40

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He had the following EKG recorded: Low voltage, suggests effusion. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. This is the ECG on V-V ECMO: Very little STE He had a lot of troponins measured. He was moderately hypoxic. 3–8 Shi et al.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

Dr. Smith's ECG Blog

JUNE 11, 2021

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. The paramedics found the patient with ROSC and a GCS 7, and an ECG showing LBBB with possible lateral ST elevation. So the RCA was stented.

EKG/ECG 52

EKG/ECG Documentation/Coding CPR Shock 52

Ziqitza HealthCare Ltd

MAY 14, 2024

Not only immediate care but emergency ambulance services provide a safe haven to the patients by offering continuous pre-hospital care like administering medications, managing airways, controlling bleeding, CPR and other interventions. This can make the difference between life and death.

Ambulance Services 52

Ambulance Services Hospitals CPR EKG/ECG 52

Dr. Smith's ECG Blog

MARCH 11, 2016

Her prehospital ECG was identical to her first ED ECG, and the cath lab was activated: There is massive ST elevation (greater than 15 mm) in V2 and V3, with ST elevation in I and aVL and reciprocal ST depression in II, III, aVF. This comes from chapter 28 of my book The ECG in Acute MI ). hours when she called 911. ng/mL time 1.5

EKG/ECG 52

EKG/ECG Outcomes CPR Shock 52

Mind The Bleep

MAY 16, 2023

Admission: Low risk patients should not be admitted to hospital for prolonged periods of observation. Other tests: At most, guidelines suggest that an ECG and pertussis test may be undertaken. Invasive tests & imaging: blood tests (including gas), lumbar punctures, neuroimaging are all generally unnecessary in low risk patients.

Basic Life Support 52

Basic Life Support Seizures CPR Wellness 52

Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. This subsequent ECG was recorded after the K was up to 2.2 The QT is much shorter There are now clear U-waves in V2 and V3 2 days later, this ECG was recorded with a K of 3.5: These two rhythms are often indistinguishable on the monitor or ECG. This was stented.

Resuscitation 52

Resuscitation EKG/ECG Hospitals Administration 52

EMDocs

JANUARY 17, 2024

She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). Her electrocardiogram (ECG) showed atrial fibrillation which was cardioverted to sinus rhythm. She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED).

Poisoning 81

Poisoning Seizures Pediatrics EMS 81

EB Medicine

NOVEMBER 1, 2018

Thankfully, that gentleman was successfully resuscitated despite no bystander CPR, and if you listen carefully, we hope to arm you with the tools to do so similarly. It was peer reviewed by Dr. O’Keefe and Dr. Silverberg from Florida State University College of Medicine and Kings County Hospital, respectively. That’s -- high.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

EMDocs

JANUARY 11, 2024

Methods This scientific statement was led by the AHA and NCS and focused on the acute and critical care management of adult cardiac arrest survivors of in-hospital and out-of-hospital cardiac arrest. This post covers the key components, with each section starting with the key takeaway followed by the scientific statements.

Seizures 94

Seizures Shock Infectious Diseases CPR 94

Critical Care Now

JUNE 21, 2022

CPR was started immediately after the coaching staff could not find a pulse and EMS arrived to find the patient in cardiac arrest. The first prehospital EKG showed Polymorphic Ventricular Tachycardia (PVT) that responded to defibrillation. Hospital Course: The patient was intubated upon arrival in the ED and sedated with propofol.

Seizures 52

Seizures EKG/ECG CPR Shock 52

Dr. Smith's ECG Blog

FEBRUARY 18, 2025

He had worked overnight the night before and presented to the hospital after his shift. Here is his presenting ECG: What do you think? The ECG shows sinus rhythm. Altogether, this ECG is suspicious (but probably not diagnostic) for hyperkalemia. This is an extremely subtle ECG. Repeat ECG was performed.

EKG/ECG 64

EKG/ECG COPD CPR Administration 64

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64