EMDocs

JANUARY 23, 2024

An inciting event will typically push them over the edge into BRASH syndrome: Dehydration Hypotension from sepsis or another condition GI illness Dosage increase of a chronic medication (e.g., Episode 93: BRASH syndrome Background: Brash syndrome has 5 components: bradycardia, renal failure, AV nodal blocker, shock, hyperkalemia.

Shock 106

Shock Dehydration Sepsis EKG/ECG 106

Ken Grauer, MD

AUGUST 18, 2023

The premature P waves preceding each of the even-numbered beats in Figure-3 are not well seen in the long lead II rhythm strip. PEARL # 4: Twelve leads are better than one. If no easily "fixable" cause is found — further evaluation including chest X-ray and/or Echo may be indicated.

EKG/ECG 195

EKG/ECG Dehydration Wellness 195

Don't Forget the Bubbles

DECEMBER 13, 2023

Susan had issues initially with ensuring the correct latch, but after a review with a lactation consultant, feeding is going well. Though it has been hard, they have been coping well and enjoying parenthood. First and foremost, do they look well or unwell? Are there signs of significant dehydration or malnutrition?

Dehydration 98

Dehydration CDC Hospitals Wellness 98

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. Furthermore, notice the well-formed Q-waves in inferior leads. The patient was suffering from severe dehydration, possibly with sepsis.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

Pediatric Emergency Playbook

MAY 1, 2017

They may get a little dehydrated, especially if mother’s milk is late to come in. Home care The neonate who is safe to go home is well appearing, and not dehydrated. Make sure to enlist the family's help and support to keep Mom hydrated, eating well, and resting whenever she can. Their livers are immature. Bhutani et al.

Dehydration 52

Dehydration Pediatrics Wellness Seizures 52

Taming the SRU

AUGUST 27, 2024

This differential is broad and reflects the clinical diversity of their presentations - in this post we will parse through the specifics of bullous lesions as well as what there is to do for them acutely. There is typically no mucous membrane involvement, however children will also have poor feeding resulting in fluid loss and dehydration.

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

ACEP Now

OCTOBER 30, 2023

Oftentimes, it can be an indication of pain, infection, distress, anxiety, dehydration, or the first sign of sepsis. If they are part of the Deaf community, ensure that they have an American Sign Language interpreter present, as well as an in-person interpreter to best communicate the emotion behind their speech.

Sexual Assault 98

Sexual Assault Teamwork Dehydration Outcomes 98

EMDocs

JULY 29, 2023

Other bacterial causes include anaerobic oral flora, Strep viridans, E. Other bacterial causes include anaerobic oral flora, Strep viridans, E.

EMS 90

EMS Dehydration Ultrasounds Emergency Department 90

EMDocs

FEBRUARY 7, 2024

Multiple well-designed, multicenter, multinational studies suggest GLP-1 agonists are associated with improved glucose control in diabetes type 2 and approximately a 15% reduction in weight over 1-2 years (around 2/3s of patients regain weight if treatment is stopped). Obesity affects over 40% of U.S.

Allergic Reactions 93

Allergic Reactions Anaphylaxis Dehydration Wellness 93

Pediatric Education

SEPTEMBER 3, 2023

He had no concerns and he was doing well in school and with his friends. He had a sprained ankle the previous year that he says was well-healed. With your sickle cell trait you usually shouldn’t have any problems, but dehydration could cause problems for you. The past medical history was positive for sickle cell trait.

Dehydration 40

Dehydration Hyperthermia / Hypothermia Pediatrics Military 40

Don't Forget the Bubbles

NOVEMBER 15, 2023

As well as requesting relevant investigations and reviewing her drugs, you send paired urine and serum electrolytes to calculate a fractional excretion of sodium to categorise the cause as pre-renal vs other (see [link] for more information). Is it any wonder all of our PICU patients suffer from fluid overload?!

Resuscitation 80

Resuscitation Dehydration Administration Shock 80

Dr. Smith's ECG Blog

DECEMBER 11, 2018

The patient had a glucose of 1400, was severely dehydrated, and after receiving 4 liters of fluid, albuterol, and insulin, the K had dropped precipitously to 5.8 Severe dehydration. When we did get a chem back (drawn after 6 g Ca gluconate), the K was 9.0 mEq/L and the ionized calcium was not reported because it was too low.

EKG/ECG 52

EKG/ECG Dehydration Burns Outcomes 52

Don't Forget the Bubbles

JANUARY 17, 2024

Other symptoms, such as constipation, abdominal pain and dehydration, were also be seen. Point-of-care ultrasound may show well-demarcated, round, and hypoechoic material in the stomach and first part of the duodenum, though it can underestimate the number of beads present. Zamora et al., Persistent vomiting affected all 43 cases.

Pediatrics 111

Pediatrics Poisoning Ultrasounds Dehydration 111

Northwestern EM Blog

FEBRUARY 21, 2022

Anticipatory guidance is not just for well-child checks ! We’ve all seen an end-of-life situation generate a second patient with dehydration mediated syncopal episode at the bedside, let’s try to prevent that. Second, I insist that the family especially the decision-maker drink a bottle of water and eat a sandwich.

Dehydration 52

Dehydration Shock Hospitals Wellness 52

Dr. Smith's ECG Blog

JUNE 20, 2020

. - He rehydrated and had no orthostatic symptoms prior to discharge, ambulated well. - He was not interested in remaining hospitalized for further cardiac monitoring or inpatient EP consultation as he felt well, was convinced dehydration was the reason for his syncope, and he adamantly wanted to go home.

EKG/ECG 52

EKG/ECG Dehydration Hospitals Wellness 52

Pediatric Emergency Playbook

FEBRUARY 1, 2017

Symptoms – either typical dysuria, urgency, frequency in a verbal child, or non-descript abdominal pain or vomiting in a well appearing child. In a low risk child, with obviously very vigilant parents, who is well appearing, you may choose not to test now, and ensure close follow up. No obvious source? How should I treat UTIs?

Dehydration 52

Dehydration Wellness Ultrasounds Pediatrics 52

The Skeptics' Guide to EM

APRIL 27, 2019

She is otherwise well appearing and has normal vitals and examines normally. We looked at a trial by Freedman et al using half-strength apple juice or fluids of choice to treat mild gastroenteritis in children who were minimally dehydrated ( SGEM#158 ). Anthony is known for his online RANThonys and website SketchyEBM.

Pediatrics 40

Pediatrics Dehydration Emergency Department Hospitals 40

Mind The Bleep

APRIL 26, 2024

Note: Painful teeth in well patients with mild, soft swellings with no palpable collection are often treatable with a course of oral antibiotics and seeking emergency dental treatment in the community via NHS111. Is there any asymmetry/fullness in the pharyngeal area? Is there tenderness of teeth to percussion/palpation?

Emergency Department 52

Emergency Department Fluid Resuscitation Dehydration Resuscitation 52

Dr. Smith's ECG Blog

FEBRUARY 29, 2016

He is worried that he may be dehydrated. Answer: There are well-formed Q-waves in inferior and lateral leads. He did have one episode of diarrhea. He denied fevers and chills, abdominal pain, chest pain, or SOB. Has been able to intermittently tolerate PO intake. He did not finish his dialysis run today.

EKG/ECG 52

EKG/ECG Dehydration Stroke Wellness 52

Don't Forget the Bubbles

SEPTEMBER 29, 2024

Most children are generally well and can be sent home directly from the ED with appropriate safety netting and follow-up. Let’s break it down: Less than 50% of normal fluid intake in a 24-hour period Children who are sick generally don’t eat or drink, so dehydration is a legitimate concern. Then, they are safe for discharge.

Emergency Department 52

Emergency Department Dehydration Hospitals Fractures 52

Dr. Smith's ECG Blog

JULY 24, 2018

Sinus tachycardia with unequivocal evidence of hyperkalemia, including widened QRS with "pulled apart" morphology (widened QRS) compared to baseline, as well as clearly peaked T-waves. We advised them to give more calcium as well as other hyperkalemia treatment during transport. This patient must receive calcium as soon as possible.

EKG/ECG 52

EKG/ECG Dehydration Resuscitation Documentation/Coding 52

Mind The Bleep

JUNE 18, 2023

environmental factors, pain, infection, dehydration, electrolyte disturbance, head injury, medication etc) Does the individual have capacity? In a general hospital there are the dementia and delirium team, as well as Liaison Psychiatry who you can refer to.

Psychiatric 52

Psychiatric Documentation/Coding Stroke Fractures 52

Dr. No

DECEMBER 19, 2021

It’s not often that Dr No’s flabber gets well and truly ghasted. An extraordinary exchange on twitter (scroll down a page or so to get to the start of the substance, and click here to see the above tweet) has revealed what many have long suspected: SAGE purposely cook the books in its modelling reports.

Infectious Diseases 52

Infectious Diseases Outcomes Dehydration Operations 52

PEMBlog

MARCH 27, 2024

Or, well, the ringer called me. GI symptoms are the second most common, and they include vomiting, food intolerance, food aversion, GERD, refractory to normal antireflux measures, diarrhea, and dehydration. This was made by people who know them very well. And you’re thinking, hey! No, I’m not.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

Dr. Smith's ECG Blog

MARCH 15, 2023

But when you see this, you should suspect that the AV node is not well. My main concern about Apple Watch monitoring — is the potential for increasing the anxiety of otherwise well individuals who become overly focused on, “What terrible arrhythmia is my Apple Watch now showing at this particular moment?”

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

Mind The Bleep

MAY 16, 2023

It is also sensible to advised to ensure good fluid intake throughout treatment to help avoid dehydration which can occur with laxatives. If the child has evidence of faltering growth , we should always test for coeliac disease and hypothyroidism.

Dehydration 52

Dehydration Best Practices Documentation/Coding Emergency Department 52

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. For the sake of completeness, just be aware that there is also the biliopancreatic diversion with or without a duodenal switch, as well as a vertical banded gastroplasty. At 6 to 8 mL/kg.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Taming the SRU

MARCH 31, 2023

of emergency medicine residents report 1 or more dimensions of burnout (Lin Annals Emerg Med 2019) Moral Injury with COVID “We pushed aside our fear and frustration to focus on saving the patients in front of us; we kept our eyes open, and our feelings closed.

Allergic Reactions 40

Allergic Reactions Seizures Anaphylaxis Leadership 40

Don't Forget the Bubbles

JANUARY 10, 2024

These were presented as hazard ratios and included fever at presentation, previous transfusion ever, haemoglobinuria, malaria, sickle cell disease on enrolment, HIV, evidence of sepsis, malnutrition, shock, hypothermia, and dehydration. Groups were well matched at baseline. Were the study groups similar at the start of the trial?

Blood Transfusions 78

Blood Transfusions Research Outcomes Hospitals 78

PEMBlog

OCTOBER 2, 2024

Children with respiratory conditions and chronic lung disease like asthma are more prone to GERD as well. So, the parents may say, well, he Doesn’t ever seem full. Well, baby doesn’t know how to be full. or somebody who appears pale, dehydrated, in severe pain, or worse, even in shock.

Pediatrics 52

Pediatrics Emergency Department Ultrasounds Wellness 52

Taming the SRU

APRIL 13, 2023

beta blockers decrease ability to dissipate heat through increase CO, diuretics predispose to dehydration, or anticholinergic agents can affect thermoregulation) Clinical Presentation: Temperature elevation, usually 40.5C EtOH, amphetamines, or cocaine) Prescription drugs (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Dr. Smith's ECG Blog

OCTOBER 25, 2022

ie, dehydration, periods of increased stress or anxiety, stimulants such as caffeine, alcohol, recreational drugs, etc.); My patient with stress-induced SVT did well for months at a time when her stress was controlled. How often she gets it? — and — How long it takes vagal maneuvers to work?; and , iv ) Previous treatments tried?

EKG/ECG 52

EKG/ECG Administration Dehydration Emergency Department 52

Mind The Bleep

JULY 23, 2023

Abnormal bicarbonate secretion due to CFTR mutation causes an acidic and dehydrated environment which results in thick, viscous mucous that forms thick meconium that can then obstruct the lumen. NG feeds if not feeding well. Biopsy shows absence of parasympathetic ganglia and presence of hypertrophied nerve trunks in the bowel wall.

Sepsis 52

Sepsis Blood Transfusions Dehydration Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

As for other invasive therapies , intra-aortic balloon counterpulsation (12, 13) appears to work well in non-randomized studies, and this would also make sense: the balloon in the aorta inflates in diastole, increasing diastolic pressure and thus coronary flow. For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Pediatric EM Morsels

SEPTEMBER 20, 2024

Though most children recover well after STEC is cultured from their stool, some will go on to display the findings that make up HUS. Considering HUS and treating dehydration early has been shown to help keep the dialysis machine away! The most notable varietal of the STEC is E.coli 0157:H7 (do you remember that from medical school?).

Pediatrics 164

Pediatrics Ultrasounds Dehydration Emergency Department 164

ACEP Now

MARCH 11, 2025

16 An elevated amylase suggests repetitive vomiting as well. It may be tempting to administer crystalloid boluses to patients with eating disorders who appear to be dehydrated in the ED; however, this should be avoided because a common cardiac complication is heart failure.

Emergency Department 52

Emergency Department Psychiatric Dehydration Pediatrics 52

Don't Forget the Bubbles

JANUARY 27, 2025

Place the patient nil by mouth Insert 2x large bore cannulae + take pre-operative blood tests including a blood gas, group & save, clotting, as well as the usual full panel including FBC, LFTs, renal profile, amylase, CRP and beta HCG to rule out relevant negatives Obtain urine for urinalysis and pregnancy test Consider Chlamydia + gonorrhoea swabs (..)

Ultrasounds 76

Ultrasounds Emergency Department Pediatrics Dehydration 76