Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A Rising Troponin That afternoon, he complained of increased shortness of breath and was noted to have oxygen saturations in the 70s, prompting a mini code to be called. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. What is it?

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Shock EKG/ECG Outcomes Hospitals 52

Dr. Smith's ECG Blog

OCTOBER 8, 2024

She was worked as a full code, and ROSC was achieved. A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. She could not be resuscitated. She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD.

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EKG/ECG Documentation/Coding Resuscitation Shock 116

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

She was in shock with thready pulses. The rate is not fast enough to be causing shock, so if it is VT, the priority is still to treat hyperK and secondarily to cardiovert. They thought it was VT, but did not shock. On arrival, the patient was in shock, was intubated, and had an immediate cardiac ultrasound.

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Shock EKG/ECG Resuscitation Ultrasounds 40

RebelEM

SEPTEMBER 26, 2022

Rezaie, MD (Twitter: @srrezaie ) The post TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding appeared first on REBEL EM - Emergency Medicine Blog. Significant coagulopathy: INR > 1.8 Significant coagulopathy: INR > 1.8

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Resuscitation Blood Transfusions Outcomes Hospitals 52

RebelEM

JUNE 8, 2023

Nontraumatic hypotension and shock in the emergency department and the prehospital setting, prevalence, etiology, and mortality: a systematic review. Emergency department hypotension predicts sudden unexpected in-hospital mortality: a prospective cohort study. 2006;130(4):941–6. PMID: 17035422 Holler JG, et al. 2015;10(3):e0119331.

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Administration Emergency Department Outcomes Documentation/Coding 98

Taming the SRU

SEPTEMBER 15, 2023

ETT onto a fiberoptic scope.

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CPR Burns Airway Management Wellness 89

Don't Forget the Bubbles

MAY 6, 2024

of patients with follow-up documentation, 70.8% (95% CI 62.9–77.9) Data collected were the worst values documented within the same calendar day as the blood cultures were obtained. The mean time to randomisation was 2 hours, which excludes the initial resuscitation window. Of the 74.9% 1872 children (mean age 2.5

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Sepsis Outcomes Pediatrics Documentation/Coding 75

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.

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Sepsis Shock Fluid Resuscitation Hospitals 40

JournalFeed

MARCH 26, 2022

Epi vs. NorEpi Spoon feed: Continuous epinephrine infusion for post-resuscitation shock in out of hospital cardiac arrest (OHCA) was associated with both higher all-cause and cardiovascular specific mortality when compared to norepinephrine. Check out journalfeed.org for details.

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Stroke Documentation/Coding Emergency Department Resuscitation 40

AED Leader

AUGUST 22, 2024

By delivering an electric shock to restore normal heart rhythm in cases of ventricular fibrillation or other arrhythmias, AEDs play a vital role in increasing survival rates following sudden cardiac arrests. If it detects such a problem, it delivers an electric shock to restore normal heart function.

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CPR Shock Operations Outcomes 52

Taming the SRU

JULY 31, 2024

morbidity and mortality - faculty case follow-up - R4 Capstone - high-risk, low prevalence diseases in pediatrics morbidity and mortality WITH dr. moulds Syncope Complete heart block is a rare but important cause of syncope P waves outnumbering QRS complexes should clue to you to high grade heart block Triage EKGs are often obtained to screen for cardiac (..)

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EKG/ECG Sepsis Documentation/Coding Stroke 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. 2 The astute paramedic recognized this possibility and announced a CODE STEMI.

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EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

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. Check temperature and blood glucose levels.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Pediatric Emergency Playbook

APRIL 1, 2016

There are two main reasons for an elevated lactate: the stress state and the shock state. The shock state is due to tissue hypoxia, seen in septic shock. We should use lactate to detect occult shock. Children compensate so well for shock, that subtle tissue hypoxia may not be detected until later. Am J Cardiol.

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Pediatrics Sepsis Shock Outcomes 52

EMDocs

JANUARY 11, 2024

Cardiac Management Takeaway : Perform an echo as soon as you can to guide resuscitation. Individualize the choice of using inotropes, vasopressors, or fluids to treat post-CA hypotension and to target the likely cause(s) contributing to the shock and hemodynamic state (100%, 23/23). There are no hard MAP recommendations.

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Seizures Shock Infectious Diseases CPR 75

Downeast Emergency Medicine

APRIL 26, 2021

Trauma patients between the ages of 18-90 years had to have either had one documented episode of hypotension (defined as a systolic BP <90 mmHg) or tachycardia (>100 beats/minute) to be included in the study. When looking at the subgroups with severe shock, there was an 18.5% MI or stroke).

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Head Injuries Administration Outcomes Seizures 52

Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

The latter 1950s and 1960s, quested for nerve gas defense studying expired air resuscitation and modern resuscitology; developing intensive care units. To me, it harkens a new scientific renaissance of resuscitation science, emergency care, and creating systems for care. 1950s & 1960s Resuscitation Research.

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Emergency Nursing EMS Resuscitation Military 40

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. Click to enlarge.) Emerg Med Pract. Am J Cardiol.

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Burns Fluid Resuscitation EKG/ECG EMS 52

RebelEM

MARCH 27, 2023

What They Did: Retrospective, observational cohort study in a single high-volume academic hospital The ED had a 5 bed area used for ongoing management and resuscitation of patients who clinically deteriorate while boarding or while actively undergo a workup in other sections of the ED. J Crit Care.

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Emergency Department Operations Documentation/Coding Academics 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

This pattern is essentially always accompanied by cardiogenic shock and high rates of VT/VF arrest, etc. The patient arrived to the ED in cardiogenic shock but awake. Code STEMI was activated. This one of the highest risk OMI patterns possible to see on an ECG. in-hospital mortality was 18.8% for AMI with new RBBB alone).

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EKG/ECG Shock EMS Documentation/Coding 52

Pediatric Emergency Playbook

JUNE 1, 2017

Hemodynamically labile children should be resuscitated and a stat transesophageal echocardiogram obtained. The best documented cormorbidity is sickle cell disease, although other pro-thrombotic conditions also put the child at risk. The high-velocity object: coronary artery dissection or thrombus Direct trauma (e.g. Pongratz G et al.

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Pediatrics EKG/ECG Wellness Seizures 52

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Nachi: Moving on to blood pressure: frank hypotension should make you immediately think of a ruptured AAA or septic shock 2/2 an intra abd infection. In one study, a SI > 0.7

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Ultrasounds Radiology Radiology Sepsis 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. This patient was reported to have distant heart sounds but was not hypotensive and did not have JVD according to documentation.

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EKG/ECG Ultrasounds Documentation/Coding COPD 40

EB Medicine

AUGUST 6, 2019

Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. Jeff: That is simply shocking! Jeff: For all agents, regardless of the DOAC, the initial resuscitation follows the standard principles of hemorrhage control and trauma resuscitation.

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Emergency Department Stroke Wellness Outcomes 40

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. Post opiate hypotension in prehospital trauma patients is a rare but documented complication. The latter also recommend ED thoracotomy in those with refractory shock.

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Emergency Department EKG/ECG Operations Fractures 40

EB Medicine

JULY 8, 2019

Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. PA’s and NP’s - make sure to use the code APP4 at checkout to save 50%. Finally, there is the roux-en-y gastric bypass.

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Emergency Department Sepsis Operations Dehydration 40

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). Trauma: In the trauma setting, metabolic acidosis often occurs secondary to hypoperfusion from hemorrhagic shock.

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Emergency Department Resuscitation COPD Shock 94

Taming the SRU

JUNE 6, 2023

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

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Documentation/Coding Seizures Psychiatric Wellness 64

Mind The Bleep

FEBRUARY 27, 2024

There could be any number of reasons for this but some examples are: they have severe D&V and aren’t keeping fluids down, or because they are pre or post-op, or have presented very unwell and need fluid resuscitation. saline + 5% dextrose or plasma-lyte 148 + 5% dextrose. saline), however more research is needed in this area. [4]

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Fluid Resuscitation Hospitals Dehydration Research 96

RebelEM

MAY 15, 2024

Coding for Mucositis. Give appropriate fluids, vasopressors, and antibiotics. Cohort Study of the Impact of Time to Antibiotic Administration on Mortality in Patients with Febrile Neutropenia. Antimicrob Agents Chemother. 2014 Jul; 58(7): 3799–3803. doi: 10.1128/AAC.02561-1 02561-1 Stiff, PJ. Loyola University Medical Center.

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Infectious Diseases Administration Sepsis Anaphylaxis 104

EB Medicine

JANUARY 2, 2019

For a completed abortion, you would expect a closed OS with no IUP on ultrasound with a previously documented IUP. Nachi: All unstable patients or those with suspected or proven ectopic or heterotopic pregnancies should be immediately resuscitated and taken for surgical intervention.

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Ultrasounds Radiology Radiology Infectious Diseases 40