Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He was admitted on oxygen and was doing fairly well with saturations of 100% on 2 L nasal cannula. 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. Assessment was severe sudden cardiogenic shock. What is it?

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

American Medical Compliance

OCTOBER 25, 2024

Compliance isn’t just a box to check—it’s a vital responsibility that safeguards patient well-being and protects organizations from significant financial losses. Shockingly, over $54 billion is stolen each year through scams targeting patients and insurance companies with fraudulent medical charges, according to the NHCAA.

Documentation/Coding 85

Documentation/Coding Operations Best Practices Shock 85

EM Guide Wire

SEPTEMBER 9, 2020

0.5 – 1 mg q5min, max dose 3 mg peds = 0.02 Epinephrine bolus 20-40 mcg IV (EMCRIT recommended dose using push dose epi) peds 0.01 Dosing formula on MedCalc using serum level & amount ingested (mg ingested x 0.8

Documentation/Coding 52

Documentation/Coding Hyperthermia / Hypothermia Sepsis Shock 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.

Administration 98

Administration Emergency Department Outcomes Documentation/Coding 98

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. About 45 minutes after the second EKG, the patient was found in cardiac arrest. She was taken to the cath lab, where she was found to have 100% in-stent restenosis of the proximal LAD.

EKG/ECG 116

EKG/ECG Documentation/Coding Resuscitation Shock 116

Dr. Smith's ECG Blog

JUNE 17, 2024

There are well preserved R-waves in Wellens waves. 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.

EKG/ECG 141

EKG/ECG Emergency Department Shock Ultrasounds 141

Don't Forget the Bubbles

MAY 10, 2023

Then you hear the words coming out of the speaker, “ Paediatric code black. Paediatric code black ”. You’ve heard the phrase code black before – it’s a traumatic cardiac arrest. A shocked friend is being ushered out of the way. You know a paediatric code black means paediatric traumatic cardiac arrest.

Emergency Department 91

Emergency Department Resuscitation Documentation/Coding Teamwork 91

Don't Forget the Bubbles

JULY 26, 2023

A cardiac family history should of course be sought, but think a little outside the box as well. For anyone approaching a structured ABC would be a priority to establish whether shock was present or not. We now have a patient who is in sustained SVT but with no features of shock. Family history. What if this does not work?

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Taming the SRU

SEPTEMBER 15, 2023

Limited availability of radiology-performed US services in certain hospitals, especially overnight Can avoid unnecessary anticoagulation in patients Reduce time in ED to disposition In terms of workflow, when there is suspicion for a DVT, you need to first calculate a Wells’ Score for a DVT If low/moderate risk, can start with a D-dimer prior to committing (..)

CPR 89

CPR Burns Airway Management Wellness 89

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. In both tracings — an exceedingly fast PMVT is documented. LAD — 100% proximal occlusion; with 70-89% mid-vessel narrowing. RCA — 100% proximal occlussion. What About Procainamide?

EKG/ECG 122

EKG/ECG Shock Hospitals Sepsis 122

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? Jeff : So get this -- one study showed that out-of-hospital shock index and respiratory rate were highly predictive of ICU admission.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. There are of course much more complex neurohumoral, inflammatory type cytokiney thingies going on but as you can tell they are well over my head so I’ve skipped them for now. I’ll let that sink in. I’ll let that sink in.

Sepsis 96

Sepsis Shock Wellness Documentation/Coding 96

ACEP Now

JUNE 14, 2024

The inaugural ACEP Accelerate conference – which combined the ED Director’s Academy, the Advanced Pediatrics EM Assembly, Reimbursement & Coding, and Teaching Fellowship—took place in Arlington, TX in March 2023. There were some ACEP business decisions at the April Board meeting, as well. 17-23, 2025 in Orlando, Florida.

Sexual Assault 52

Sexual Assault Seizures Documentation/Coding EMS 52

AED Leader

NOVEMBER 25, 2024

Effective January 1, 2017, the state’s Health and Safety Code 19300 mandates that certain high-occupancy buildings must install Automated External Defibrillators (AEDs). AEDs are portable devices designed to diagnose and treat SCA by delivering a controlled electric shock to restore normal heart rhythm.

CPR 52

CPR Documentation/Coding Shock Hospitals 52

PulmCCM

MARCH 4, 2024

About half of participants had had documented prior Covid infection. While not IQ tests per se , the tests (branded as Cognitron ) purport to correlate well with, and to be indexed to, formal IQ tests. Thanks to the large data set, however, other demographics were well-represented and analyzable. standard deviation).

Sepsis 52

Sepsis CDC Pediatrics Documentation/Coding 52

RebelEM

AUGUST 12, 2024

Thus further adding to the well known safety of amino acid infusions The lack of a diversified patient population in combination with having used only one type of amino acid formulary greatly limits this study’s generalizability.

Outcomes 81

Outcomes Hospitals Operations Shock 81

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. While the use of oral corticosteroids to treat wheeze in asthma is well-established, evidence for their benefit in viral-induced wheeze is mixed.

Sepsis 75

Sepsis Outcomes Pediatrics Documentation/Coding 75

Dr. Smith's ECG Blog

AUGUST 9, 2024

He had no previously documented medical problems except polysubstance use. The LCx and OM vessels are not as well visualized. below) Other examples of AIVR: Young man with Gunshot wound to right chest with hemorrhagic shock, but bullet path not near heart. An ECG was obtained shortly after arrival: What do you think?

EKG/ECG 92

EKG/ECG EMS Emergency Department Outcomes 92

Pediatric Emergency Playbook

APRIL 1, 2016

Brain natriuretic peptide (BNP) In adults, we typically think of a BNP Luckily, we have data in children with congenital heart disease as well. This has been studied in children as well, and an elevated lactate in children – typically above 4 – was a predictor of prolonged ICU course and mortality in septic patients.

Pediatrics 52

Pediatrics Sepsis Shock Outcomes 52

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.

CPR 52

CPR Shock Operations Outcomes 52

Medical Law

JULY 19, 2024

However, the influx of cyclists also highlights the pressing need for well-maintained infrastructure to ensure safety. Unlike vehicles, bicycles have less stability and shock absorption, making them more susceptible to road imperfections. Moreover, these issues often go unrepaired for extended periods, exacerbating the risk.

Documentation/Coding 52

Documentation/Coding Shock Wellness 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. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis. What do you see?

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

AED Leader

JUNE 25, 2024

Philips is a well-known and trusted brand in the AED market, providing reliable and user-friendly devices. Keep Track of Maintenance and Servicing Proper documentation of maintenance and servicing activities is crucial for record-keeping and compliance purposes.

Operations 52

Operations Best Practices Documentation/Coding Shock 52

EMDocs

JANUARY 11, 2024

Individualize MAP targets based on the patient, as well as treatments (inotropes, vasopressors, and fluids) for hypotensive patients. 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).

Seizures 75

Seizures Shock Infectious Diseases CPR 75

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9%

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

PulmCCM

OCTOBER 30, 2023

Professional Medical Societies Call for Elimination of SEP-1 The Infectious Diseases Society of America (IDSA), along with societies for emergency medicine physicians and hospitalists, are again speaking up about the ongoing policy experiment known as the Centers for Medicare and Medicaid Severe Sepsis/Septic Shock Management Bundle (SEP-1).

Sepsis 52

Sepsis Shock Hospitals Outcomes 52

EMDocs

FEBRUARY 9, 2024

She is well appearing, and while being placed on the monitor becomes anxious stating the symptoms are recurring. A 200J shock is reasonable – though a higher dose may be needed for larger patients. The literature base for the use of lidocaine for torsade storm is documented primarily by case studies in drug-induced TdP.

EKG/ECG 72

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 72

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. Documentation with coronary arteriography within 12 1/2 hours of the onset of symptoms in two cases (three episodes). FIGURE 2: Traumatic amputation and electrical burn of the patient’s left arm.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Sensible Medicine

AUGUST 14, 2024

In popular (lay) understanding, SIDS represents a common danger that a well-cared for and apparently healthy baby will suddenly and terrifyingly be found dead in the morning. ” Indeed, cause of death is coded differently over time and across counties, states, and countries.

CDC 76

CDC Sepsis Research Pediatrics 76

Don't Forget the Bubbles

OCTOBER 10, 2024

The others, such as respiratory rate, heart rate, and decompensated shock, were excluded due to the presumed difficulty for non-healthcare professionals to assess them accurately. Adopting this approach would reduce time in surgery for the child as well as the financial cost of nail bed repair.

Emergency Department 75

Emergency Department Outcomes Research Operations 75

ACEP Now

AUGUST 15, 2023

Friends are getting joint replacements, cancer, and other illnesses, and I am now having some of those same ailments as well. The AMA Code of Medical Ethics’ Opinion on Physicians Treating Family Members advises against it. I was recently hospitalized for a fever of unknown origin at a well-respected teaching hospital.

Hospitals 52

Hospitals Documentation/Coding Fractures Dislocations 52

Don't Forget the Bubbles

OCTOBER 16, 2024

Don’t forget the essentials: Eat Hydrate +/- caffeinate Exercise Unwind Sleep It’s not rocket science, but it’s shocking how many of us forget! Don’t be afraid to ask the simple questions: Where do I document? Top tip: verbally communicating your plan followed by clear documentation can help avoid confusion!

Teamwork 52

Teamwork Documentation/Coding Leadership Burns 52

RebelEM

MARCH 27, 2023

4 Using factors such as shock, pneumonia, and sepsis this score allows an accurate prediction of developing ARDS. There may have very well been a policy where only RTs can make changes to a ventilator after an order was placed to ensure accurate documentation.

Emergency Department 52

Emergency Department Operations Documentation/Coding Academics 52

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).

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Advanced Emergency Nursing from AENJ

MAY 3, 2014

Although told several times, the story of the development by Henning Ruben of the prototypical modern manual resuscitator, the self-refilling bag with unidirectional non-rebreathing valves which now dominate the world of resuscitation, is still not well-known. Documents improvements in BVMs previously investigated and found deficient in FIO2.

Resuscitation 40

Resuscitation Military Operations Emergency Nursing 40

Dr. Smith's ECG Blog

MAY 8, 2023

Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessively discordant TE in V2-V4. This is a huge anterolateral OMI. I cannot be anything else.

EKG/ECG 52

EKG/ECG Documentation/Coding Outcomes Shock 52