Taming the SRU

JUNE 26, 2024

TEE can be helpful in guiding resuscitation if available. Factors that improve survival rates include cardiac activity on ultrasound, initial shockable rhythm, witnessed arrest, extremity only trauma, and bystander CPR. Unresponsive patients with undetectable MAP or EtCO2 less than 20 should undergo CPR.

Blood Transfusions 86

Blood Transfusions Sepsis CPR EKG/ECG 86

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Our first 12 lead ECG was then recorded at 0926. What do you think?

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

Dr. Smith's ECG Blog

OCTOBER 24, 2013

The physician recorded this ECG, interpreted it as normal, and sent the patient home on an antacid. He underwent immediate CPR, was found to be in ventricular fibrillation, and was successfully resuscitated. I do not have the post-resuscitation ECG. Did the ECG offer unseen hints? See explanation below. Lesson : 1.

EKG/ECG 52

EKG/ECG Resuscitation CPR Ultrasounds 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. Multiorgan POCUS The diagnostic power of POCUS often resides in combining multiple ultrasound exams. During a short period of ROSC an ECG was performed. EKG RV strain.

Ultrasounds 82

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 82

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

A prehospital ECG was recorded: Limb leads: Precordial Leads What is the therapy? On arrival, the patient was in shock, was intubated, and had an immediate cardiac ultrasound. 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.

Shock 40

Shock EKG/ECG Resuscitation Ultrasounds 40

EM Curious

JULY 8, 2015

ULTRASOUND GOODIE BAG ULTRASOUND FOR LATE PREGNANCY [PODCAST]: While not a routine exam we perform other than confirming fetal heart tones, definitely some great pearls on more advanced US topic. Consider an ultrasound guided ulnar nerve block. Part 1 here. US GUIDED ULNAR NERVE BLOCK [BLOG]: Boxer's fracture need a reduction?

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

ACEP Now

OCTOBER 9, 2024

However, the persistence of tachycardia despite fluid resuscitation and dosing with lorazepam to help with his panic disorder raised concerns that warranted further investigation. Collaborating with one of my ultrasound faculty, we conducted a bedside echocardiogram to explore potential cardiac anomalies. Eur J Cardiothorac Surg.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Ultrasounds Outcomes 52

EMDocs

MAY 15, 2024

ECG: Evaluate for ischemia, right heart strain. Ultrasound Sensitivity 88-100%, specificity 68-94% Positive likelihood ratio of 14.6 (95% Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Overestimates arterial oxygen saturation. Up to 3x less accurate in black patients. times maintenance.

Blood Transfusions 78

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 78

Taming the SRU

AUGUST 25, 2023

bicarb <18mEq/L) ketosis (preferably serum beta-hydroxybutyrate >3mmol/L) Risk factors SGLT2 inhibitor use fasting state ketogenic diet intra-abdominal pathology (AGE, pancreatitis, etc.) to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

An immediate 12-lead EKG was obtained: There is ST elevation in leads aVR and V1, with marked ST depression in I, II, III, aVF, V3-V6. Smith comment: This patient did not have a bedside ultrasound. In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. What should be done?

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Taming the SRU

FEBRUARY 23, 2024

Clinical pathologic case presentation - r1 diagnostics/therapeutics: Lumbar punctures - AIRWAY GROUND ROUNDS- r4 capstone - r3 taming the sru - ultrasound grand rounds Clinical pathologic case presentation WITH Drs. If assessing for SAH, xanthochromia may not appear until 12 hours after onset, though may appear after 2-4 hours.

Pediatrics 74

Pediatrics Ultrasounds Fractures Wellness 74

EMDocs

MAY 28, 2024

ECG: Evaluate for ischemia, right heart strain. Ultrasound Sensitivity 88-100%, specificity 68-94% LR+ of 14.6 (95% Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Overestimates arterial oxygen saturation. Up to 3x less accurate in black patients. times maintenance.

Blood Transfusions 75

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 75

Dr. Smith's ECG Blog

JULY 22, 2012

As part of her workup, this ECG was recorded: What do you think? Hemodynamic instability in trauma is usually due to bleeding, but if ultrasound shows poor contractility, then this may be due to cardiac contusion. The finding of RBBB on this ECG is highly suggestive, if not diagnostic, of myocardial contusion.

Head Injuries 52

Head Injuries EKG/ECG Outcomes Ultrasounds 52

Emergency Medicine Cases

OCTOBER 18, 2021

The post EM Quick Hits 33 Polytrauma Tips & Tricks, Toxic Megacolon, ECG in PE, Patch Calls, CT Before LP, Nebulized Ketamine appeared first on Emergency Medicine Cases.

EMS 52

EMS EKG/ECG Ultrasounds Resuscitation 52

ACEP Now

OCTOBER 29, 2024

Caring for critically ill patients with limited information requires snap assessments and judgements for timely resuscitation and efficient emergency department throughput. In this study, clinical gestalt is not only fast, but accurate for the benefit of timely resuscitation and intervention. Sound familiar?

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

EMDocs

OCTOBER 8, 2024

Glucose POC ECG: Is this actually sinus tachycardia? Looking at the initial or even repeating the ECG will be helpful here. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? Poor waveforms more often indicate decreased perfusion than hypoxia. Do they have edema?

Shock 95

Shock Emergency Department Pediatrics EKG/ECG 95

EMDocs

APRIL 10, 2024

1-3,5,7,9] All patients developing symptoms of LAST should be placed on a continuous cardiac monitor and have an ECG performed. [2] 2] Labs that may be useful after the initial resuscitation and for the admitting physician may include a basic metabolic panel and an arterial or venous blood gas analysis. [2]

Advances Cardiac Life Support (ACLS) 93

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 93

Dr. Smith's ECG Blog

MAY 19, 2020

A followup ECG was recorded 2 days later: No definite evidence of infarction. The ways to tell for certain include intravascular ultrasound (to look for extra-luminal plaque with rupture) or "optical coherence tomography," something I am entirely unfamiliar with. For clarity — I’ll again show the initial ECG done in the ED in Figure-1.

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He had the following EKG recorded: Low voltage, suggests effusion. A bedside cardiac ultrasound was normal, with no effusion. He was started on Extracorporeal Life Support ("VA ECMO") Here is the ECG on ECMO: Very low voltage On Day 3, the EF recovered (that seems quick!) Figure-1: The first 2 ECGs in today’s case ( See text ).

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

EB Medicine

MARCH 1, 2019

Again, no standard definition exists, with some diagnostic criteria including simply chest pain and increasing cardiac enzymes, and others including cardiac dysfunction, ecg abnormalities, wall motion abnormalities, and an elevation of cardiac enzymes. New EKG findings requires admission for monitoring. of those patients.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

Here is his ECG: The resident was alarmed at the "ST elevation in III with reciprocal ST depression in aVL" Are you alarmed? An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." What do you think?

EKG/ECG 40

EKG/ECG CPR Resuscitation Outcomes 40

ACEP Now

AUGUST 12, 2024

Every 30 minutes, a range of topics draws new participants to discuss everything from mastering ultrasound techniques to finding career mentorship. Get a personal financial plan, immerse yourself in hands-on training, brush up on your ultrasound and more. Emergency Ultrasound Management Course: (Sept. 28: 10 a.m.–5 28: 8 a.m.–5:30

Ultrasounds 52

Ultrasounds Research Radiology Radiology 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

What is your ECG interpretation and what would you do next? This ECG shows a normal sinus rhythm with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, late R wave progression (and misplaced V2), normal voltages, ST-elevation in aVR and global ST-depressions. BP was 110 and oxygen saturation was normal.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

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. Those with low voltage injuries and a normal EKG do not require monitoring. Jeff: Real quick – in case you missed it – ultrasound sneaks in again.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. This patient is only pseudo-stable.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

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: Diagnosis of appendicitis, in a pregnant patient, ultrasound vs. mri. Jeff: Next we have everybody’s favorite, the ultrasound. Jeff: Indeed. Sounds familiar.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Don't Forget the Bubbles

FEBRUARY 5, 2024

Sustained inflation and chest compression versus 3:1 chest compression to ventilation ratio during cardiopulmonary resuscitation of asphyxiated newborns (SURV1VE): A cluster randomised controlled trial. Assessing fluid responsiveness with ultrasound in the neonatal intensive care setting: the mini-fluid challenge. Schmölzer GM, et al.

Pediatrics 52

Pediatrics Research Resuscitation Psychiatric 52

Mind The Bleep

DECEMBER 31, 2023

Again, ask your registrar or consultant if you are unsure about fluid resuscitation/balance/maintenance in renal patients. or the patient is symptomatic or shows signs of hypokalaemia (ECG changes, weakness, arrhythmias). Acutely, the first step is to ensure there are no ECG changes caused by low calcium.

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

EMDocs

JANUARY 11, 2024

Cardiac Management Takeaway : Perform an echo as soon as you can to guide resuscitation. Early coronary angiography in post-CA patients with no ST-segment elevation on the presenting ECG may still be of benefit by potentially salvaging myocardium and decreasing the incidence of systolic heart failure in survivors (95.7%, 22/23).

Seizures 75

Seizures Shock Infectious Diseases CPR 75

Pediatric Emergency Playbook

JUNE 1, 2017

Electrocardiography (ECG) should be performed on any patient with significant blunt chest injury. A negative ECG is highly consistent with no significant blunt myocardial injury. Any patient with a new abnormality on ECG (dysrhythmia, heart block, or signs of ischemia) should be admitted for continuous ECG monitoring.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

EB Medicine

JULY 8, 2019

Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. Nachi: If possible, obtain a view of the IVC also while doing your ultrasound to assess for volume status. Nachi: If possible, obtain a view of the IVC also while doing your ultrasound to assess for volume status.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Rural Doctors Net

AUGUST 30, 2013

Intubation for humanitarian reasons is also reasonable – he’ll be in pain and this is not the time to be faffing around with the ultrasound or nerve stimulator doing blocks! Ultrasound can be useful – I am a fan of the SUSS-IT examination (seconary ultrasonographic survey in trauma). How to intubate?

Burns 52

Burns Hospitals Wellness Ambulance Services 52

EMDocs

JANUARY 20, 2024

ECG shows ST-segment elevation in V3-V6 only with depression in aVR. Initial vital signs include BP of 157/80, HR of 96, RR 14, SpO2 of 97% on RA, T 37.5. On exam, she is clutching her chest and is in acute distress due to pain with no other remarkable findings. Initial troponin is mildly elevated.

EMS 74

EMS Fluid Resuscitation Shock EKG/ECG 74

EMDocs

OCTOBER 7, 2023

neurologic damage and thrombosis) 20,21 Resuscitation Lactated ringers > Normal saline due to reduced need for urinary alkalinization 22 Place foley and target urine output >300 mL/hr Electrolyte abnormalities Hyperkalemia: Obtain an ECG Stabilization: Calcium gluconate 2 g over 5-10 min.

EMS 73

EMS Fluid Resuscitation Fractures Resuscitation 73

Critical Care Now

JUNE 21, 2022

His main areas of interest are Critical Care, Ultrasound, Prehospital Resuscitation, and Medical Education. The first prehospital EKG showed Polymorphic Ventricular Tachycardia (PVT) that responded to defibrillation. Reading Time: 3 minutes Mohamed Hagahmed, MD, EMT-P Mohamed is an Emergency Medicine Physician and EMS director.

Seizures 52

Seizures EKG/ECG CPR Shock 52

Downeast Emergency Medicine

MARCH 13, 2022

Key Concepts Quickly rule out life-threatening emergencies that require immediate resuscitation. rebound tenderness), getting an EKG if you have a high suspicion for cardiac involvement, or using ultrasound to assess for free fluid. ruptured ectopic pregnancy, etc. These are the “can’t miss” diagnoses!

Ultrasounds 52

Ultrasounds EKG/ECG Radiology Radiology 52

EMDocs

OCTOBER 29, 2024

Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit. Conventional cardiopulmonary resuscitation-induced refractory cardiac arrest due to latent left ventricular outflow tract obstruction due to a sigmoid septum: a case report. J Thorac Dis.

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Shock EMS Sepsis Resuscitation 87