Dr. Smith's ECG Blog

OCTOBER 26, 2010

He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. More often, tachycardia with ST segment abnormalities (elevation or depression) is due to an underlying illness (PE, sepsis, hemorrhage, dehydration, hypoxia, respiratory failure, etc.). He had this ECG recorded. The K returned at 6.9

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

Don't Forget the Bubbles

MAY 17, 2023

This month’s list features answers to intriguing questions such as: ‘ Is the neonatal sepsis calculator useful if women were not screened for GBS? ’, ‘ Who can best score postoperative pain: parents or the children? ’, ‘ Is functional constipation associated with hypohydration? Diagnosis and Management of Pituitary Adenomas: A Review.

Pediatrics 72

Pediatrics X-Ray Interpretation Sepsis Fractures 72

The Skeptics' Guide to EM

OCTOBER 23, 2021

Pathway with single-dose long-acting intravenous antibiotic reduces emergency department hospitalizations of patients with skin infections. AEM October 2021 Guest Skeptic: Dr. Lauren Westafer an Assistant Professor in the Department of Emergency Medicine at the University of Massachusetts Medical School – Baystate.

Emergency Department 52

Emergency Department Sepsis Hospitals Research 52

EMDocs

JULY 29, 2023

A 75-year-old male with past history of HTN, CVA, DM II presents to the emergency department with right facial swelling since last night. Transoral Ultrasound in the Diagnosis of Obstructive Salivary Gland Pathologies. Ultrasound Med Biol. We’ll keep it short, while you keep that EM brain sharp. RR 18, SpO2 97% on RA.

EMS 83

EMS Dehydration Ultrasounds Emergency Department 83

EM Curious

JULY 15, 2015

Intravenous Metoclopramide for Acute Migraine Therapy in the Emergency Department PMID : 26048068 FOAM : EM Lit of Note Immediate Discharge and Home Treatment With Rivaroxaban of Low-risk Venous Thromboembolism Diagnosed in Two U.S.

Airway Management 52

Airway Management EMS Poisoning Emergency Department 52

Northwestern EM Blog

MAY 16, 2022

What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Many patients in the ultrasound groups did get additional imaging, but this was not the majority. How do you proceed?

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

EB Medicine

SEPTEMBER 1, 2018

Jeff: Welcome back to Emplify, the podcast corollary to EB Medicine’s Emergency Medicine Practice. I’m Jeff Nusbaum, and I’m back with my co-host, Nachi Gupta and we’ll be taking you through the September 2018 issue of Emergency Medicine Practice - Emergency Department Management of North American Snake envenomations.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

Broome Docs

APRIL 6, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. Clinical risk factors for testicular torsion and a warning against falsely reassuring ultrasound scans: a 10-year single-centre experience. A prospective cluster-randomized trial to implement the Canadian CT Head Rule in emergency departments.

Sepsis 52

Sepsis Ultrasounds Hospitals Fractures 52

The Skeptics' Guide to EM

JANUARY 25, 2020

His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. Case: A 60-year-old male is […] The post SGEM#281: EM Docs Got an AmbuBag – The PreVent Trial first appeared on The Skeptics Guide to Emergency Medicine. Date: January 9th, 2020 Reference: Casey et al.

EMS 40

EMS Airway Management Administration Resuscitation 40

Pediatric Emergency Playbook

JUNE 1, 2016

Cardiogenic Shock: Act Use point-of-care cardiac ultrasound : Good Squeeze? It’s seen easily enough on point of care ultrasound. Tamponade: if any sign of shock, pericardiocentesis, preferentially ultrasound-guided. Children with sepsis come in two varieties: warm shock and cold shock. Pericardial Effusion? Pediatrics.

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

Taming the SRU

MAY 1, 2023

A retrospective evaluation of phenobarbital versus benzodiazepines for the treatment of alcohol withdrawal in a regional Canadian emergency department Link: [link] Bottom Line: This study in a small regional ED showed a QI project rolling out a Phenobarbital or Diazepam for Alchohol withdrawal syndrome. and NPV(50%).

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

PEMBlog

JANUARY 17, 2024

Full blown sepsis and toxic shock syndrome. If you think that there’s an abscess, you can diagnose it clinically by a localized area of induration or fluctuance or use an ultrasound. You’re concerned about SIRS or sepsis. Now, some facilities have a short stay unit, like in their emergency department.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). 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.

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

Don't Forget the Bubbles

FEBRUARY 5, 2024

Role of diagnostic tests for sepsis in children: a review. Assessing fluid responsiveness with ultrasound in the neonatal intensive care setting: the mini-fluid challenge. Procedural sedation programme minimising adverse events: a 3-year experience from a tertiary paediatric emergency department. Anagnostou A, et al.

Pediatrics 52

Pediatrics Research Resuscitation Psychiatric 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

New insights into the use of the 12-lead electrocardiogram for diagnosing acute myocardial infarction in the emergency department. Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g., Am J Med 2019, 132(5):622-630. Miranda DF, Lobo AS, Walsh B, et al.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

EMDocs

MARCH 4, 2024

Darnall Army Medical Center) // Reviewed by: Joshua Lowe, MD (EM Attending Physician, USAF); Marina Boushra (EM-CCM, Cleveland Clinic Foundation); Brit Long, (@long_brit) Disclaimer: The views expressed in this post are those of the authors and do not reflect the official policy or position of the Department of the Army, DoD, or the US Government.

Emergency Department 99

Emergency Department Ultrasounds EMS Radiology 99

ACEP Now

OCTOBER 29, 2024

On a busy day shift in the emergency department, our seasoned triage nurse comes to me after I finish caring for a hallway patient, “Hey, can you come see this guy in the triage room? This means deviating from protocols (when warranted) for sepsis because your initial impression is the patient would be harmed with that much fluid.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

EMDocs

DECEMBER 18, 2023

Introduction Sepsis and septic shock are life-threatening conditions characterized by severe systemic inflammation and organ dysfunction due to a dysregulated host response to infection. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician.

Sepsis 75

Sepsis Fluid Resuscitation Resuscitation Shock 75

Don't Forget the Bubbles

JULY 5, 2023

Vaccination: PCV13 (pneumococcal vaccination), meningococcal vaccines, and Hib conjugated vaccines are important to prevent life-threatening sepsis. Sickle cell patients also qualify to receive the annual influenza vaccine, since influenza virus infection predisposes to bacterial pneumonia and sepsis caused by S. Pneumococcal sepsis B.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

Don't Forget the Bubbles

JULY 17, 2023

Reviews and opinion articles Point-of-care ultrasound in pediatric nephrology. Evaluating the Impact of the 2017 Dutch Neonatal Early-Onset Sepsis Guideline. 2023 Jun 1;76(6):731-736 The Association Between Media-Based Exposure to Nonsuicidal Self-Injury and Emergency Department Visits for Self-Harm. Sethi SK, et al.

Pediatrics 98

Pediatrics Emergency Department Outcomes Fractures 98

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Some may present with isolated tachycardia while others may present with profound sepsis – tachycardia, hypotension, and fever.

Emergency Department 40

Emergency Department Sepsis Operations Ultrasounds 40

Pediatric Emergency Playbook

AUGUST 1, 2017

One of our largest responsibilities in the Emergency Department is sorting out benign from surgical or medical causes of abdominal pain. Abdominal Surgical Emergencies in Children: A Relative Timeline General Advice Neonate (birth to one month) Necrotizing Enterocolitis Pneumatosis Intestinalis. J Ultrasound. 2008; 15-21.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

EB Medicine

NOVEMBER 1, 2018

But this month’s episode is special in its own way - we’ll be tackling Electrical Injuries in the emergency department - from low and high voltage injuries to the more extreme and rare lightning related injuries. Jeff: Let’s move on to evaluation in the emergency department. Jeff: You’re right. Let’s move on to treatment.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Taming the SRU

AUGUST 30, 2023

While PCT may be more specific for bacterial infections, it is flawed by still being rather non-specific and is not validated as a stand-alone diagnostic criteria for infection in the setting of the emergency department. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. ng/mL, 0.25-0.5

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88

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. was sensitive for 28-day mortality in sepsis. Sounds familiar. Jeff: We sure did!

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EMDocs

MAY 11, 2024

Cavernous sinus syndrome (B) usually presents with cranial nerve deficits, diplopia, periorbital cellulitis, and facial swelling that may progress to meningitis or sepsis. Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Ann Emerg Med. Erratum in: Ann Emerg Med. anatomic region). doi: 10.1053/j.sult.2013.01.004.

Stroke 101

Stroke EMS EKG/ECG Radiology 101

EMDocs

JULY 15, 2023

A lower extremity radiograph does not reveal any gas formation and an ultrasound of the lower extremity is negative for DVT or cobblestoning, WBC is within normal limits and there are mild elevations in ESR and CRP. No fungal infections are identified on the feet. Given the patient’s comorbidities laboratory and imaging studies are ordered.

EMS 76

EMS Infectious Diseases Shock Ultrasounds 76

ACEP Now

MAY 4, 2023

Case A 37-year-old white male with no past medical history presented to the emergency department (ED) for left testicular pain, redness, and swelling. Diagnosis: Complex Hydrocele (Pyocele) The testicular ultrasound revealed a small left complex hydrocele suspicious for pyocele. The testicle did not appear to be malpositioned.

Urgent Care 52

Urgent Care Ultrasounds Sepsis Emergency Department 52

Taming the SRU

MAY 5, 2023

Early Restrictive or Liberal Fluid Management for Sepsis-Induced Hypotension. doi:10.1056/NEJMoa2212663 BACKGROUND Sepsis, including severe sepsis and septic shock, is a frequently encountered condition in the emergency department and carries a high mortality rate. N Engl J Med. 2023;388(6):499-510. N Engl J Med.

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Don't Forget the Bubbles

NOVEMBER 1, 2023

This month, Bubble Wrap has teamed up with Sheffield Children’s Hospital Emergency Department to have a look at what’s new in paediatric literature. Lactate as a screening tool for critical illness in a pediatric emergency department. Pediatric Emergency Care. 2023 Oct 1;39(10):735-8. What’s it about?

Emergency Department 140

Emergency Department Hospitals Resuscitation Administration 140

Don't Forget the Bubbles

MARCH 4, 2024

We have teamed up with the team from the Emergency Department at Bristol Royal Hospital, who have used this as a springboard for their journal club. (It’s The children’s Emergency department sees approximately 50,000 presentations per year. Reviewed by: John Coveney Article 2: How do we define sepsis in children?

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

Don't Forget the Bubbles

SEPTEMBER 23, 2024

You are working in the paediatric emergency department of a busy District General Hospital. These centres have a close relationship with their patients, but this does not mean they may not turn up at your emergency department! Consider sepsis and treat it accordingly. How does your differential diagnosis change?

Pediatrics 52

Pediatrics Fractures Dehydration Sepsis 52

Don't Forget the Bubbles

MAY 8, 2024

A silent scream in the pediatric emergency department: child abuse and neglect. Emergency department discharge practices for children with acute wheeze and asthma: a survey of discharge practice and review of safety netting instructions in the UK and Ireland. Akkaya B et al. Eur J Pediatr. 2024 Apr 13. Yager H et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

The Skeptics' Guide to EM

NOVEMBER 23, 2024

Dennis Ren is a pediatric emergency medicine physician at Children’s National Hospital in Washington, DC. Case: A 10-year-old boy presents to the community emergency department (ED) with abdominal pain. He’s also the host of SGEMPeds. It started last night but the pain seemed to worsen this morning.

Pediatrics 74

Pediatrics Sepsis Academics Emergency Department 74

EMDocs

JANUARY 20, 2025

Sepsis There has been much controversy over the last two decades around the various nuances of volume resuscitation in ED patients with suspected sepsis, much of which goes beyond the scope of this limited review. For links to FOAM-ED ultrasound content, see the section after take-home points.) 11 A study by Stephan et al.

Dehydration 69

Dehydration Fluid Resuscitation Sepsis Resuscitation 69

Don't Forget the Bubbles

FEBRUARY 17, 2025

1] Fred is a 3-year-old boy who presents to the emergency department. He has received 20ml/kg in 5 to 10ml/kg aliquots in the ED, as his blood pressure keeps dropping, and the ED team is concerned about possible sepsis. Before considering a further fluid bolus, you do a point-of-care ultrasound (POCUS).

Pediatrics 78

Pediatrics Ultrasounds Shock Resuscitation 78