Dr. Smith's ECG Blog

APRIL 2, 2024

He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. Patient received 11 shocks by ICD and was in V-fib when EMS arrived. Here is the initial ED ECG.

EKG/ECG 131

EKG/ECG Shock CPR Stroke 131

EM Curious

SEPTEMBER 2, 2015

The idea of the FOAMed review is to give you a digestible selection of reliable content from the online EM/CC world, including interesting and relevant evidence based medicine, that you can fit into your busy weekly schedule. Ultrasound of the Week Procedure Pearl Ear foreign body removal with modified suction setup.

Ultrasounds 52

Ultrasounds EMS Shock Hospitals 52

RebelEM

APRIL 29, 2024

The current standard of practice has moved away from landmark-based central line placement given the efficacy and safety of ultrasound-based techniques. Rezaie, MD (Twitter/X: @srrezaie ) The post Don’t Forget About the IO in the Critically Ill Patient appeared first on REBEL EM - Emergency Medicine Blog. minutes CVC group.

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

Taming the SRU

JUNE 24, 2024

Follow this algorithm in patients with unstable bradycardia with acute heart failure, change in mental status, or concern for shock, physicians should start with atropine, 1 mg and may be continued every 3 to 5 minutes if effective.

Advances Cardiac Life Support (ACLS) 91

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 91

EM Curious

JULY 1, 2015

The idea of the FOAMed review is to give you a digestible selection of reliable content from the online EM/CC world that you can fit into your busy weekly schedule. Over a year's span we will be sure to include topics from all core EM content areas.even the ones that may not be the coolest. Should we all be jumping on board?

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

ALiEM

OCTOBER 30, 2024

Case A patient arrives via EMS from the bus station complaining of fever, vomiting, and back pain. Clinical impact: The patient’s DVT ultrasounds were negative. Our experience: It was not long ago that we instructed our staff that: ‘COWS >8, give ’em 8 (mg of buprenorphine).’

Emergency Department 64

Emergency Department Operations Psychiatric Hospitals 64

PHEM Cast

APRIL 16, 2018

Ultrasound during TCA: Cureton et al. The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest. The outcomes from different resuscitative interventions in a haemorrhagic shock model in porcine model: From: Watts et al. Use of CPR in hemorrhagic shock, a dog model. 2012; 73: 102-10.

Resuscitation 52

Resuscitation Shock Ultrasounds CPR 52

EM Curious

SEPTEMBER 9, 2015

The idea of the FOAMed review is to give you a digestible selection of reliable content from the online EM/CC world, including interesting and relevant evidence based medicine, that you can fit into your busy weekly schedule. Learn the presentation and management of this disease process in the core content post at Core EM.

Stroke 52

Stroke Pediatrics Best Practices EMS 52

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. The TOMAHAWK Investigators.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Critical Care Now

APRIL 26, 2022

Reading Time: 3 minutes Mohamed Hagahmed, MD, EMT-P Mohamed is an Emergency Medicine Physician and EMS director. His main areas of interest are Critical Care, Ultrasound, Prehospital Resuscitation, and Medical Education. When EMS arrived, they found the patient to be responsive only to painful stimuli and was moaning.

Resuscitation 52

Resuscitation Fluid Resuscitation EMS Sepsis 52

Dr. Smith's ECG Blog

MAY 13, 2020

A 60-something man presented by EMS with 5 hours of fairly typical sounding substernal chest pain. Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS. What do you think the echocardiogram shows?

EKG/ECG 52

EKG/ECG EMS Shock Ultrasounds 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. Smith comment: This patient did not have a bedside ultrasound. En route, EMS administered aspirin 325mg by mouth, but withheld nitroglycerin due to initial hypotension.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Dr. Smith's ECG Blog

OCTOBER 17, 2024

I would do bedside ultrasound to look at the RV, look for B lines as a cause of hypoxia (which would support OMI, and argue against PE), and if any doubt persists, a rapid CT pulmonary angiogram. The paramedic notes called STEMI into question: “EMS disagree with monitor for STEMI callout. Coronaries were normal, as was serial troponin.

EKG/ECG 72

EKG/ECG EMS Shock Ultrasounds 72

Emergency Medicine Cases

MARCH 10, 2020

Dr. Allan Shefrin tells his Best Case Ever of a child who presents in shock and discusses the causes of tension hydrothorax, indications for tube thoracostomy for hydrothorax and integration of POCUS into pediatric resuscitation. The post BCE 81 Tension Hydrothorax appeared first on Emergency Medicine Cases.

Shock 52

Shock Pediatrics Resuscitation Ultrasounds 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. Bedside ultrasound is another very important piece. Do you activate the Cath Lab?

Ultrasounds 40

Ultrasounds EKG/ECG EMS Radiology 40

RebelEM

JANUARY 25, 2023

2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 2.3 – 5.4) (-) LR: 0.18 (0.09 – 0.35) Ultrasound Findings Dilated loops of bowel (diameter > 2.5 3.6 – 55.6) (-) LR: 0.13 (0.08 – 0.20) ED US (+) LR: 9.5 (2.1 0.27 – 0.83 0.34 – 0.43

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Advanced Emergency Nursing from AENJ

NOVEMBER 24, 2016

While Point of Care Ultrasound has made limited entry in prehospital care, largely with physician-led services and some Advanced Paramedics; it has largely been as a proof of concept rather than everyday care. An elderly lady in cardiogenic shock (BP 60/40) with no veins , I was lucky to get a 24-gauge PIV into the back of her wrist.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

Dr. Smith's ECG Blog

AUGUST 3, 2018

Nurses found him with a BP of 50/30 and heart rate of 130 and called EMS. Here was his prehospital ECG, which I viewed immediately while the resident performed cardiac ultrasound: What do you think? Here is the cardiac ultrasound which the resident performed as I viewed the ECG: This shows a huge pericardial effusion.

EKG/ECG 40

EKG/ECG Ultrasounds Stroke Shock 40

EB Medicine

JULY 8, 2019

Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

Dr. Smith's ECG Blog

MARCH 15, 2023

Her bedside cardiac ultrasound was normal We decided to cardiovert her since the time of onset was very recent. We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion. But when you see this, you should suspect that the AV node is not well.

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

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. Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

EMDocs

NOVEMBER 4, 2023

We’ll keep it short, while you keep that EM brain sharp. An ultrasound of the testes reveals the following: What is the diagnosis? J Emerg Trauma Shock. A 54-year-old male with a history of diabetes presents with “pain in my groin” for the past two weeks. Insights Imaging. 2016;7(5):689-711. 2012;5(2):206. N Engl J Med.

EMS 93

EMS Ultrasounds Emergency Department Infectious Diseases 93

EMDocs

JULY 15, 2023

We’ll keep it short, while you keep that EM brain sharp. 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.

EMS 91

EMS Infectious Diseases Shock Ultrasounds 91

EB Medicine

AUGUST 6, 2019

Interestingly, one retrospective study found limited agreement between EMS records and hospital documentation on current DOAC usage. But next we should talk about ultrasound. Jeff: That is simply shocking! This can help with destination selection when relevant. Nachi: Extremely important to identify DOAC use early.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Shocked x 2 without effect. Pads were placed with ultrasound guidance, so they were in the correct position. Warning: if this is VT, a calcium channel blocker can result in shock and death. Read this post: Idiopathic Ventricular Tachycardias for the EM Physician 2. However, this is not SVT. What to do now? K returned 3.6

EKG/ECG 138

EKG/ECG Shock Academics Documentation/Coding 138

EMDocs

DECEMBER 18, 2023

Today, she would not get out of bed, prompting the facility to call EMS. Septic shock is high on the differential diagnosis for this patient’s presentation. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. The patient currently resides at a skilled nursing facility.

Sepsis 90

Sepsis Fluid Resuscitation Resuscitation Shock 90

Taming the SRU

FEBRUARY 7, 2024

AirCare - Derm Emergencies - R4 Capstone - Landmarks of EM - Global Health - Toxicology Aircare Grand ROunds WITH Drs. Ultrasound: Make “windows of access”. Keep your upper chest and sternum clear. Lung and heart views are most critical in HEMS as they determine interventions that change patient care.

PPE 99

PPE Administration Ultrasounds Poisoning 99

RebelEM

JUNE 26, 2023

appeared first on REBEL EM - Emergency Medicine Blog. Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03

Administration 143

Administration Outcomes Resuscitation Radiology 143

Dr. Smith's ECG Blog

AUGUST 9, 2024

About 2 hours later the patient arrived at a PCI-capable center and repeat ECG was obtained: The transferring EMS crew noted “runs of VT” during transport. However the patient continued to have chest pain and bedside ultrasound showed hypokinesis of the septum with significantly reduced LVEF. In fact, use of antidyrhythimcs (e.g.,

EKG/ECG 106

EKG/ECG EMS Emergency Department Wellness 106

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. EMS verbalized concern to EPs that an “intracranial bleed” may have precipitated the event. 1-3 As many as 25% of acute PE cases present as sudden cardiac death.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

EMDocs

JANUARY 16, 2024

Authors: Christian Gerhart, MD (EM Resident Physician, Washington University in St. Louis); Dr. Jessica Pelletier, DO (EM Attending Physician, Washington University in St. You receive a page for a cardiac arrest and take report from emergency medical services (EMS). Per EMS he was very cold to touch. 2009;338:b2085.

Hyperthermia / Hypothermia 109

Hyperthermia / Hypothermia Resuscitation CPR EMS 109

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.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

EMDocs

JULY 17, 2023

3 Point of care ultrasound (POCUS) can be highly sensitive for free fluid and pneumoperitoneum when used by a trained physician in the appropriate patient population. However, surgical consultation should not be delayed while waiting for imaging in a patient who is in shock, appears toxic, or has signs of peritonitis. -In

Operations 97

Operations EMS Fluid Resuscitation Resuscitation 97

RebelEM

JANUARY 29, 2024

Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. A prospective, Single-Arm Multicenter Trial of Ultrasound-Facilitated, Catheter-Directed, Low-Dose Fibrinolysis for Acute Massive and Submassive Pulmonary Embolism: The SEATTLE II Study. CHEST 2010.

Stroke 136

Stroke Outcomes Hospitals Administration 136

Dr. Smith's ECG Blog

OCTOBER 7, 2019

This is by one of our outstanding 3rd year residents , Aaron Robinson, with some edits and comments by Smith EMS responded to a reported seizure in a 42 year old male. One of our EMS Fellows along with a Senior EM Resident were on duty that evening, and arrived on the scene with the Fire Department. Why is the patient in shock?

Seizures 40

Seizures EKG/ECG Shock EMS 40

Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. 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 138

EKG/ECG Emergency Department Shock Ultrasounds 138

Dr. Smith's ECG Blog

JULY 18, 2014

He had walked into the ED (did not use EMS). Case Continued 2 days later the patient became increasingly tachycardic, hypotensive, ashen, clammy (in cardiogenic shock) and had a new murmur. If detected early by ultrasound, the patient can be saved. Exact pain history was difficult to ascertain. There was some SOB.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52