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. Then the patient's electronic record from an outside hospital appeared. Here is the initial ED ECG. What do you think?

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Dr. Smith's ECG Blog

JUNE 17, 2024

Given his exertional chest pain and elevated troponin, the patient was admitted to the hospital for "NSTEMI" with a plan for left heart catheterization the next day. Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism. Now another, with ultrasound. What is the Diagnosis?

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EKG/ECG Emergency Department Shock Ultrasounds 140

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.

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Stroke Outcomes Hospitals Administration 133

Taming the SRU

JUNE 3, 2024

Myth: Some patients are “too sick to transport” Myth Part B: The receiving hospital gets to decide if a patient is too sick to transport. What drives the concern? Relative to inactions, actions receive more attention, elicit stronger emotional reactions, trigger higher regret, and are often perceived as more consequential.

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Shock Seizures Airway Management Stroke 91

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Assessment was severe sudden cardiogenic shock. He remained hypotensive and in shock. He was intubated and then went pulseless.

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Shock EKG/ECG Outcomes Hospitals 52

JournalFeed

JULY 6, 2024

Monday Spoon Feed : The only strong recommendation for corticosteroid use was in patients needing to be hospitalized with severe community acquired pneumonia. The panel recommended against high-dose/short duration corticosteroids in patients with septic shock. for appendicitis. for appendicitis.

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Shock Ultrasounds Pediatrics Hospitals 52

Taming the SRU

JANUARY 10, 2024

There are 38 states where it currently is a felony of some level to assault a healthcare worker BUT there is currently no federal law that protects hospital employees from assault or intimidation. Current bills in progress: US H.R.2663 2663 & S.1176 1176 focuses on violence prevention (introduced for the 3rd time 4/18/23); US H.R.2584

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EKG/ECG Shock Fractures Dislocations 93

EMDocs

APRIL 22, 2024

1-3 VTE is responsible for hospitalizing over 250,000 Americans every year, and there are an estimated 100,000 deaths annually associated with these conditions. 1-3 VTE is responsible for hospitalizing over 250,000 Americans every year, and there are an estimated 100,000 deaths annually associated with these conditions.

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Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Shock 97

ACEP Now

SEPTEMBER 3, 2024

Hahnemann University Hospital in Philadelphia closed in 2019, a year and a half after it was acquired along with St. Christopher’s Hospital for Children by private equity (PE) firm Paladin Healthcare Capital for 170 million dollars. 14 Dr. Stinson remembers what it was like to work for a PE-owned hospital early in her career. “I

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EMDocs

JANUARY 16, 2024

He subsequently walks out of the hospital with a normal neurologic exam two weeks after admission. VF/asystole), a pulse cannot be identified via Doppler ultrasound for a full minute, or if lack of organized cardiac activity is confirmed on bedside echocardiogram. The patient is extubated and decannulated four days later.

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EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. For those listening, my hospital probably looks a little bit like yours. Roughly half of in-hospital mortality is associated with septic in some fashion. At our hospital in northern Manhattan they like to breath around 18.

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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. The patient was extubated on Day-3 of the hospital stay. The patient improved, and on Day-11 of the hospital stay — he was off inotropes and on a small dose of a ß-blocker.

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EKG/ECG Shock Hospitals Sepsis 132

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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EM Curious

SEPTEMBER 2, 2015

CORE CATEGORIES Airway Preparation EM in 5 Ultrasound Case 56 year old male presents with right sided hemiparesis and expressive aphasia. Ultrasound of the Week Procedure Pearl Ear foreign body removal with modified suction setup.

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Ultrasounds EMS Shock Hospitals 52

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.

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Taming the SRU

SEPTEMBER 15, 2023

ultrasound grand rounds: bedside dvt studies - family presence in the ed/icu - r1 clinical knowledge: aicd - r3 small groups: difficult airway management Ultrasound grand rounds: DVT studies WITH Dr. minges Why should we perform bedside DVT studies in the ED? ETT onto a fiberoptic scope.

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ACEP Now

MAY 9, 2024

6 The increasing mortality rate led to an additional emergency regulation in 2022 requiring the consenting physician to perform the critical steps of the case, limiting surgeons to three cases per day, and mandating continuous, recorded ultrasound guidance for gluteal AFT procedures.

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Emergency Department Operations Ultrasounds Shock 52

Total Medical ComplianceHIPAA

OCTOBER 9, 2024

Clean and disinfect surfaces with an EPA registered hospital level disinfectant. Maintenance should be performed on any equipment before using in the delivery of patient care, this includes autoclaves, suction lines, ultrasounds, radiology equipment, etc. If the testing reveals failing water quality, shock and test again.

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Hazardous Materials Infectious Diseases PPE Shock 59

ACEP Now

MAY 4, 2023

Diagnosis: Complex Hydrocele (Pyocele) The testicular ultrasound revealed a small left complex hydrocele suspicious for pyocele. Dr. Rader works at Ascension Macomb-Oakland Hospital. Dr. Fishman is an associate program director at Ascension Macomb-Oakland Hospital. J Emerg Trauma Shock. Click to enlarge.) 2012;5(2):206.

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Urgent Care Ultrasounds Sepsis Emergency Department 52

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. Angiography after Out-of-Hospital Cardiac Arrest without ST-Segment Elevation. She arrives in the emergency department (ED) with decreased level of consciousness and shock. Date: September 8th, 2021 Reference: Desch et al. The TOMAHAWK Investigators.

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Northwestern EM Blog

FEBRUARY 14, 2022

The ATHOS-3 trial in 2017 explored the efficacy of angiotensin II as a vasopressor for severe vasodilatory shock. Severe shock is defined as persistent hypotension requiring vasopressors to maintain a mean arterial pressure of 65mmHg and serum lactate <2 despite adequate volume resuscitation.

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Shock Resuscitation Fluid Resuscitation Sepsis 52

Taming the SRU

OCTOBER 1, 2023

Possibly more useful in trauma patients during e-FAST to determine presence or absence of PTX and less helpful in spontaneous PTX where management is partially based on size, which is difficult to quantify on ultrasound and may be falsely positive in the setting of emphysematous blebs. References Onuki T, Ueda S, Yamaoka M, et al.

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Fractures COPD Hospitals Emergency Department 96

EMDocs

JANUARY 11, 2024

Methods This scientific statement was led by the AHA and NCS and focused on the acute and critical care management of adult cardiac arrest survivors of in-hospital and out-of-hospital cardiac arrest. This post covers the key components, with each section starting with the key takeaway followed by the scientific statements.

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Taming the SRU

MAY 5, 2023

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. Each subsequent one-hour delay in antimicrobial administration increases mortality by 35% in patients with septic shock (Im, Kang et al.

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Taming the SRU

FEBRUARY 19, 2024

A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. Arterial lines require specialized monitoring and nursing resources which are not available in all hospital settings. Cite As: Snyder, B. Broadstock, A.

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Shock Resuscitation Ultrasounds Research 59

Pediatric Emergency Playbook

AUGUST 1, 2017

Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. J Ultrasound. Management of the child after enema-reduced intussusception: hospital or home? The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study? Ultrasound Evaluation for Appendicitis.

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Dr. Smith's ECG Blog

OCTOBER 10, 2022

He spent almost 2 months in the hospital, and reportedly made a full neurologic recovery. 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. This is a quiz.

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Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

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PulmCCM

OCTOBER 16, 2023

hospitals, between roughly one and four central line-associated bloodstream infections (CLABSI) occur per 1,000 days with a central line in place (catheter-days). Central line infections result in excess mortality, hospital stays, and cost (although the magnitude of all three are debated). How Often Do Central Lines Become Infected?

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Advanced Emergency Nursing from AENJ

FEBRUARY 29, 2016

Still, except for the public hospital, other hospitals did little emergency work and would have unattended first aid or treatment room in which one could meet one's physician or have an intern provide care in the meanwhile. Rebuilding of EDs in proximity to Radiology, Blood Bank, OR, and ICU, becoming organic to the hospital.

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PulmCCM

JULY 10, 2023

In the MERCY trial, 607 critically ill patients with sepsis (most with septic shock) at 26 hospitals in Croatia, Italy, Kazakhstan, and Russia were randomized to receive meropenem by either continuous (3 g / 24 hours) or intermittent administration (1 g every 8 hours). However, the practice has not been supported by randomized trials.

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Stroke Sepsis Infectious Diseases Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

An elderly man with sudden cardiogenic shock, diffuse ST depressions, and STE in aVR Literature 1. However, STE-aVR with multilead ST depression was associated with 31% in-hospital mortality compared with only 6.2% Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g.,

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EKG/ECG Shock Sepsis Emergency Department 52

Downeast Emergency Medicine

APRIL 26, 2021

Four level-1 US trauma centers participated in the study where the inclusion criteria were trauma patients who were within 2 hours of their injury and were transported to the trauma center from either the field or another hospital. When looking at the subgroups with severe shock, there was an 18.5% MI or stroke).

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Dr. Smith's ECG Blog

DECEMBER 18, 2022

It was notable for a normal cardiac ultrasound with no pericardial fluid, normal LV and RV function (though the quality was not sufficient to evaluate for wall motion abnormalities) and normal IVC dynamics. Bedside ultrasound is another very important piece. Ultrasound can be very helpful to distinguish causes of hypotension.

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Dr. Smith's ECG Blog

JANUARY 23, 2023

PMID: 34775811; PMCID: PMC9075358 A bedside ultrasound was performed, shown here: Parasternal short axis view demonstrating inferior LV wall motion akinesis Apical 2 chamber view again demonstrating inferior LV wall akinesis The cath lab was not activated based on the ECG and bedside echo. J Am Heart Assoc. 2021 Dec 7;10(23):e022866.

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EB Medicine

JUNE 6, 2019

Taylor and Shaukat of Emory and Coney Island Hospital respectively for their efforts in peer reviewing this huge topic. CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Jeff: Indeed. Sounds familiar. Jeff: We sure did!

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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 patient had a protracted hospitalization and did not survive. There is sinus tachycardia at ~100/minute.

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