Dr. Smith's ECG Blog

JANUARY 30, 2019

I remember Allie well from her days in the Research volunteer program at Hennepin. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. A repeat EKG was performed at that time and showed this: The STE had almost completed resolved and the STE depression is improved as well. F (rectal).

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

Pediatric EM Morsels

SEPTEMBER 22, 2023

” Children compensate for blood and volume loss very well… until they don’t. Shunting of blood to the extremities results in thermal dysregulation and subsequent hypothermia. As our fearless leader likes to say: “children are not aliens, but they are a special population with unique anatomy and physiology.”

Shock 304

Shock Pediatrics Dislocations Hyperthermia / Hypothermia 304

Dr. Smith's ECG Blog

OCTOBER 8, 2023

There are well formed R-waves with good voltage/amplitude which is uncommon for ischemia. There again are well for med R-waves. Severe hypothermia not uncommonly has accompanying T waves inversions. Maybe the main cause of the ECG-findings here then is benign T inversion and not hypothermia. There are also J-waves.

Hyperthermia / Hypothermia 124

Hyperthermia / Hypothermia EKG/ECG Shock Wellness 124

PulmCCM

JANUARY 22, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival. Read on for details.

Hyperthermia / Hypothermia 80

Hyperthermia / Hypothermia Outcomes Research Hospitals 80

EM SIM Cases

NOVEMBER 3, 2023

This case comes from Dr. Jared Baylis and Dr. Kelly Huang Dr. Baylis is the Simulation Medical Director at University of British Columbia – Southern Medical Program and Interior Health, as well as an editor of EM Sim Cases.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG EMS Hospitals 52

EMDocs

NOVEMBER 6, 2023

Patients with severe agitation from sympathomimetic poisoning require sedation to manage hyperthermia and acidosis, to prevent rhabdomyolysis and injury, and to allow evaluation for other life-threatening conditions. Life-Threatening Cocaine Toxicity We recommend rapid external cooling for life-threatening hyperthermia from cocaine poisoning.

Poisoning 112

Poisoning Hyperthermia / Hypothermia Seizures Administration 112

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]. Exposure Expose the patient in a systematic manner while keeping remaining body areas covered e.g. 1 limb at a time, to reduce the risk of hypothermia.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

The Skeptics' Guide to EM

JULY 3, 2021

Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. Hypothermia versus Normothermia after Out-of-Hospital Cardiac Arrest. Background: Hypothermia has been a mainstay of post-arrest care after the publication of two trials in 2002 that both suggested a benefit. This gives a NNT of 4.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Outcomes Wellness 52

Northwestern EM Blog

MAY 9, 2022

There is no gold standard with respect to its definition, and it requires a medication history (which we typically don't do very well in the emergency department). Any life-threatening hyperthermia should be treated immediately with an ice bath.[2] A tricky cause of NMS is the removal of a dopamine agonist.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Fluid Resuscitation Psychiatric Emergency Department 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

First described in 1953 ( by Dr. John Osborn ) — these Osborn waves are most commonly associated with significant hypothermia ( usually not seen until core temperature is below 90°F ). Rituparna et al — as well as Chauhan and Brahma ( Int. They’ve also been called the “camel-hump” sign.

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia CPR EKG/ECG Resuscitation 40

Don't Forget the Bubbles

JUNE 19, 2023

Fetal Growth Restriction (FGR) and dysmaturity are common in neonatology and are a leading cause of morbidity during the neonatal period, as well as later in life. Hypothermia should be prevented both directly after birth (this includes considering the use of polythene bags in very small neonates born >32 weeks) and during admission.

Pediatrics 143

Pediatrics Ultrasounds Hyperthermia / Hypothermia Sepsis 143

Taming the SRU

NOVEMBER 4, 2023

D Thompson and Goel C-spine Imaging: NEXUS is a large, well-done study validating criteria for low-risk of cervical injury that are easy to remember and use at the bedside, and is used in our clinical decision guidelines on AgileMD. Differences with Canadian criteria from NEXUS include elderly, ROM and mechanism.

Hyperthermia / Hypothermia 84

Hyperthermia / Hypothermia Resuscitation Burns Emergency Department 84

PulmCCM

JANUARY 24, 2024

Background Therapeutic hypothermia, later rebranded as targeted temperature management, became a standard post-cardiac arrest therapy for comatose patients after two 2002 NEJM trials ( n=273 and n=77 ) suggested reducing core temperature to 32°C to 34°C markedly improved neurologic outcomes and survival. Read on for details.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Outcomes Hospitals Stroke 52

RebelEM

JUNE 19, 2023

This balance is upset in trauma by loss of blood and factors, acidosis, hypothermia and the inflammatory cascade. Demographics were well balanced in the two groups. Our bodies have a finely tuned system that allows blood to flow freely and not clot too easily while also allowing the body to form clots when needed.

Blood Transfusions 105

Blood Transfusions Outcomes Administration Hyperthermia / Hypothermia 105

Taming the SRU

APRIL 13, 2023

Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Dr. Smith's ECG Blog

JULY 22, 2023

The patient did well and was ultimately discharged home. This discussion comes from this previous post: Hyperthermia and ST Elevation Discussion Brugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias. There were no dysrhythmias on cardiac monitor during observation.

EKG/ECG 92

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Administration 92

Taming the SRU

JULY 19, 2023

Fundamentals of ECMO - leadership curriculum - ultrasound GR - macgyver techniques fundamentals of ecmo WITH dr. bonomo ECPR from the ED: The ideal patients: Young patients with refractory VF/VT arrest ≤ 30 min since arrest onset Poisonings with cardiogenic shock Severe hypothermia with arrest Massive PE with arrest Key points: Good CPR/advanced ACLS (..)

Ultrasounds 84

Ultrasounds Leadership Hyperthermia / Hypothermia Poisoning 84

Dr. Smith's ECG Blog

OCTOBER 12, 2024

The providers documented concern for ST elevation in the precordial and lateral leads as well as a concern for hyperkalemic T waves in the setting of succinylcholine administration. Potassium resulted as 4.9, initial troponin I 0.05 ng/mL (consistent with prior baseline), and a repeat EKG was obtained 1 hour after the initial EKG.

EKG/ECG 117

EKG/ECG Documentation/Coding Emergency Department COPD 117

EMDocs

JUNE 25, 2024

Consider escharotomy if there is any issue with perfusion or neurologic deficit, as well as difficult ventilation in the intubated patient. Severely burned patients have impaired thermoregulation and are at risk of hypothermia. Chest burns/flank/back/abdominal burns may cause issues with ventilation.

Burns 92

Burns Fluid Resuscitation Resuscitation Poisoning 92

EM Guide Wire

SEPTEMBER 9, 2020

Epinephrine bolus 20-40 mcg IV (EMCRIT recommended dose using push dose epi) peds 0.01

Documentation/Coding 52

Documentation/Coding Hyperthermia / Hypothermia Sepsis Shock 52

Pediatric Education

MAY 7, 2023

The fever was responsive to antipyretics, and he was taking some dextromethorphan as well. Malignant hyperthermia is associated with inhaled anesthetics and some muscle relaxants and occurs usually very suddenly within minutes to hours. Maximum temperature was 102.4F 5 days ago. Resolution is also longer (9 or so days).

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Infectious Diseases Pediatrics Poisoning 40

Don't Forget the Bubbles

JUNE 26, 2023

Too much pulmonary blood flow and we will see well-oxygenated blood ( SpO2 >85% ) but insufficient systemic blood flow (pallor/mottling, cool peripheries, delayed capillary refill time, weak pulses, hypotension, narrow pulse pressure) and hypoxia (lactic acidosis). This is the most nuanced aspect.

Operations 128

Operations Research Hyperthermia / Hypothermia Hospitals 128

The Skeptics' Guide to EM

MAY 8, 2021

He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR […] The post SGEM#329: Will Corticosteroids Help if…I Will Survive a Cardiac Arrest? He is an EMS medical director with Lexington Fire/EMS as well as the AMR/NASCAR Safety Team. first appeared on The Skeptics Guide to Emergency Medicine.

CPR 52

CPR Hyperthermia / Hypothermia EMS Documentation/Coding 52

ACEP Now

OCTOBER 3, 2023

Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented. The GCS must be obtained through interaction with the patient (i.e.,

Fluid Resuscitation 98

Fluid Resuscitation Documentation/Coding Resuscitation EMS 98

The Skeptics' Guide to EM

JANUARY 9, 2021

JAMA 2020 Guest Skeptic: Mike Carter is a former paramedic and current PA practicing in pulmonary and critical care as well as an adjunct professor of emergency medical services […] The post SGEM#314: OHCA – Should you Take ‘em on the Run Baby if you Don’t get ROSC? first appeared on The Skeptics Guide to Emergency Medicine.

EMS 52

EMS Resuscitation CPR Hyperthermia / Hypothermia 52

Don't Forget the Bubbles

JANUARY 24, 2024

The first human trials for children with SRSE were conducted in 2014 where 2 patients responded well to the treatment and there have been encouraging results in open label adult trials more recently. Hypothermia for Neuroprotection in Convulsive Status Epilepticus. N Engl J Med. 2016 Dec 22;375(25):2457-2467. PMID: 28002714.

Seizures 111

Seizures Pediatrics Outcomes Hyperthermia / Hypothermia 111

Advanced Emergency Nursing from AENJ

MAY 2, 2017

Consider the traumas and medical emergencies that have a seasonal prominence in your locality, then prepare topical presentations in formats that work well with your group. Useful combinations can be made such as near-drowning & hypothermia & intoxication. Not an impossible likelihood, eh?)

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia Emergency Nursing Documentation/Coding Pediatrics 40

Greater Sydney Area HEMS

APRIL 15, 2023

Consider skin-to-skin on Mum’s chest to keep an otherwise well baby warm. Don’t forget that every ambulance has a maternity kit with bunny rugs, surgical gown, umbilical cord clamps, nappy, tiny warm hat… Consider reducing the risk of hypothermia by working inside the ambulance, and warming the vehicle, particularly in winter.

Hospitals 85

Hospitals Resuscitation Hyperthermia / Hypothermia Teamwork 85

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? had at least 2 potential etiologies for developing acute myocarditis: i ) Profound hypothermia ( core temperature = 90°F = 32.2°C So this is STEMI, right? Which artery? There is ST Elevation in every lead except aVR (STD in aVR). Our THANKS to Dr.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

Taming the SRU

AUGUST 27, 2024

This differential is broad and reflects the clinical diversity of their presentations - in this post we will parse through the specifics of bullous lesions as well as what there is to do for them acutely. The first step is to determine what disease you are dealing with.

Emergency Department 83

Emergency Department Dehydration Burns Sepsis 83

EMDocs

FEBRUARY 9, 2024

She is well appearing, and while being placed on the monitor becomes anxious stating the symptoms are recurring. Common causes include hypokalemia, hypocalcemia, hypomagnesemia, and hypothermia 3. In patients that are refractory to other interventions, phenytoin is a well-understood and safe medication to trial.

EKG/ECG 91

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 91

Mind The Bleep

OCTOBER 17, 2024

Of the medical conditions reported, hypothermia was the largest group – the vast majority mild. I’ve done the course and now instruct and examine on it – well worth doing if you join to help determine what’s appropriate and sensible, and what you can expect of RRMTs who attend a scene with you. In addition to hands-on when available!

Soft Tissue Injuries 52

Soft Tissue Injuries Seizures Ambulance Services Teamwork 52

Taming the SRU

MAY 1, 2023

Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures. Poisoned patients will have a Digoxin level, but it is not at all quantitative like it is when dealing with an actual Digoxin overdose.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Pediatric Education

SEPTEMBER 3, 2023

He had no concerns and he was doing well in school and with his friends. He had a sprained ankle the previous year that he says was well-healed. Other states which could also affect sickling would be dehydration, acidosis, hypoxia and hyperthermia. The past medical history was positive for sickle cell trait.

Dehydration 40

Dehydration Hyperthermia / Hypothermia Pediatrics Military 40

Greater Sydney Area HEMS

APRIL 26, 2023

Both the stuff of legend and go by multiple names including harness hang syndrome and orthostatic intolerance, as well as bigfoot and the abominable snowman, respectively. – Concurrent traumatic injuries , along with hypothermia, hypoglycaemia, pain and fear can all stimulate maladaptive compensation, potentiating the above mechanisms.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Shock Research Operations 52

Taming the SRU

APRIL 17, 2023

Thankfully, some of the more common and/or dangerous plant poisonings have been well-categorized, and are summarized below. Deadly Nightshade and Jimson Weed are well known among the poisonous plants. Patients typically present with tachycardia, mydriasis hyperthermia, altered mental status, anhidrosis, and urinary retention.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Anaphylaxis Pediatrics 52

Emergency Medicine Ireland

MAY 3, 2021

Now is not the time for permissive hypercapnoea and so for your patients with head injury and ARDS this can be really challenging The BTF guidance is the key guideline document that should be referenced and it is well worth a read for any exam candidate and indeed any clinician dealing with TBI. The following summarises some of the headlines.

Head Injuries 40

Head Injuries Hyperthermia / Hypothermia Documentation/Coding Outcomes 40