Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

I sent it to 5 of my OMI friends without any clinical information or outcome and all 5 independently responded with exactly the same diagnosis: "reperfused inferior OMI". Resuscitative attempts were initiated quickly. There is ischemic ST depression in V4-V6. This is diagnostic of ACS; it appears to be a reperfused acute inferior OMI.

EKG/ECG 137

EKG/ECG Resuscitation CPR Emergency Department 137

PHEM Cast

APRIL 16, 2018

It might be better to consider traumatic cardiac arrest as a completely different disease eg LOST: Low Output State due to Trauma The 2015 European Resuscitation Council and UK Resuscitation Council Algorithms for Traumatic Cardiac Arrest: To read the whole ERC guideline on special circumstances cardiac arrest including trauma, click here.

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Resuscitation Shock Ultrasounds CPR 52

EMDocs

DECEMBER 1, 2024

The disease is generally mild, but in untreated cases, it can lead to more severe outcomes, especially in patients with underlying conditions such as glucose-6-phosphate dehydrogenase deficiency. Even though the disease often resolves spontaneously, prompt antibiotic therapy is essential for optimal outcomes. pregnant patients).

EMS 82

EMS Infectious Diseases Shock Resuscitation 82

EMDocs

JUNE 22, 2023

Remember that while mistakes in resuscitation are often dissected and analyzed, it is equally crucial to acknowledge and celebrate the moments of impeccable execution, where lives are saved and hope is restored. He is on a vasopressin infusion now after the four unit bolus from the initial resuscitation. This guy is an ultrasound guru.

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Resuscitation Ultrasounds Critical Access Documentation/Coding 96

PulmCCM

JULY 3, 2023

If those grizzled veterans give you a hard time, remember, they’re also the ones who dispensed attaboys in the pre-ultrasound era like “if you’re not cannulating the carotid artery or dropping lungs, you’re not doing enough central lines!”) (Who themselves would be less experienced at video.) (If

Airway Management 105

Airway Management Outcomes Hospitals Emergency Department 105

ACEP Now

JUNE 21, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes including successful development of a niche in the specialty. 11 What should we take away?

EMS 114

EMS Academics Telemedicine Operations 114

The Skeptics' Guide to EM

NOVEMBER 23, 2019

Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs. Increased Sensitivity of Focused Cardiac Ultrasound for Pulmonary Embolism in Emergency Department Patients With Abnormal Vital Signs. Date: November 21st, 2019 Reference: Daley et al.

Ultrasounds 52

Ultrasounds Emergency Department Academics Outcomes 52

The Skeptics' Guide to EM

SEPTEMBER 29, 2018

His primary interests are resuscitation, prehospital critical […] The post SGEM#231: You’re So Vein – IO vs. IV Access for OHCA first appeared on The Skeptics Guide to Emergency Medicine. His primary interests are resuscitation, prehospital critical care, airway management, and point-of-care ultrasound.

Basic Life Support 52

Basic Life Support Airway Management CPR Resuscitation 52

EMDocs

MAY 15, 2024

Ultrasound Sensitivity 88-100%, specificity 68-94% Positive likelihood ratio of 14.6 (95% Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Causes and outcomes of the acute chest syndrome in sickle cell disease. Look for B lines, consolidation, pleural effusion. times maintenance. N Engl J Med.

Blood Transfusions 78

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 78

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?

CPR 89

CPR Burns Airway Management Wellness 89

EMDocs

MAY 28, 2024

Ultrasound Sensitivity 88-100%, specificity 68-94% LR+ of 14.6 (95% Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. Causes and outcomes of the acute chest syndrome in sickle cell disease. Look for B lines, consolidation, pleural effusion. Decreases splinting and improves tidal volumes.

Blood Transfusions 75

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 75

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

JournalFeed

MAY 7, 2022

Airway POCUS Spoon Feed: Upper airway ultrasound (UA-US) may eventually help us predict if a patient will have a difficult laryngoscopy ahead of time. For access to more, please visit JournalFeed.org for details about becoming a member. However, this is not ready for prime-time, and more studies are needed.

Advances Cardiac Life Support (ACLS) 40

Advances Cardiac Life Support (ACLS) Resuscitation Ultrasounds Outcomes 40

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

Taming the SRU

OCTOBER 1, 2023

As these patients are typically already at a high risk for poor health outcomes, secondary spontaneous PTX is often more serious in presentation and management more complex [11]. Unsuspected tension pneumothorax as a hidden cause of unsuccessful resuscitation. The "lung point": an ultrasound sign specific to pneumothorax.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

The Skeptics' Guide to EM

JANUARY 25, 2020

His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. His primary interests are resuscitation, critical care, airway management, and point-of-care ultrasound. Secondary Outcome: The incidence of severe hypoxemia (oxygen saturation of less than 80%).

EMS 40

EMS Airway Management Administration Resuscitation 40

Pediatric Emergency Playbook

AUGUST 1, 2017

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Hirschsprung disease, associated syndromes and genetics: a review. J Med Genet 2008; 45:1. Arshad A, Powell C, Tighe MP. Hirschsprung's disease. BMJ 2012; 345:e5521. Aworanti OM, McDowell DT, Martin IM, Quinn F. Eur J Pediatr Surg 2016; 26:192.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Dr. Smith's ECG Blog

JULY 22, 2012

Hemodynamic instability in trauma is usually due to bleeding, but if ultrasound shows poor contractility, then this may be due to cardiac contusion. Outcome Three weeks later, shortly after having been physically active (bouncing on a trampoline), she was found unresponsive. In the ED, ultrasound showed hemopericardium with tamponade.

Head Injuries 52

Head Injuries EKG/ECG Outcomes Ultrasounds 52

Taming the SRU

MAY 5, 2023

The CLASSIC trial is a randomized controlled trial conducted in the ICU setting which compared restrictive versus standard fluid strategies with a primary outcome of death by 90 days in patients with septic shock. Safety outcomes Serious adverse event occurrences were similar in both groups. versus 59.2%). versus 14.9%

Sepsis 52

Sepsis Shock Administration Resuscitation 52

Northwestern EM Blog

FEBRUARY 14, 2022

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. The primary outcome of the study was the response in MAP three hours after the start of angiotensin II infusion.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

Downeast Emergency Medicine

APRIL 26, 2021

4] We also know that severe TBI is commonly associated with the development of intracranial hemorrhage where the presence and volume of blood are associated with increased mortality and poor outcomes.[5] Association between prehospital tranexamic acid administration and outcomes of severe traumatic brain injury. JAMA Neurol.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Don't Forget the Bubbles

MAY 8, 2024

An interesting study (JAMA Pediatrics) shows the benefits of newborn screening for spinal muscular atrophy (SMA), as initiating disease-modifying therapy earlier improves clinical outcomes. These findings advocate for expanding newborn screening programs to enhance outcomes for children with SMA. Dell KM, et al. Koenis MM et al.

Pediatrics 69

Pediatrics Emergency Department Outcomes Research 69

ACEP Now

OCTOBER 9, 2024

In the emergency department (ED), physicians face the challenge of making rapid decisions that can significantly impact patient outcomes. However, the persistence of tachycardia despite fluid resuscitation and dosing with lorazepam to help with his panic disorder raised concerns that warranted further investigation. 2003;22(3):465-466.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Ultrasounds Outcomes 52

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

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. Acute mechanical bowel obstruction: clinical presentation, etiology, management and outcome. World J Gastroenterol. 2007 Jan 21;13(3):432-7. doi: 10.3748/wjg.v13.i3.432.

Operations 77

Operations EMS Fluid Resuscitation Resuscitation 77

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. One such study of 263 patients without hypertensive emergencies treated in a resuscitation unit found that 40% of patients had a MAP difference ≥ 10 mmHg between IABP and NIBP measurements. Critical care and resuscitation, 11(1). Broadstock, A.

Shock 59

Shock Resuscitation Ultrasounds Research 59

EMDocs

JULY 13, 2024

Favorable infertility outcomes following anti-tubercular treatment prescribed on the sole basis of a positive polymerase chain reaction test for endometrial tuberculosis. Incidence, treatment and outcome of peripartum sepsis. Plasma cell endometritis is associated with Chlamydia trachomatis infection. Am J Clin Pathol. PMID: 10439801.

OB/GYN 64

OB/GYN EMS Sepsis Fluid Resuscitation 64

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 Small bowel obstruction: Outcome and cost implications of admitting service. Am Surg 2010; 76:687-691.

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

University of Maryland CC Project

NOVEMBER 24, 2021

Maryland Critical Care Conference 2021 with various talks on the topic of Resuscitation.

Resuscitation 40

Resuscitation Outcomes CPR Ultrasounds 40

Don't Forget the Bubbles

FEBRUARY 5, 2024

Their main outcome measure was the proportion of pictures inconsistent with current safety recommendations. Are sucking patterns and early spontaneous movements related to later developmental functioning outcomes? Assessing fluid responsiveness with ultrasound in the neonatal intensive care setting: the mini-fluid challenge.

Pediatrics 52

Pediatrics Research Resuscitation Psychiatric 52

Don't Forget the Bubbles

SEPTEMBER 5, 2024

In the emergency department resuscitation room, weight is usually estimated using an age-based formula until the child is stabilised and can be safely weighed. Obesity is considered a contributing factor for some musculoskeletal outcomes. Therefore, it is important that the method used gives the most accurate weight estimate.

Ultrasounds 52

Ultrasounds Research Emergency Department Outcomes 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

A bedside ultrasound was done by the emergency physician, using Speckle Tracking. It is highly associated with proximal LAD occlusion or severe left main ACS and with bad outcomes. Unfortunately, that video is unavailable. It appeared to show a lateral wall motion abnormality. So this is diagnostic of proximal LAD occlusion.

EKG/ECG 40

EKG/ECG CPR Resuscitation Outcomes 40

ACEP Now

NOVEMBER 16, 2023

The lack of differences in the observed outcomes do not suggest one EM training length is superior. The additional year may improve career trajectory or longevity, entrance into fellowship or academic practice, or other longer-term outcomes, including successful development of a niche in the specialty. 11 What Should We Take Away?

Academics 52

Academics EMS Telemedicine Research 52

Don't Forget the Bubbles

AUGUST 14, 2023

Short and long-term outcomes in Hirschsprung disease: Are the syndrome-associated patients really doing worse? Severe encephalitis: aetiology, management and outcomes over 10 years in a paediatric intensive care unit. Outcome of Absence Epilepsy With Onset at 8-11 Years of Age: Watershed Ages When Syndromes Overlap. 2023 Jul 27.

Pediatrics 52

Pediatrics Hospitals Emergency Department Outcomes 52

PEMBlog

FEBRUARY 22, 2024

And I mentioned it before and I’ll say it again, but intracranial bleeding is the worst possible outcome. So get a chest x-ray or an ultrasound, determine if there’s bleeding in the body cavities, you know, the chest or the abdomen. Imaging is targeted at the differential diagnosis in the site of bleeding. So treatment.

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Pediatrics Anaphylaxis Administration Wellness 72

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. She was defibrillated and resuscitated. It can only be seen by IVUS.

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

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.

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Ultrasounds Radiology Radiology Sepsis 40