Taming the SRU

JANUARY 10, 2024

R4 Case Follow-up: SCAD WITH dr. Martella Spontaneous Coronary Artery Dissection (SCAD) is a diagnosis confirmed via imaging: Coronary Angiography, Optical Coherence Tomography, Intravascular Ultrasound Therefore, treatment in the ED is the same as atherosclerotic ACS: ASA, heparin gtt and possible statin.

EKG/ECG 93

EKG/ECG Shock Fractures Dislocations 93

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

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. That’s where we’re at.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

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.

Shock 52

Shock Resuscitation Fluid Resuscitation Sepsis 52

EM Curious

JULY 1, 2015

ULTRASOUND IN CHEST PAIN: [BLOG]: It is never a bad idea to throw an ultrasound probe on your patient with chest pain. Onto the FOAMed WEINGART ON HFNC [PODCAST]: The new oxygen wonder child is taking critical care by storm. Should we all be jumping on board? Weingart discusses some background, the evidence and his opinions here.

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

ACEP Now

MAY 9, 2024

These questionable practices led to a rash of bad outcomes. 6 Theoretically, ultrasound guidance should decrease this risk, which formed the basis for the 2022 Florida Medical Board regulation. This should be suspected in patients with intraoperative cardiac arrest or shock. References Garcia SE. Butt Lifts Are Booming.

Emergency Department 52

Emergency Department Operations Ultrasounds Shock 52

Taming the SRU

FEBRUARY 19, 2024

This has been the central question of many research projects with variable outcomes. A recent observational study was performed to pragmatically assess clinically meaningful differences in BP in a diverse critically ill cohort with shock. Damping Damping is essentially the shock absorbers in the pressurized system.

Shock 59

Shock Resuscitation Ultrasounds Research 59

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

She arrives in the emergency department (ED) with decreased level of consciousness and shock. Her point-of-care ultrasound (POCUS) shows appropriate-appearing global ejection fraction and no marked wall motion abnormalities. Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Dr. Smith's ECG Blog

JULY 18, 2014

such Q-waves are associated with larger MI and worse outcomes (2. 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. Very unlikely. Raitt et al.), Armstrong et al.),

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

EMDocs

JANUARY 11, 2024

Individualize the choice of using inotropes, vasopressors, or fluids to treat post-CA hypotension and to target the likely cause(s) contributing to the shock and hemodynamic state (100%, 23/23). In patients with enteral intolerance or shock, start with trophic EN (rates of 10–20 mL/h) and adjust according to tolerance (91%, 19/21).

Seizures 87

Seizures Shock Infectious Diseases CPR 87

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). A sequel to that trial, BLING III, is underway. access, etc.,

Stroke 52

Stroke Sepsis Infectious Diseases Outcomes 52

Dr. Smith's ECG Blog

JULY 7, 2013

and these are associated with larger MI and worse outcomes (2. Rupture can be either free wall rupture (causing tamonade) or septal rupture, causing ventricular septal defect with left to right flow and resulting pulmonary edema and shock. If detected early by ultrasound, the patient can be saved. Very unlikely. Raitt et al.) [and

Ultrasounds 52

Ultrasounds EKG/ECG Emergency Department Shock 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

AED Leader

OCTOBER 25, 2023

VF is a critical medical emergency, demanding prompt treatment to ensure the best possible outcome. AEDs are designed to safely deliver the required life-saving shocks to restore a normal heart rhythm during this type of cardiac emergency. Implantable Loop Recorder. Echocardiogram. Advanced Imaging.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Research 52

AED Leader

OCTOBER 25, 2023

VF is a critical medical emergency, demanding prompt treatment to ensure the best possible outcome. AEDs are designed to safely deliver the required life-saving shocks to restore a normal heart rhythm during this type of cardiac emergency. Implantable Loop Recorder. Echocardiogram. Advanced Imaging.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Research 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. Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g., Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g.,

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

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

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.

EKG/ECG 52

EKG/ECG Shock Emergency Department Ultrasounds 52

Northwestern EM Blog

DECEMBER 27, 2021

Marc Sala, summarize the current literature on the peripheral infusion of vasopressors, which is becoming more and more commonplace as the evidence evolves to support earlier initiation of pressors and more judicious use of crystalloid for many forms of shock. The expert review of Dr. Matthew Levine, Dr.

Dislocations 52

Dislocations Emergency Department Burns Shock 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. These indices would have reinforced the clinical decision progress and avoided bad outcomes from unsuccessful estimates.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

Taming the SRU

MAY 1, 2023

Midline Ludwig’s angina Dermoid cyst Thyroglossal duct cyst Thyroid mass Thyroid goiter Lateral Sialadenitis Branchial cleft cyst Kawasaki’s Lymphoma Diagnosis: Thyroglossal Duct cyst with a superimposed strep throat infection without typical symptoms of pharyngitis Test of choice: Ultrasound Thyroglossal Duct cyst Most common pediatric cervical congenital (..)

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock. Outcome of our case Once the type 2 SCAD was identified, the heparin drip was stopped. Lobo et al. The SCAD cases in Lobo et al.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

EB Medicine

SEPTEMBER 1, 2018

Nachi: Not only are they out, they actually worsen outcomes, so definitely don’t pursue any of them. Instead, since no treatment has been shown to improve outcome, you should prioritize prompt transport. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Nachi: Let’s move on to diagnostic studies.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

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. That’s probably something different. Fortunately, those are rare. Labs or imaging are not routinely necessary.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Rural Doctors Net

AUGUST 30, 2013

Intubation for humanitarian reasons is also reasonable – he’ll be in pain and this is not the time to be faffing around with the ultrasound or nerve stimulator doing blocks! Flooding him with crystalloid is going to dilute his clotting factors, make him hypothermic and potentially worsen outcomes. How to intubate?

Burns 52

Burns Hospitals Wellness Ambulance Services 52

EMDocs

JANUARY 16, 2024

Patients can have excellent outcomes despite prolonged resuscitation. 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. This is a good time to utilize an arterial line or use the ultrasound to find a central pulse.

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Hyperthermia / Hypothermia Resuscitation CPR EMS 97

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 94

EMS Infectious Diseases Shock Airway Management 94

EMDocs

NOVEMBER 13, 2024

Older age, recurrent episodes of SBP, hepatorenal syndrome, hepatic encephalopathy, acute kidney injury (AKI), concurrent GI bleeding, and higher MELD scores are predictors of worse outcomes. Ultrasound can assist: confirm ascites, evaluate for best site, abdominal wall thickness, blood vessels along needle track. 2019 Jan 14;11:13-22.

Hyperthermia / Hypothermia 99

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 99

ACEP Now

SEPTEMBER 3, 2024

These stakeholders are similarly shielded in court when adverse patient outcomes, such as negligent deaths, occur under their management or when the bought-out companies are challenged for anticompetitive business practices overseen by the PE firm. Her primary interests are in ultrasound, machine learning, and health justice.

Hospitals 113

Hospitals Radiology Radiology Administration 113

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. The patient awoke and had a good outcome!

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EKG/ECG Shock CPR Stroke 135

EMDocs

DECEMBER 18, 2023

Septic shock is high on the differential diagnosis for this patient’s presentation. 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. What are the most up-to-date guidelines for managing this patient?

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Sepsis Fluid Resuscitation Resuscitation Shock 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. 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 89

Operations EMS Fluid Resuscitation Resuscitation 89

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.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

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]. J Emerg Trauma Shock. Accuracy of Ultrasound in Diagnosis of Pneumothorax: A Comparison between Neonates and Adults-A Systematic Review and Meta-Analysis.

Fractures 96

Fractures COPD Hospitals Emergency Department 96

Pediatric Emergency Playbook

AUGUST 1, 2017

Does Functional Outcome Improve with Time Postsurgery for Hirschsprung Disease? Single-stage versus multi-stage pull-through for Hirschsprung's disease: practice trends and outcomes in infants. Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. J Ultrasound. J Med Genet 2008; 45:1. 2007; 16:27-33.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Don't Forget the Bubbles

JULY 5, 2023

Furthermore, educating both patients and their families is important in order to achieve good treatment compliance and better clinical outcomes. Symptoms may be non-specific in the beginning with patients quickly developing septic shock and disseminated intravascular coagulation. coli and Staphylococcus aureus.

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Blood Transfusions Stroke Dehydration Sepsis 126

Dr. Smith's ECG Blog

AUGUST 9, 2024

However the patient continued to have chest pain and bedside ultrasound showed hypokinesis of the septum with significantly reduced LVEF. Opioids associate with worse outcomes in myocardial infarction , probably because they eliminate the pain signal that informs the clinician of the urgency of revascularization. Do not treat AIVR.

EKG/ECG 110

EKG/ECG EMS Emergency Department Outcomes 110