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 79

Hyperthermia / Hypothermia Ultrasounds Shock Hospitals 79

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

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 Emergency Department 93

Taming the SRU

JUNE 3, 2024

CESAR Trial Published in 2009 Found that even those who didn’t get ECMO, but were transported to a tertiary care center had better outcomes No matter where you go, critical care transport will be part of your life as a sending physician, receiving physician, or both. Benefits of transport are evidenced based.

Shock 91

Shock Seizures Airway Management Stroke 91

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. Studies have compared IO to peripheral intravenous (PIV) and central venous (CVC) access for resuscitation. This study also showed the median time for IO placement was only 1.2

Resuscitation 105

Resuscitation Administration Emergency Department Ultrasounds 105

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

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.

Hyperthermia / Hypothermia 85

Hyperthermia / Hypothermia Resuscitation CPR EMS 85

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

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.

Sepsis 52

Sepsis Shock Administration Resuscitation 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 Hospitals 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

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

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

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 92

EKG/ECG EMS Emergency Department Outcomes 92

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

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 77

Operations EMS Fluid Resuscitation Resuscitation 77

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

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

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 75

Seizures Shock Infectious Diseases CPR 75

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

Mind The Bleep

AUGUST 5, 2023

Example of pneumoperitoneum following perforated NEC Other Investigations Blood tests and abdominal ultrasound. Abdominal ultrasound may show bowel wall thickening, altered vascular state and free fluid. One-year outcomes following surgery for necrotising enterocolitis: a UK-wide cohort study. Necrotizing Enterocolitis.

Sepsis 52

Sepsis Ultrasounds Radiology Radiology 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

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. You can also use the shock index, which as a reminder is simply the HR/SBP. Jeff: Indeed.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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 69

Hospitals Radiology Radiology Administration 69

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

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.

Blood Transfusions 126

Blood Transfusions Stroke Dehydration Sepsis 126

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. Jeff: Interestingly, the system I work in has prehospital physicians, who do carry US, but I can’t think of a major trauma where ultrasound changed any of the decisions we made.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 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 Emergency Department Seizures 52

Taming the SRU

AUGUST 30, 2023

Significantly elevated CRP (>122mg/L) and PCT (>0.5ng/mL) levels are predictors of bad outcomes, and are useful for tracking therapy progress, but are not specific enough to rule-in infectious endocarditis [38-39]. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. Epub 2021 Oct 2.

Infectious Diseases 88

Infectious Diseases Sepsis Emergency Department Point-of-Care Testing 88