Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Taking a step back , remember that sinus tachycardia is less commonly seen in OMI (except in cases of impending cardiogenic shock). Answer : Bedside ultrasound! Smith : RV infarct may also have this appearance on ultrasound. So hypoxia without B lines on lung ultrasound strongly weights toward PE. Both were wrong.

EKG/ECG 128

EKG/ECG Ultrasounds Shock EMS 128

Pediatric Emergency Playbook

JUNE 1, 2016

Do we recognize shock early enough? World wide, shock is a leading cause of morbidity and mortality in children, mostly for failure to recognize or to treat adequately. So, what is shock? Simply put, shock is the inadequate delivery of oxygen to your tissues. How do we prioritize our interventions? Pericardial Effusion?

Shock 40

Shock Sepsis Pediatrics Ultrasounds 40

ACEP Now

JANUARY 4, 2025

Medical anti-shock trousers (MAST) being applied for a trauma patient and a Datascope cardiac monitor in use during traumatic full arrest. Notice the use of the medical anti-shock trousers and the ECG machine. Now, we have ultrasound or CT scans to confirm. From 1978 to 1980 MAST suits were used in most trauma patients.

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

Sensible Medicine

JUNE 17, 2024

PFA destroys myocardium with electricity (shocks). Every “application” is actually a shock. PFA is especially concerning because the shocks in the left atrium create intense microbubbles. It’s expected to grow at high rates, powered largely by expansion of catheter ablation.

Shock 127

Shock Stroke Operations Ultrasounds 127

RebelEM

FEBRUARY 19, 2024

Background: Use of vasopressors is a common practice to support hemodynamics and optimization of tissue perfusion in patients presenting with shock. of cases) Catheter ultrasound confirmation: 49.8% (i.e. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2021. Not met in 16.7%

Administration 137

Administration Sepsis EMS Shock 137

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Shocked x 2 without effect. Pads were placed with ultrasound guidance, so they were in the correct position. Warning: if this is VT, a calcium channel blocker can result in shock and death. We are told that " the Patient was Shocked X2 Without Effect." However, this is not SVT. What to do now? K returned 3.6

EKG/ECG 139

EKG/ECG Shock Academics Documentation/Coding 139

Dr. Smith's ECG Blog

DECEMBER 15, 2015

No shock was ever delivered. He was in profound shock. A bedside cardiac ultrasound was recorded: Here is a still image of the echo: The red arrows outline the right ventricle and the yellow arrows outline the left ventricle chamber. There is no pericardial fluid to account for shock. Sixth: Severe shock (e.g.,

Shock 40

Shock Ultrasounds EKG/ECG Wellness 40

PulmCCM

NOVEMBER 17, 2023

’ This could be done with the Venous Excess Ultrasound Score [VExUS] [5, 6]. Beaubien-Souligny W, Rola P, Haycock K, Bouchard J, Lamarche Y, Spiegel R et al : Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. The ultrasound journal 2020, 12(1):1-12.

Operations 132

Operations Ultrasounds Resuscitation Blood Transfusions 132

Taming the SRU

FEBRUARY 7, 2024

Ultrasound: Make “windows of access”. The Aircare package to increase DASH-1A airways includes placing patient on AirCare monitor, apneic oxygenation, 3 minutes NRB, bagging after paralytic given, starting only when patient > 97%, push dose pressors if needed for hypotension before paralytic, and make sure to use the checklist!

PPE 98

PPE Administration Ultrasounds Poisoning 98

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

EB Medicine

NOVEMBER 17, 2020

Write us at emplify@ebmedicine.net.

Emergency Department 40

Emergency Department Shock Resuscitation CPR 40

University of Maryland CC Project

JANUARY 22, 2021

Hyeong Kim, assistant professor of medicine at the University of Maryland and RDCS certified, presents a five lecture course on critical care ultrasound.

Ultrasounds 40

Ultrasounds Shock 40

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. Here is the initial ED ECG. What do you think?

EKG/ECG 133

EKG/ECG Shock CPR Stroke 133

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

Ultrasound Gel

AUGUST 20, 2018

It's a reliably easy to recall hypotensive protocol that uses ultrasound to help determine the etiology of a patient's shock. Well here's a new idea - trauma patient's can be in shock too, right? It's a reliably easy to recall hypotensive protocol that uses ultrasound to help determine the etiology of a patient's shock.

Shock 52

Shock Ultrasounds Wellness 52

Don't Forget the Bubbles

MARCH 4, 2024

International Consensus Criteria for Pediatric Sepsis and Septic Shock. The aim of this paper was to update and evaluate the criteria for sepsis and septic shock in children. Check out DFTB’s module on SIRS, Sepsis and Shock Module – Don’t Forget the Bubbles (dontforgetthebubbles.com) Why does it matter?

Hospitals 78

Hospitals Sepsis Fractures Emergency Department 78

EMDocs

APRIL 22, 2024

Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. Multiorgan POCUS The diagnostic power of POCUS often resides in combining multiple ultrasound exams. 1-3 As many as 25% of acute PE cases present as sudden cardiac death.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

Dr. Smith's ECG Blog

JUNE 17, 2024

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. Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism.

EKG/ECG 139

EKG/ECG Emergency Department Shock Ultrasounds 139

EMDocs

OCTOBER 8, 2024

POCUS: RUSH exam (Rapid Ultrasound for Shock and Hypotension) While derived to help identify unexplained hypotension, if we accept that sinus tachycardia may be an early indicator of shock, we can utilize this general approach to help reevaluate as clinically indicated. Axilla, Sacral, GU Overall Volume Status?

Shock 105

Shock Emergency Department Pediatrics EKG/ECG 105

Taming the SRU

JUNE 3, 2024

Get a blood gas when possible to help guide your ventilation. glenn, haffner, and jackson In Flight Emergencies: As a responding physician to an in-flight emergency, you may recommend diverting the plane, however, the captain (lead pilot) will make the final decision.

Shock 91

Shock Seizures Airway Management Stroke 91

EM Ottawa

APRIL 4, 2024

Point-of-care ultrasound (PoCUS) is becoming a cornerstone tool in our assessment of patient presentations and is helping us guide our clinical management. This is also represented in the amount of literature that has been published on the use of PoCUS in 2023.

Ultrasounds 73

Ultrasounds Infectious Diseases COPD Shock 73

JournalFeed

JULY 6, 2024

The panel recommended against high-dose/short duration corticosteroids in patients with septic shock. Tuesday Spoon Feed : In pediatric patients who have an Alvarado score 6 and below, the absence of free fluid or periappendiceal fat inflammation, when the appendix was not visualized on ultrasound, had a negative predictive value of 99.4%

Shock 52

Shock Ultrasounds Pediatrics Hospitals 52

Ultrasound Gel

SEPTEMBER 17, 2018

The authors here took on an important question - does point of care ultrasound make a difference in mortality when applied to patients in shock? The authors here took on an important question - does point of care ultrasound make a difference in mortality when applied to patients in shock?

Shock 52

Shock Ultrasounds Wellness 52

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.

Shock 40

Shock EKG/ECG Resuscitation Ultrasounds 40

Greater Sydney Area HEMS

DECEMBER 3, 2023

Join for the second part of Dr Brian Burns’ episode, as we continue to discuss mimics of shock in our trauma population. Show notes: Reference on pulmonary embolism : [link] Reference on pulmonary contusion: [link] Reference on pulmonary contusion lung ultrasound : [link] See some show notes below for more resources.

Burns 52

Burns Shock Ultrasounds 52

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

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

PulmCCM

NOVEMBER 11, 2023

Diagnosis because P ra is non-invasively transduced with ultrasound, for instance via the size and collapsibility of the inferior vena cava [1] and/or the Venous Excess Ultrasound Score [VExUS] [2-4]. If changes in P ra cause changes in CO, shouldn’t we then know the etiology of shock with certainty?

Ultrasounds 87

Ultrasounds Operations Shock 87

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

Dr. Smith's ECG Blog

MARCH 26, 2024

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. Cardiac Ultrasound may be a surprisingly easy way to help make the diagnosis Answer: pulmonary embolism.

EKG/ECG 69

EKG/ECG Shock Ultrasounds Wellness 69

EMDocs

NOVEMBER 4, 2023

An ultrasound of the testes reveals the following: What is the diagnosis? J Emerg Trauma Shock. He reports approximately one month of dysuria, and around two weeks ago noticed a dull aching sensation in his testicles that has progressively gotten worse. Insights Imaging. 2016;7(5):689-711. Scrotal pyocele: Uncommon urologic emergency.

EMS 94

EMS Ultrasounds Emergency Department Infectious Diseases 94

RebelEM

JUNE 26, 2023

Severe acute traumatic coagulopathy = PT >1.5 to 3.33; P = 0.72 NOT STATISTICALLY SIGNIFICANT Also no difference in individual components given Thromboembolic Events: 4F-PCC: 35% Placebo: 24% Absolute Diff: 11%; 95% CI 1 to 21% Relative Risk 1.48; 95% CI 1.04 to 2.10; P = 0.03

Administration 143

Administration Outcomes Resuscitation Radiology 143

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

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.

Stroke 136

Stroke Outcomes Hospitals Administration 136

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.

Ultrasounds 52

Ultrasounds EMS Shock Hospitals 52

Taming the SRU

JUNE 24, 2024

Follow this algorithm in patients with unstable bradycardia with acute heart failure, change in mental status, or concern for shock, physicians should start with atropine, 1 mg and may be continued every 3 to 5 minutes if effective.

Advances Cardiac Life Support (ACLS) 90

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 90

Dr. Smith's ECG Blog

OCTOBER 26, 2010

ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. Then ACS (STEMI) might be primary; this might be cardiogenic shock. One very useful adjunct is ultrasound: Echo of his heart can distinguish aneurysm from acute MI by presence of diastolic dyskinesis, but it cannot distinguish demand ischemia from ACS.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52