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

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 133

EKG/ECG Shock Documentation/Coding Academics 133

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

Ultrasound Gel

SEPTEMBER 17, 2018

Well the dust has somewhat settled from the initial explosion that this article made when it first hit street corners everywhere. 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

MARCH 26, 2024

There is also STE in lead III with reciprocal depression in aVL and I, as well as some subendocardial ischemia pattern with STD in V5-V6 and STE in aVR. Acute pulmonary embolism was confirmed on CT: The patient did well with treatment. Now another, with ultrasound. For Americans , you need to wait for the FDA. This is a quiz.

EKG/ECG 72

EKG/ECG Shock Ultrasounds Wellness 72

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

A bedside cardiac ultrasound was normal, with no effusion. He was admitted on oxygen and was doing fairly well with saturations of 100% on 2 L nasal cannula. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. He remained hypotensive and in shock.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

EMDocs

OCTOBER 8, 2024

Tachycardia may be present both from many medications or drugs, as well as withdrawal. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? Does the patient require blood, a procedure to address obstructive shock, or other source control? Do they have edema? Sinus Tachycardia.

Shock 95

Shock Emergency Department Pediatrics EKG/ECG 95

RebelEM

JUNE 26, 2023

4F-PCC contains factors II, VII, IX, X as well as Proteins S and C. Some clinicians have advocated for early administration of 4-factor prothrombin complex concentrate (4F-PCC) based on limited observational data. High-quality studies are needed to determine the utility of this intervention. Severe acute traumatic coagulopathy = PT >1.5

Administration 140

Administration Outcomes Resuscitation Radiology 140

Dr. Smith's ECG Blog

JUNE 17, 2024

There are well preserved R-waves in Wellens waves. 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. Now another, with ultrasound. This is a quiz.

EKG/ECG 135

EKG/ECG Emergency Department Shock Ultrasounds 135

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

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 88

CPR Burns Airway Management Wellness 88

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. There is reciprocal ST depression in I and aVL.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 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) 88

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 88

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 82

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 82

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

EB Medicine

OCTOBER 1, 2018

This month, we’ll be talking Updates and Controversies in the Early Management of Sepsis and Septic Shock. Jeff : So as well all know Sepsis is bread and butter emergency medicine, but, what is sepsis? Jeff : So get this -- one study showed that out-of-hospital shock index and respiratory rate were highly predictive of ICU admission.

Sepsis 40

Sepsis Shock Fluid Resuscitation Hospitals 40

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case presented in cardiogenic shock from proximal LAD occlusion, in conjunction with a subtotally stenosed LMCA. In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ).

EKG/ECG 117

EKG/ECG Shock Hospitals Sepsis 117

Total Medical ComplianceHIPAA

OCTOBER 9, 2024

This list is not all inclusive, there may be other challenges as well. Maintenance should be performed on any equipment before using in the delivery of patient care, this includes autoclaves, suction lines, ultrasounds, radiology equipment, etc. If the testing reveals failing water quality, shock and test again.

Hazardous Materials 59

Hazardous Materials Infectious Diseases PPE Shock 59

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. More FOAMed HARDWARE MALFUNCTION PACEMAKER AND AICD MANAGEMENT IN THE ED [BLOG]: EM Docs brings us some well needed cardiac hardware meducation on the patient with AICD/pacemaker issues presenting to the ED.

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

Dr. Smith's ECG Blog

JULY 18, 2014

the presence of such well developed, wide, anterior Q-wave suggests completed transmural STEMI. 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. Raitt et al.), Lessons : 1.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 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

Dr. Smith's ECG Blog

JULY 7, 2013

Armstrong et al.)], the presence of such well developed anterior Q-wave suggests completed transmural STEMI. 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. Raitt et al.) [and 3) Oliva et al. (3)

Ultrasounds 52

Ultrasounds EKG/ECG Emergency Department Shock 52

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. The LCx and OM vessels are not as well visualized. below) Other examples of AIVR: Young man with Gunshot wound to right chest with hemorrhagic shock, but bullet path not near heart.

EKG/ECG 84

EKG/ECG EMS Emergency Department Outcomes 84

Taming the SRU

OCTOBER 1, 2023

This topic is additionally complicated by the development of multiple diagnostic tools now available for diagnosis as well as variable sizing algorithms used around the world. J Emerg Trauma Shock. Accuracy of Ultrasound in Diagnosis of Pneumothorax: A Comparison between Neonates and Adults-A Systematic Review and Meta-Analysis.

Fractures 95

Fractures COPD Hospitals Emergency Department 95

Dr. Smith's ECG Blog

JANUARY 15, 2024

Tachycardia is unusual for OMI, unless the patient is in cardiogenic shock (or getting close). A bedside ultrasound should be done to assess volume and other etiologies of tachycardia, but if no cause of type 2 MI is found, the cath lab should be activated NOW. There are also diagonal branches which are not well visualized.

EKG/ECG 67

EKG/ECG Wellness Point-of-Care Testing Shock 67

Dr. Smith's ECG Blog

DECEMBER 3, 2024

I put this through the Queen of Hearts and was shocked that she did not see it. Case continued A bedside cardiac ultrasound revealed grossly preserved left ventricular function, no appreciable wall motion abnormality, pericardial effusion, or obvious valvular abnormality. A large RPDA and a small RPAV giving rise to RPL1 was seen.

EKG/ECG 92

EKG/ECG Burns Wellness Shock 92

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Smith comment: This patient did not have a bedside ultrasound. Had one been done, it would have shown a feature that is apparent on this ultrasound (however, this patient's LV function would not be as good as in this clip): This is recorded with the LV on the right. In fact, bedside ultrasound might even find severe aortic stenosis.

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Pediatric Emergency Playbook

AUGUST 1, 2017

Hypertrophic pyloric stenosis: tips and tricks for ultrasound diagnosis. J Ultrasound. The non-diagnostic ultrasound in appendicitis: is a non-visualized appendix the same as a negative study? Utility of MRI After Inconclusive Ultrasound in Pediatric Patients with Suspected Appendicitis. Semin Pedaitr Surg. Dias SC et al.

Pediatrics 52

Pediatrics Ultrasounds Resuscitation Sepsis 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

In addition to all of the above, there are T wave inversions in III and aVF, as well as T wave inversions in V2-V4. Here are a few more ECGs during this time: He was on ECMO for 5 days with improvement and decannulation, as well as discontinuation of CRRT. Now another, with ultrasound. What is the Diagnosis? This is a quiz.

EKG/ECG 52

EKG/ECG Resuscitation Ultrasounds CPR 52

EMDocs

JANUARY 11, 2024

Individualize MAP targets based on the patient, as well as treatments (inotropes, vasopressors, and fluids) for hypotensive patients. 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).

Seizures 75

Seizures Shock Infectious Diseases CPR 75

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

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Importantly, there is also STE in aVL, as well as V1. It was notable for a normal cardiac ultrasound with no pericardial fluid, normal LV and RV function (though the quality was not sufficient to evaluate for wall motion abnormalities) and normal IVC dynamics. Bedside ultrasound is another very important piece.

Ultrasounds 40

Ultrasounds EKG/ECG EMS Radiology 40

EB Medicine

NOVEMBER 1, 2018

Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. Pay attention to the entry and exit sites, as the pathway of the shock is predictive of the potential for myocardial injury and arrhythmia. Jeff: Vascular injuries include coagulation necrosis as well as thrombosis.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Advanced Emergency Nursing from AENJ

JANUARY 26, 2015

All went well. Keep your ultrasound handy. Journal of Emergencies, Trauma and Shock, 3(1), 39. Not in the textbook, but it worked. Usually, in the ED, the simple and great goal is to get the parturient upstairs to OB-GYN, if you have one, as soon as possible. Here, then, are some links for Third Trimester Emergencies.

OB/GYN 40

OB/GYN Ultrasounds Emergency Department Resuscitation 40

PEMBlog

JANUARY 17, 2024

Well when a break in the skin occurs, normal skin, flora, and bacteria can enter the subcutaneous tissue, where they do not belong, and they can also invade the lymphatic system. You can also see petechiae and hemorrhage, as well as superficial bulla, vesicles, or even echemosis. Full blown sepsis and toxic shock syndrome.

Infectious Diseases 59

Infectious Diseases Sepsis Wellness Pediatrics 59

Dr. Smith's ECG Blog

OCTOBER 7, 2019

When the physicians approached him, he was ashen, diaphoretic, and appeared in shock. Why is the patient in shock? He was in profound cardiogenic shock. Although the shock is no doubt partly a result of poor pump function, with low stroke volume, especially of the RV, it should be compensated for by tachycardia.

Seizures 40

Seizures EKG/ECG Shock EMS 40

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.

Dislocations 52

Dislocations Emergency Department Burns Shock 52