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

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 103

Shock Emergency Department Pediatrics EKG/ECG 103

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 71

EKG/ECG Shock Ultrasounds Wellness 71

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 135

Administration Outcomes Resuscitation Radiology 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

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) 89

Advances Cardiac Life Support (ACLS) CPR Burns Resuscitation 89

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 134

EKG/ECG Shock Hospitals Sepsis 134

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

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 113

EKG/ECG Burns Wellness Shock 113

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

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 87

Seizures Shock Infectious Diseases CPR 87

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 66

EKG/ECG Wellness Point-of-Care Testing Shock 66

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

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

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

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

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. How useful these would have been to let us know how well the patient was oxygenating and ventilating! Intraosseous Infusion.

Emergency Nursing 40

Emergency Nursing Seizures CPR Wellness 40

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 Late findings Fever Abdominal distension (+) LR: 5.64 – 16.8 (-) LR: 0.34 – 0.43

Operations 52

Operations Sepsis Resuscitation Ultrasounds 52

Pediatric Emergency Playbook

SEPTEMBER 1, 2015

The combination of abnormalities determines the category of pathophysiology: respiratory distress, respiratory failure, CNS or metabolic problem, shock, or cardiopulmonary failure. Was there any prenatal care or ultrasound done? Do a total body check. Heart disease or Hypovolemia - is there a history of congenital heart disease?

Seizures 40

Seizures Sepsis Pediatrics Shock 40

PEMBlog

OCTOBER 2, 2024

Children with respiratory conditions and chronic lung disease like asthma are more prone to GERD as well. So, the parents may say, well, he Doesn’t ever seem full. Well, baby doesn’t know how to be full. or somebody who appears pale, dehydrated, in severe pain, or worse, even in shock.

Pediatrics 52

Pediatrics Emergency Department Ultrasounds Wellness 52

Stop and Think

OCTOBER 2, 2024

Their argument required high levels of trust in measurements from ultrasound images. Well known is the fact that procedures put out a much stronger placebo effect than tablets. The first ORBITA trial shocked the cardiology world when it failed to find a placebo-resistant effect of stenting substantial coronary lesions.

Stroke 44

Stroke Academics Shock Ultrasounds 44

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis. On the other hand , high-risk lesions appear to do well with aggressive treatment. were pretty sick, with mostly LM/pLAD lesions and high rates of cardiogenic shock. Lobo et al. The SCAD cases in Lobo et al.

EKG/ECG 52

EKG/ECG Shock Ultrasounds Wellness 52

Downeast Emergency Medicine

APRIL 26, 2021

When looking at the subgroups with severe shock, there was an 18.5% When stratifying TXA administration time after injury and qualifying shock incidence, there appeared to be a lower 30 d mortality if TXA was given within 1 hour of the incident. MI or stroke). DOES TXA IMPROVE OUTCOMES IN PATIENTS WITH TBI? 67% received TXA.

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

Rural Doctors Net

AUGUST 30, 2013

I’d raise here the concept of his ‘anticipated clinical course’ – he’s going to OT and has airway injury that will likely progress – so you might as well intubate on these grounds alone. Sure he’s got a traumatic amputation – your tourniquet has arrested the bleeding, but there may well be more blood loss.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

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

EB Medicine

SEPTEMBER 1, 2018

You may have heard of the recommendations for incision / excision, use of venom extraction devices, tourniquets, chill methods and even electroshock therapy – well these methods are all OUT. In severe cases this can lead to systemic bleeding and even hemorrhagic shock. Jeff: Pit viper envenomation can also cause hematologic effects.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 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 141

EKG/ECG Shock Documentation/Coding Academics 141