Dr. Smith's ECG Blog

MAY 26, 2023

A 20-something presented after a huge verapamil overdose in cardiogenic shock. He was admitted to the ICU and was unstable, in shock, overnight. Thus, since high dose insulin's (HDI) primary beneficial effect on calcium channel overdose is to as a positive inotrope, it does not work well for dihydropyridine overdose.

Shock 98

Shock EKG/ECG Documentation/Coding Resuscitation 98

PHARM

APRIL 28, 2023

Some joker on Twitter called Chrimes took this at Aspen, Colorado It is an oft quoted maxim of trauma resuscitation that shock is haemorrhagic until proven otherwise. Cardiac causes of shock in trauma? Albeit yes he/she may be in shock due to a smashed femur but what of their cardiogenic shock from the acute anterior MI?

Shock 52

Shock Resuscitation Wellness 52

EMDocs

JANUARY 11, 2025

Well keep it short, while you keep that EM brain sharp. 2, 8-10, 14 The clinical symptoms range from vague abdominal pain to florid septic shock and peritonitis secondary to bowel perforation. 2-4 Any patient with evidence of complications or septic shock may need surgical management or a higher level of care.

EMS 98

EMS Sepsis Shock Fluid Resuscitation 98

Sensible Medicine

APRIL 1, 2024

In the same session, Jacob Eifer Møller, MD, PhD, from Odense University in Denmark, will present the results of the DanGer-Shock trial. I rank this trial—of the Impella ventricular assist device in patients with cardiogenic shock—as one of the most important trials of this decade.

Shock 137

Shock Wellness Outcomes 137

Dr. Smith's ECG Blog

MAY 30, 2023

A 50-something man presented in shock with severe chest pain. The patient was in clinical shock with a lactate of 8. This confirms inferior, posterior, lateral, and RV MI RV MI often leads to shock and (systolic) hypotension. RVMI explains part of the shock. The RV is supplied during systole as well as diastole.

Shock 97

Shock EKG/ECG Academics Stroke 97

Taming the SRU

MARCH 30, 2023

Diastolic shock index and clinical outcomes in patients with septic shock. O: There was an association between increased diastolic shock index score and mortality at 90 days and performed similarly to more advanced measures of morbidity and mortality in septic shock including lactate levels and SOFA scores.

Shock 52

Shock Outcomes Sepsis Resuscitation 52

EM Ottawa

APRIL 18, 2024

In this Prehospital Journal Club Recap, let us take a deep dive into the use of blood products, as well as the adjunct use of automated controlled elevation in CPR.

CPR 115

CPR Resuscitation Shock Wellness 115

RebelEM

FEBRUARY 24, 2025

Well, the established cutoff for the distensibility index is 18%. 13 That is to say nothing of the effect that the type and response to shock has on the individual patients involved in these studies. Why does it matter? A cutoff of 18% has a positive predictive value (PPV) of 92% and NPV of 90% for fluid responsiveness.

Ultrasounds 75

Ultrasounds Shock Fluid Resuscitation Resuscitation 75

EMDocs

DECEMBER 23, 2024

Do we still shock? The most recent and well-known trial is the PROCAMIO trial (1). Well, the trial was a multicenter prospective open label trial. Well, lets look at some other trials. If the patient has a BP of 60/palp, its easy, right? Synchronized cardiovert and move on with your day. Are there any meds you can give?

EKG/ECG 75

EKG/ECG Shock Wellness EMS 75

RebelEM

MAY 25, 2023

I recently gave a talk on the initial management of trauma patients with hemorrhagic shock. Clinical Take Home Point: In patients with TBI and hypovolemic shock, target a SBP or MAP ≥90mmHg, but know this is based on limited evidence. vs SBP target <90mmHg which resulted in a mortality of 33.4% NEJM 1994. [2]

Resuscitation 145

Resuscitation Fluid Resuscitation Head Injuries Shock 145

Dr. Smith's ECG Blog

FEBRUARY 22, 2024

She did well and stabilized after dialysis. Here is her ECG the next day with normal potassium level: She did well. Physician also reads it as normal) Severe shock, obtunded, and a diagnostic prehospital ECG. ST elevation in aVL with reciprocal ST depression in the inferior leads Shock, bradycardia, ST Elevation in V1 and V2.

EKG/ECG 140

EKG/ECG EMS Shock Wellness 140

The Trauma Pro

AUGUST 22, 2023

The EMS report indicates that your incoming patient is in shock. The patient is doing well but has an unexplained pressure dip. A simple one is the use of any of your blood refrigerator products or emergency release blood , or a calculated score such as the ABC score or shock index (SI). And it happens again.

Shock 100

Shock Wellness EMS 100

RebelEM

FEBRUARY 15, 2024

Additionally, intubation can risk hemodynamic instability as well as hypoxemia from the procedure itself. It is unclear, though, if the risks of intubation (including ventilator associated pneumonia) outweighs the benefits. of the risk of pneumonia by not intubating patients (NNT = 13) Additionally there was an absolute reduction of 12.2%

Poisoning 141

Poisoning Airway Management Seizures Shock 141

Pediatric EM Morsels

JULY 21, 2023

Pediatric adjusted reverse shock index multiplied by Glasgow Coma Scale as a prospective predictor for mortality in pediatric trauma. Fun fact for animal lovers!- cats and dogs have their own GCS scores [Lapsley 2019, Ash 2018] Moral of the Morsel Modified can make it Merrier! 2008 Apr;39(4):1347-8. doi: 10.1161/STROKEAHA.107.498345.

Head Injuries 246

Head Injuries Pediatrics Outcomes Shock 246

Dr. Smith's ECG Blog

OCTOBER 20, 2024

Figure B At this point, with the ECG changing from diffuse ST depression to widespread ST elevation and the patient presenting in cardiogenic shock, left main coronary artery (LMCA) occlusion is the likely diagnosis. Complete LMCA occlusion is associated with clinical shock and/or cardiac arrest. This is an ominous sign.

EKG/ECG 128

EKG/ECG Shock Emergency Department Ambulance Services 128

Don't Forget the Bubbles

MARCH 31, 2025

The primary outcome was to evaluate the impact of % FO in paediatric patients with sepsis or septic shock at any time after PICU admission. 41% of patients with septic shock had MODS. Reviewed by Dr Sadia Irshad Article 3: Updates on the management of sepsis and shock Long B, Gottlieb M. Am J Emerg Med. 2025 Apr;90:179-191.

Sepsis 59

Sepsis Fluid Resuscitation Shock Resuscitation 59

The Trauma Pro

JUNE 18, 2024

Objective MTP activation criteria have been developed and are well-supported by the literature. The ABC score and the shock index are two of the more common methods. The Shock Index (SI) uses the initial vital signs to perform a quick and dirty calculation by dividing the heart rate by the systolic blood pressure.

Pediatrics 113

Pediatrics Blood Transfusions Resuscitation Shock 113

Thinking Critical Care

DECEMBER 8, 2024

Every resus doc needs to have a holistic approach to shock – MAP and forward flow simply isn’t enough. Here, Matt and I chat a bit about recent things we’ve heard in the world around us, as well as how we use and see the use of the interface concept. Don’t forget to come up your game at #HR25!!!

Shock 90

Shock Wellness 90

EMDocs

DECEMBER 6, 2024

Stage 3 (timing variable) Shock 1 : Can occur within hours for massive ingestion, but may occur over a longer time course. 6 Severe toxicity and shock are typically seen with serum iron concentrations above 500 g/dL and serum iron concentrations above 1000 g/dL are associated with significant mortality.

Poisoning 98

Poisoning Fluid Resuscitation Seizures Resuscitation 98

RebelEM

MAY 18, 2023

Background: IV fluids are part of the standard resuscitation bundle in septic shock, however it is unclear if they provide a significant benefit. The goal of the trial was to see if early vasopressors improved shock control by 6 hours. This resulted in better shock control by 6hrs (76.1% Liberal: 14.9%

Sepsis 104

Sepsis Shock Resuscitation Outcomes 104

EMDocs

JANUARY 23, 2024

Episode 93: BRASH syndrome Background: Brash syndrome has 5 components: bradycardia, renal failure, AV nodal blocker, shock, hyperkalemia. BRASH Syndrome: Bradycardia, Renal Failure, AV Blockade, Shock, and Hyperkalemia. BRASH syndrome: Bradycardia, Renal failure, Av blocker, Shock, and Hyperkalemia. J Emerg Med. 2020.05.001.

Shock 115

Shock Dehydration Sepsis EKG/ECG 115

The Trauma Pro

APRIL 26, 2024

A multi-center trial published in 2015 showed an astounding 32% mortality rate for patients with shock from pelvic fracture. Years ago, we tried to pack the pelvis from the inside (peritoneal cavity), but it never worked very well. As I continue to preach, going anywhere but the OR is dangerous for the patient.

Fractures 147

Fractures Head Injuries Radiology Radiology 147

Greater Sydney Area HEMS

FEBRUARY 20, 2024

Obtaining access in shocked trauma patients can be notoriously difficult due to circulatory collapse. Those who are shocked, shut down with limited or no other options for peripheral access require central access. The evidence for improved safety and quality with the use of ultrasound for CVC implementation is well established [i].

Ultrasounds 98

Ultrasounds Shock Research Emergency Department 98

Mount Sinai EM

NOVEMBER 14, 2022

I included several resources including a link to “One pager ICU” which is where my drawing is derived from as well as several podcasts recommended by Dr. Pesyna. Contact Dr. Greg Serrao (917) – 756 – 6852 or 1-833-MH-SHOCK (1-833-647-4625) 2.) How can I activate ECMO at Mount Sinai vs Elmhurst? Mount Sinai VA ECMO: 1.)

Shock 130

Shock Wellness 130

Sensible Medicine

JUNE 17, 2024

PFA destroys myocardium with electricity (shocks). Every “application” is actually a shock. Europeans do PFA ablation in well under an hour. PFA is especially concerning because the shocks in the left atrium create intense microbubbles. Sensible Medicine is a reader-supported publication.

Shock 127

Shock Stroke Operations Ultrasounds 127

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Shocked x 2 without effect. Warning: if this is VT, a calcium channel blocker can result in shock and death. Today's case is insightful in many ways — especially since despite prompt electrical cardioversion, we are told that this patient "was shocked X 2 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

NOVEMBER 12, 2020

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. Assessment was severe sudden cardiogenic shock. He remained hypotensive and in shock.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

RebelEM

SEPTEMBER 28, 2023

The STREAM-1 trial found that for [2] patients with STEMI presenting within 3 hours of symptom onset and unable to attain PCI within 1 hour of first medical contact, a pharmaco-invasive strategy resulted in similar rates of death, shock, heart failure, or reinfarction compared to primary PCI. Primary PCI: 95.7% Primary PCI: 95.7%

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. 6 What Can I Do Outside of Repeated Shocks and Standard ACLS? amiodarone or lidocaine).

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? Referring to Figure-1 — this 53-year old woman who presented in extremis with cardiogenic shock and an initial pH = 6.9, This was sent by a reader.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

PulmCCM

OCTOBER 14, 2024

How well does it work? In this way albumin produces most of the vascular system’s oncotic pressure—the force tending to retain fluid in blood vessels without its leaking into the extravascular space. This increases mean arterial pressure.

Resuscitation 52

Resuscitation Shock 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 105

Shock Emergency Department Pediatrics EKG/ECG 105

EM Literature of Note

JANUARY 27, 2024

A brief post collating a few bits of my various work published across the interwebs … The Annals of Emergency Medicine Podcast continues to summarise the meatiest articles from each month, featuring a cycle of new co-hosts, as well: Apple Podcasts Google Podcasts Soundcloud Naturally, there are continuing Journal Club features, covering the (..)

Resuscitation 96

Resuscitation Emergency Department Shock Wellness 96

EMDocs

NOVEMBER 6, 2023

Venoarterial extracorporeal membrane oxygenation can be lifesaving for patients with cardiogenic shock or dysrhythmias that are refractory to other treatment measure s. The usefulness of administering methylene blue for refractory vasodilatory shock due to CCB poisoning is uncertain. COR 2a, LOE C-LD. COR 2a, LOE C-LD.

Poisoning 115

Poisoning Hyperthermia / Hypothermia Seizures Administration 115

EMDocs

NOVEMBER 19, 2024

1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. Low-dose lipid emulsion for pediatric vasoplegic shock due to quetiapine and fluvoxamine overdose: a case report.

Poisoning 111

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 111

Ken Grauer, MD

SEPTEMBER 28, 2024

The ECG in Figure-1 — was obtained from a 45-year old man with diabetes, who was being treated for septic shock. PEARL # 2: The reason today's tracing is so challenging — is that every 3rd P wave is so well hidden within the T waves of every odd-numbered beat. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? What is the rhythm?

EKG/ECG 266

EKG/ECG Shock Wellness 266

Taming the SRU

MARCH 10, 2024

critical AS, ASD, HCM) Arrhythmogenic right ventricular cardiomyopathy Pulmonary embolism Thoracic aortic dissection Transient occult shock Sepsis Hemorrhagic shock (ex. Can’t miss ED diagnosis for syncope Brady/tachy dysrhythmia, arrhythmias such as ARVC, channelopathy (Brugada) Acute MI Structural heart disease (ex.

EKG/ECG 97

EKG/ECG Shock Wellness EMS 97