Taming the SRU

FEBRUARY 5, 2024

The LP is now a standard procedure and in 2010 well over 135,000 LPs were performed in Emergency Departments throughout the US (3). As may be seen in the table below, there are several themes as well a range of stringency. This resource offers additional information on ultrasound assisted LP’s. WHO - Who Needs an LP in the ED?

Infectious Diseases 97

Infectious Diseases Seizures Ultrasounds Sepsis 97

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 145

Administration Outcomes Resuscitation Radiology 145

Taming the SRU

NOVEMBER 3, 2023

Ultrasound‐Guided Serratus Anterior Plane Block (SAPB) Improves Pain Control in Patients With Rib Fractures. Ultrasound Med. The thought with introducing the serratus anterior plane block was that regional anesthesia is well within the purview of EM physicians and can offer a safe alternative to systemic pain medications.

Fractures 98

Fractures Ultrasounds Outcomes Research 98

Dr. Smith's ECG Blog

JULY 5, 2024

But the duration of symptoms was prolonged and so to avoid the risk of stroke, AV nodal blockade (rate control) was preferred. That would likely slow the ventricular rate as well, but would have a higher likilihood of converting to sinus. We want to avoid a stroke. What AV nodal blocker should we give? How about amiodarone?

EKG/ECG 104

EKG/ECG Stroke Administration Wellness 104

Taming the SRU

FEBRUARY 24, 2024

Providers should use ultrasound as early as possible to evaluate for cardiac dysfunction, pulmonary edema, and fluid status. They tend to be hypertensive, tachycardic, tachypneic, and hypoxic. Do not always appear volume overloaded on exam. Early recognition and prompt treatment is key.

Leadership 93

Leadership EMS Pediatrics Stroke 93

RebelEM

JUNE 19, 2023

SBP < 75 mm Hg: 39% SBP 76-89 mm Hg: 33% Critical Findings: No statistically significant difference in safety outcomes (DVT, PE, MI, Stroke) TXA Placebo RR (95% CI) Primary Outcome Good Functional Outcome (6 months) 53.7% Demographics were well balanced in the two groups. Majority of patients (92%) had blunt trauma.

Outcomes 105

Outcomes Blood Transfusions Administration Hyperthermia / Hypothermia 105

Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift.

Emergency Department 85

Emergency Department Dislocations Documentation/Coding Burns 85

Northwestern EM Blog

MAY 16, 2022

What is your initial imaging test of choice, ultrasound (US) or non-contrast CT, and why? Would you be confident in a point-of-care-ultrasound evaluation or a formal ultrasound? Many patients in the ultrasound groups did get additional imaging, but this was not the majority. How do you proceed? In this study, 40.7%

Ultrasounds 52

Ultrasounds Radiology Radiology Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Over some time and the pain moved into her other arm as well as her jaw. Stroke-volume:50 ml. Plaque rupture or erosion has been diagnosed by intravascular ultrasound in about 40 percent of women with MINOCA [ 12 ]. Over the course of the next hour, this pain turned into a pressure in her chest. Normal wall thickness.

EKG/ECG 108

EKG/ECG Ultrasounds Wellness Stroke 108

All Ohio EM

FEBRUARY 11, 2019

Dr. Mike Pallaci covered endovascular therapy for stroke with a quick review of some very relevant studies that put endovascular therapy on the map. Based on data from MR CLEAN, merely 1/110 screened strokes would meet inclusion criteria. This medication has specific indications and contraindications that we should know well.

EMS 52

EMS Stroke Leadership Documentation/Coding 52

ACEP Now

OCTOBER 29, 2024

4 However, emergency physicians rely on gestalt to predict outcomes well. In the diagnosis of pulmonary emboli, experienced emergency physicians’ gestalt performed similarly to prediction rules of PERC, Revised Geneva, and Wells. A testicular ultrasound confirmed restored blood flow. Urology took him for orchiopexy.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

Dr. Smith's ECG Blog

OCTOBER 28, 2023

There is very little filling, and thus very poor stroke volume. Further ultrasound showed no B-lines (no pulmonary edema). We gave him IV fluids and metoprolol, and his pulse normalized, after which he felt completely well. This is because of the large LV myocardial mass due to HOCM. He stated he had stopped taking them.

EKG/ECG 61

EKG/ECG Stroke Ultrasounds Wellness 61

EB Medicine

AUGUST 6, 2019

Nachi: Specifically, we’ll be focusing on the use of DOACs for the indications of stroke prevention in atrial fibrillation and the treatment and prevention of recurrent venous thromboembolisms. Nachi: Well, I’m sure more of those studies are still coming. Show More v Jeff: Fair enough, we’ll take what we can get. Jeff: Agree.

Emergency Department 40

Emergency Department Stroke Wellness Outcomes 40

Downeast Emergency Medicine

APRIL 26, 2021

MI or stroke). Secondary outcomes were early head injury related death (within 24 hours after injury), all-cause and cause-specific mortality, disability, vascular occlusive events (MI, stroke, DVT, PE), seizures, complications, neurosurgery, days of ICU care, and adverse events within 28 days. in the TXA group and 9.9%

Head Injuries 52

Head Injuries Administration Outcomes Seizures 52

Dr. Smith's ECG Blog

MAY 30, 2023

Case continued A bedside ultrasound showed diminished LV EF and of course bradycardia. The RV is supplied during systole as well as diastole. 1 mg of Atropine was given and the heart rate increased transiently to 60. RVMI explains part of the shock. STD in V2 without STD in V1 is a sign of RV MI 5. RV MI can cause hypotension.

Shock 86

Shock EKG/ECG Academics Stroke 86

Mind The Bleep

NOVEMBER 21, 2023

” Yes, I have seen clerking look like this and I can confirm, it does not go down well. Examples of examination findings you might find helpful to keep in mind (list not exhaustive): GCS 15/15- alert, orientated, looks comfortable, warm and well perfused, in obvious pain, looks pale and clammy etc.

Documentation/Coding 52

Documentation/Coding COPD EKG/ECG Wellness 52

PulmCCM

SEPTEMBER 13, 2021

While more detailed analyses are available for the keen reader [1-3], this brief approach will consider a simplified model first proposed well over a century ago. This is analogous to a left ventricle with constant stroke volume and heart rate, respectively. Taylor KJW, Burns PN, Wells PNT: Clinical Applications of Doppler Ultrasound.

Burns 40

Burns Stroke Ultrasounds Wellness 40

Stop and Think

OCTOBER 2, 2024

It is actually simple: you use an online calculator to get your 10-year risk of a heart attack or stroke. 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. If not, you don’t take the pill.

Stroke 43

Stroke Academics Shock Ultrasounds 43

Taming the SRU

AUGUST 25, 2023

wrist in extension clavicle tibial pediatric forearm Most likely injuries to need an x-ray? bicarb <18mEq/L) ketosis (preferably serum beta-hydroxybutyrate >3mmol/L) Risk factors SGLT2 inhibitor use fasting state ketogenic diet intra-abdominal pathology (AGE, pancreatitis, etc.)

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

Dr. Smith's ECG Blog

MARCH 15, 2023

But when you see this, you should suspect that the AV node is not well. Her bedside cardiac ultrasound was normal We decided to cardiovert her since the time of onset was very recent. I do not know why she did not have a rapid rate. I signed her out to one of my partners.

EKG/ECG 52

EKG/ECG Dehydration Stroke Wellness 52

Dr. Smith's ECG Blog

AUGUST 3, 2018

Here was his prehospital ECG, which I viewed immediately while the resident performed cardiac ultrasound: What do you think? Here is the cardiac ultrasound which the resident performed as I viewed the ECG: This shows a huge pericardial effusion. There is some risk of stroke when converting atrial flutter. Is is sinus?

EKG/ECG 40

EKG/ECG Ultrasounds Stroke Shock 40

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

Taming the SRU

MAY 1, 2023

Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Emergency Department Seizures 52

EB Medicine

NOVEMBER 1, 2018

Nachi: There is a school of thought out there that victims of electrical injury can have delayed onset arrhythmias and require prolonged cardiac monitoring – however several well-designed observational studies, including 1000s of patients, have demonstrated no such evidence. Let’s move on to treatment.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Taming the SRU

AUGUST 30, 2023

As the name would suggest, inflammatory markers are biological markers of, well, inflammation. Instead, they strongly advocated for the use of lung ultrasound to diagnose bacterial CAP [45]. They are used clinically to detect pathological inflammation or measure response to treatment [1-2].

Infectious Diseases 88

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

Dr. Smith's ECG Blog

OCTOBER 7, 2019

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. Cardiac output is stroke volume x rate, so this patient needs a higher heart rate. He was discharged neurologically intact and did very well. Learning Points : 1.

Seizures 40

Seizures EKG/ECG Shock EMS 40

Pediatric Emergency Playbook

JANUARY 1, 2017

Tachycardia, tachypnea, and a change in behavior can be indicators not only to the presence of pain, but possibly to its etiology as well. For children greater than one year who are preverbal, a well performing scale is the FLACC score: Face, Legs, Activity, Cry, Consolability ( Table 3 ).

Pediatrics 40

Pediatrics Soft Tissue Injuries Burns Emergency Department 40

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. Jeff: I feel like we should get some entry music for every ultrasound reference because it seems to make its way into just about every episode.

Emergency Department 40

Emergency Department Poisoning Anaphylaxis Allergic Reactions 40

EB Medicine

FEBRUARY 1, 2019

Gabrielle Procopio, a PharmD, have done a fantastic job parsing through the literature, which included over 500 abstracts, 89 full text articles, guidelines from ACEP and the American Academy of Neurology, as well as canadian and european neurology guidelines, to summarize the best evidence based recommendations for you all.

Emergency Department 40

Emergency Department Stroke Outcomes Ultrasounds 40

EB Medicine

AUGUST 1, 2018

It was peer-reviewed by Joseph Habboushe, assistant professor at NYU and Nadia Maria Shaukat, director of the emergency and critical care ultrasound at Coney Island Hospital in Brooklyn, New York. First up is the link between cannabis use and stroke or TIA. times higher risk of stroke or TIA.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. Stroke Authors’ Recommendation: CTA head/neck should be acquired in patients with stroke symptoms presenting within 24 hours of symptom onset.

Stroke 87

Stroke Radiology Radiology Emergency Department 87

Dr. Smith's ECG Blog

APRIL 8, 2015

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Aortic Dissection, Valvular (especially Aortic Stenosis), Tamponade. Vasovagal syncope is generally benign. orthostatic vitals b.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

NOVEMBER 4, 2024

She denies any trauma, swelling, or redness in the joints, as well as fever or weight loss. 80 It can be caused by traumatic nerve, spinal cord, or brain injury (including stroke) or can be a sequela of conditions like diabetes, HIV/AIDS, postherpetic neuropathies, multiple sclerosis, cancer, or chemotherapies. 2020;120(10):696-697.

Emergency Department 99

Emergency Department Fractures Burns EMS 99

Sensible Medicine

NOVEMBER 11, 2024

The ACE-inhibitor trials in patients after myocardial infarction, for instance, were well conducted and positive. The question tested in EARLY TAVR is what to do with patients whose aortic valve looks terribly diseased on ultrasound, but they report no symptoms. Bottom left is stroke—also not significantly different.

Stroke 94

Stroke Outcomes Hospitals Ultrasounds 94

Mind The Bleep

NOVEMBER 2, 2024

Babies in the neonatal unit will typically wait until they are well enough for the examination e.g. NIPE is not performed for baby’s who are ventilated, on CPAP or have lots of different lines inserted. Other important questions to ask: Have they been feeding well? Was the baby head down presentation from 36 weeks onwards?

Documentation/Coding 52

Documentation/Coding Dislocations Ultrasounds Wellness 52