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EM@3AM: Hyperthermia

EMDocs

A 12-lead EKG shows sinus tachycardia but is otherwise normal. Broad-spectrum antibiotics (A) for septic shock are not inappropriate given the hyperthermia, tachycardia, and hypotension. The patient is agitated, not oriented, and becoming combative with ED staff. 1 Fever is usually < 40C. 1 Fever is usually < 40C.

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Hypothermia and drowning

Don't Forget the Bubbles

You request a 12 lead ECG and repeat a blood gas, asking for it to be run on the PICU analyser. Your trusted nurse hands you the ECG: Paediatric ECG interpretation has never been your strong suit. What is the likely cause of Elsa’s ECG changes? You look at her monitor, and an arterial blood gas performed moments ago.

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What is this ECG finding? Do you understand it before you hear the clinical context?

Dr. Smith's ECG Blog

Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. These are Osborn waves usually associated with hypothermia. C), with Cardiac Echo -- A Pathognomonic ECG. Is there a long QT?

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ECG Pointers: Recurrent and Refractory Torsades de Pointes

EMDocs

An ECG is performed and is shown below: Figure 1. Adapted from Dr. Smith’s EKG Blog. Another ECG is obtained and shown below. Source: [link] As you are calling the ICU and cardiology team, the patient has recurrence of her symptoms and repeat ECG shows return of the PVT. She denies chest pain. What do you do?

EKG/ECG 69
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EM Quick Hits 24 Lateral Canthotomy, Cannabis Poisoning, Hyperthermia, Malignant Otitis Externa, BBB in Occlusion MI, Prone CPR

Emergency Medicine Cases

In this month's EM Quick Hits podcast: Anand Swaminathan on lateral canthotomy, Emily Austin on pediatric cannabis poisoning, Reuben Strayer on an approach to hyperthermia, Brit Long on diagnosis and management of malignant otitis externa, Jesse McLaren on ECG diagnosis of occlusion MI in patients with BBB and Peter Brindley on prone CPR.

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SGEM#391: Is it Time for a Cool Change (Hypothermia After In-Hospital Cardiac Arrest)?

The Skeptics' Guide to EM

You are tidying your things […] The post SGEM#391: Is it Time for a Cool Change (Hypothermia After In-Hospital Cardiac Arrest)? A post-arrest ECG doesn’t show any signs of STEMI. Are we supposed to be starting hypothermia?” The six-month mortality was also improved in the hypothermia group (41% vs 55%, p=0.02) NNT 7.

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40. Hypothermia- The Great Chicago Cold

Board Bombs

We discuss hypothermia, diagnosis, approach to rewarming, EKG and lab findings, and complications. We discuss hypothermia, diagnosis, approach to rewarming, EKG and lab findings, and complications. Let’s defrost you with a “hot” board topic that is SURE to come up. Want to experience the greatest in board studying?