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 75

Shock EKG/ECG Academics Stroke 75

Stop and Think

APRIL 16, 2024

I wrote this week, on Sensible Medicine, a summary of the DanGer-Shock trial of a mechanical assist device in patients with cardiogenic shock due to acute myocardial infarction (heart attack). Because doctors and hospital are compensated well for its use—which may be a reason why it became a popular device.

Shock 48

Shock Wellness Hospitals 48

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 126

EKG/ECG EMS Shock Wellness 126

PEMBlog

OCTOBER 18, 2023

The night prior to presentation, mom noticed he was not feeding as well and seemed fussy. Initially in the emergency department he was generally well-appearing with normal vital signs. Neonatal Toxic Shock Syndrome C. Neonatal Toxic Shock Syndrome-Like Exanthematous Disease E. Overnight, she had to wake him to feed.

Infectious Diseases 59

Infectious Diseases Shock Pediatrics Wellness 59

AED Leader

APRIL 23, 2024

A manual defibrillator is a device used to deliver an electric shock to the heart to restore its normal rhythm. When activated, the defibrillator delivers a controlled electric shock, interrupting the heart’s chaotic electrical activity and allowing it to reset and resume its regular beating pattern.

Shock 52

Shock Best Practices Outcomes Pediatrics 52

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

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 105

Resuscitation Emergency Department Shock Wellness 105

AED Leader

APRIL 29, 2024

In today’s fast-paced world, businesses must prioritize their employees’ and customers’ safety and well-being. AEDs are portable devices that can be used to deliver an electric shock to the heart in case of sudden cardiac arrest (SCA), a condition that can strike anyone, anywhere, at any time.

Shock 52

Shock Resuscitation Pediatrics Wellness 52

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

AED Leader

MAY 3, 2024

AEDs are designed to deliver an electric shock to the heart, restoring its normal rhythm. Knowing that a church is well-prepared for emergencies instills confidence in the congregation and the surrounding community. It sends a message that the church values the well-being of its members and visitors. Q3: Are AEDs safe to use?

CPR 52

CPR Operations Shock Pediatrics 52

University of Maryland CC Project

JUNE 16, 2023

The first annual Mid-Atlantic Neurocritical Care Symposium will bring together experts from The University of Maryland/Shock Trauma Hospital, Johns Hopkins University, INOVA, Christiana Care, and beyond to discuss the basics of caring for critically ill neurological patients, as well as highlight recent innovations in the field.

Shock 70

Shock Hospitals Wellness Stroke 70

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 86

Shock Dehydration Sepsis EKG/ECG 86

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 86

EKG/ECG Shock Wellness EMS 86

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

AED Leader

MAY 8, 2024

It features an advanced biphasic waveform, which delivers a highly effective shock to the patient’s heart. The Defibtech DBP 2003 excels in this aspect, with a battery that can deliver up to 300 shocks or 16 hours of continuous monitoring. Its rugged construction and compact size make it durable and highly portable.

Shock 52

Shock CPR Operations Resuscitation 52

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 83

Sepsis Shock Resuscitation Outcomes 83

JournalFeed

JANUARY 13, 2024

Monday Spoon Feed: This expert panel from Canada has compiled a list of what they deem to be the most influential POCUS papers with regard to cardiac arrest as well as evaluation of shock. For access to more, please visit JournalFeed.org for details about becoming a member.

Shock 52

Shock Outcomes Wellness 52

The Skeptics' Guide to EM

FEBRUARY 24, 2018

Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. He writes an […] The post SGEM#208: It Makes No Difference – Glucocorticoids for the Treatment of Septic Shock first appeared on The Skeptics Guide to Emergency Medicine. Adjunctive Glucocorticoid Therapy in Patients with Septic Shock. NEJM January 2018.

Shock 40

Shock Sepsis Emergency Department Resuscitation 40

PulmCCM

FEBRUARY 12, 2024

SCCM Guideline Update: Steroids for Community-Acquired Pneumonia, ARDS, Septic Shock Steroids are good medicine in the ICU, U.S. The 2017 SCCM/ESICM suggestion had been to use steroids for severe septic shock (requiring high-dose or multiple vasopressors). critical care professional societies agree.

Shock 52

Shock Administration Sepsis Fractures 52

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

Taming the SRU

JANUARY 12, 2024

Often AE-ILD is idiopathic, but treatable causes must be excluded (PNA, PE, volume overload) Treatment for AE-ILD should include antibiotics for CAP coverage (specifically including azithromycin), steroids, and respiratory support; consider opportunistic infection if immunosuppressed as well as diuresis as needed for euvolemia HFNC should be favored (..)

Fluid Resuscitation 59

Fluid Resuscitation Pediatrics Sepsis Shock 59

AED Leader

NOVEMBER 15, 2023

The device will perform charge and shock tests and prompt the user to press the shock button (on semi-automatic units) when required. Please note that running a manual self-test on this unit depletes the battery capacity by one shock. As the pads dry out, they may not attach as well to the skin, resulting in poor conductivity.

Shock 52

Shock CDC Wellness Pediatrics 52

AED Leader

NOVEMBER 15, 2023

The device will perform charge and shock tests and prompt the user to press the shock button (on semi-automatic units) when required. Please note that running a manual self-test on this unit depletes the battery capacity by one shock. As the pads dry out, they may not attach as well to the skin, resulting in poor conductivity.

Shock 52

Shock CDC Wellness Pediatrics 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. Thus, the ECG could be considered similar to Aslanger's pattern (inferior OMI plus SEI pattern).

EKG/ECG 65

EKG/ECG Shock Ultrasounds Wellness 65

University of Maryland CC Project

JUNE 16, 2023

The first annual Mid-Atlantic Neurocritical Care Symposium will bring together experts from The University of Maryland/Shock Trauma Hospital, Johns Hopkins University, INOVA, Christiana Care, and beyond to discuss the basics of caring for critically ill neurological patients, as well as highlight recent innovations in the field.

Shock 52

Shock Hospitals Wellness 52

Dr. Smith's ECG Blog

DECEMBER 15, 2015

No shock was ever delivered. He was in profound shock. There is no pericardial fluid to account for shock. Fifth: the ultrasound in RV MI can look identical to that of PE: there can be both McConnell's sign and "D" sign, as well as enlarged RV with poor function. Sixth: Severe shock (e.g., He was intubated.

Shock 52

Shock Ultrasounds EKG/ECG Wellness 52

AED Leader

APRIL 30, 2024

As a responsible parent or guardian, the safety and well-being of your child are of utmost importance. AEDs are designed to deliver a life-saving shock to the heart, restoring its normal rhythm and allowing vital organs to receive the needed oxygen.

CPR 52

CPR Operations Shock Resuscitation 52

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 127

EKG/ECG Shock Documentation/Coding Academics 127

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 92

Poisoning Hyperthermia / Hypothermia Seizures Administration 92

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). While ABGs and VBGs usually correlate well, there are a few situations where this correlation is disturbed.

Emergency Department 93

Emergency Department Resuscitation COPD Shock 93

Sensible Medicine

AUGUST 20, 2023

One of the main lessons is that no matter how well the authors avoid causal language, the intent of an observational comparison study is causal. To receive new posts and support our work, consider becoming a free or paid subscriber. I learned a lot from this conversation.

Shock 52

Shock Research Wellness 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 127

EKG/ECG Allergic Reactions Shock Stroke 127

AED Leader

APRIL 21, 2024

An AED is a portable device that delivers an electric shock to the heart to restore its normal rhythm. Remember, investing in an AED is investing in the safety and well-being of those around you. Q: What should I do if the AED does not deliver a shock? This is where an AED comes into play.

Shock 52

Shock CPR Research Wellness 52

RebelEM

FEBRUARY 7, 2024

Triple antibiotic coverage is recommended. Suggested regimens include: Ampicillin AND Gentamicin AND Clindamycin OR Metronidazole Update tetanus vaccination Usually requires dilation and curettage to remove any retained products of conception or foreign bodies.

Sepsis 75

Sepsis Shock Hospitals Ultrasounds 75

Sensible Medicine

AUGUST 7, 2023

It is shocking. Also shocking was the secondary findings. And I am happy to show you science done well. These were all eye-opening trials. But today I present an even more surprising one. It’s called REVIVED-BCIS. First some background. Their primary outcome was death or hospitalization for heart failure. Look at that.

Shock 82

Shock Outcomes Hospitals Wellness 82

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

RebelEM

JANUARY 18, 2024

It is well-established that earlier recognition and treatment can lead to better outcome for these patients . septic shock) earlier antibiotics most likely makes a difference in morbidity and mortality, however earlier antibiotics in all patients who meet SIRS criteria may not be a good thing and potentially cause more harms than good.

Sepsis 119

Sepsis Hospitals Administration Outcomes 119