Dr. Smith's ECG Blog

APRIL 2, 2024

He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. Bedside ED ultrasound showed exceedingly poor global LV function, and no B lines. Here is the initial ED ECG. What do you think? Rhythm : Residents asked me why it is not VT. Cardiology agreed.

Defibrillator 128

Defibrillator Coronary Epinephrine CPR 128

EMDocs

APRIL 10, 2024

These medications are a vital tool in the care of ED patients, from simple local analgesia for a laceration repair to regional analgesia for painful procedures. 1,2] Consider using a physiological marker to help identify inadvertent vascular injection, such as epinephrine. [3] doi:10.1007/BF03161199 Olson K, Smollin C, eds.

E-9-1-1 94

E-9-1-1 Plasma Epinephrine Life Support 94

REBEL EM

JANUARY 23, 2023

Key Secondary Endpoints: 5 (3.9%) patients in the IV cetirizine group returned to any ED or clinic within 24 hours compared to 15 (11.1%) in the IV diphenhydramine group; P=0.04 7 (5.5%) patients in the IV cetirizine group returned to any ED or clinic within 48 hours compared to 19 (14.1%) in the IV diphenhydramine group; P=0.02

Allergic Reaction 52

Allergic Reaction ED E-9-1-1 Emergency Department 52

Core EM

OCTOBER 2, 2024

In: Marx J, ed. In: Wolfson A, ed. Author: Natalie Bertrand, MD Editor: Naillid Felipe, MD Background: Definition: adverse reaction to blood product administration Incidence: more common in children than adults, except for delayed hemolytic transfusion reactions Allergic (non-anaphylaxis) – Platelets 1-3%; RBCs 0.1-0.3%

Allergic Reaction 100

Allergic Reaction Plasma ED Epinephrine 100

The Overrun Podcast

MARCH 28, 2021

Ed and Dan sit down with Dr. Peter Antevy and talk about how we can do better with pediatric arrests. But we need to prepare for these low-frequency, high-stress events to give out patients every possible chance to survive. And the results show it. On another note, go to [link] to see the talk that inspired this episode.

Epinephrine 52

Epinephrine Paramedic ED EMS 52

ACEP Now

DECEMBER 6, 2024

Attention was turned to the consideration of severe coronary vasospasm as the inciting event for cardiopulmonary arrest and the nidus for refractory ventricular fibrillation. Traditional Advanced Cardiovascular Life Support (ACLS) medications, namely epinephrine, have been known to exacerbate coronary vasospasm. (Click to enlarge.)

Coronary 98

Coronary Life Support ALS Emergency Department 98

REBEL EM

JULY 18, 2022

When simple maneuvers fail, we proceed to topical agents such as lidocaine with epinephrine, oxymetazoline, anterior nasal packing, and electrical or chemical cauterization. TXA has become the standard practice in the ED based on small RCTs, though larger trials have not demonstrated the same benefit ( REBEL EM review ).

E-9-1-1 52

E-9-1-1 Epinephrine ED ALS 52

Don't Forget the Bubbles

MAY 8, 2024

Arch Dis Child Fetal Neonatal Ed. Arch Dis Child Fetal Neonatal Ed. Arch Dis Child Fetal Neonatal Ed. 2024 Apr 3:114037 Apnea, Intermittent Hypoxemia, and Bradycardia Events Predict Late-Onset Sepsis in Infants Born Extremely Preterm. Parasitic infections: what do paediatricians need to know? Eisen S et al. Bm MV, et al.

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E-9-1-1 ALS Emergency Department Epinephrine 69

Dr. Smith's ECG Blog

JULY 24, 2018

They stated that the patient was coded for 20 minutes, including multiple doses of epinephrine, and they also gave glucose, calcium, and bicarb. As stated above, resuscitation included epinephrine, calcium, and bicarb. Dr. Meyers skillfully walks us through the events in this case, with important lessons to be learned.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

Dr. Smith's ECG Blog

JANUARY 19, 2020

On arrival in the ED, she was profoundly hypotensive, nearly obtunded, and bradycardic. At about 30 minutes after presentation, the patient had acceptable vital signs with the TVP and low dose epinephrine drip. The ED team again pointed out the evidence of inferoposterior OMI, this time by the modified Sgarbossa criteria.

E-9-1-1 52

E-9-1-1 STEMI ED EMS 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

This is a 30-something healthy patient presented with COVID pneumonia who presented to the ED. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. He was moderately hypoxic. He had the following EKG recorded: Low voltage, suggests effusion.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED. Folland ED, et al. In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. In the cath lab, the patient’s blood pressure remained low. The mean MAP for these patients was 81 +/- 13.

Coronary 40

Coronary ACS ALS STEMI 40

The Overrun

APRIL 19, 2021

The call involved a sick patient where the student, who was on the verge of going to boards, pulled out the wrong concentration of epinephrine. A debrief for a student is a critical event. Imaging, labs, and ED level care has strong value in reinforcing why a case went the way it did, or how we can learn for the next one.

Paramedic 52

Paramedic EMT EMT OR 52

EMDocs

JANUARY 20, 2024

Prior to this intervention, management in the ED is mainly supportive of the patient’s hemodynamic and cardiac status. Because takotsubo syndrome is often clinically indistinguishable from acute myocardial infarction, primary management includes cardiac catheterization for coronary angiography and percutaneous coronary intervention.

E-9-1-1 74

E-9-1-1 EMS Coronary ACS 74

EMDocs

DECEMBER 18, 2023

On arrival to the ED, her blood pressure is 84/36 mmHg with a heart rate of 110 beats per minute. 3,4 Prompt recognition and management of sepsis and septic shock are paramount for the ED clinician. 8,9 Recently, monocyte distribution width (MDW) has shown promise in a large meta-analysis as a useful screening tool in the ED.

E-9-1-1 65

E-9-1-1 ALS Emergency Department Plasma 65