Volume Assessment Using POCUS in the Emergency Department

An 83-year-old male with a history of HFrEF (40%), CAD, hypertension, and hyperlipidemia presented to the ED with generalized weakness and fatigue. His vitals were remarkable for hypotension with a MAP of 58. On physical exam, the patient appeared non-toxic and was able to answer questions appropriately. He did not appear frankly fluid overloaded, other than mild, chronic peripheral edema. Additional laboratory studies and chest x-ray were performed. A fluid bolus was given to treat his hypotension, however there was minimal response. Given his heart failure, there was concern that aggressive fluid resuscitation would result in pulmonary edema. Additionally, inserting a central line and starting vasopressors is not without risk. Fortunately, this clinical team knows how to use ultrasound to do a proper volume assessment to manage this patient appropriately…

Ultrasound, ResuscitationJoshua NimsApril 11, 2022POCUS, ShockComment

The History of Resuscitation

“Since the dawn of humanity, medical procedures have been used and are one of our species’ defining characteristics. …Various procedures and tinctures were used to ameliorate a wide range of pains and suffering, so it is no wonder that early medicine was also applied to resuscitating the dead.”

Resuscitation, Conference RecapsAustin QuinnFebruary 25, 2022resuscitation, history of resuscitation, health humanitiesComment

Hypothermic Cardiac Arrest

An unknown age male, estimated 30 years old, is brought into the emergency department by emergency medical services in cardiac arrest. He was found unresponsive on a park bench outside on a cold night. When EMS arrived he was noted to be very cold with no palpable pulse, spontaneous respirations, or response to sternal rub. A supraglottic airway was placed but they were unable to establish IV access. They performed 30 minutes of chest compressions and brought him to the emergency department on a LUCAS device…

Critical Care, ResuscitationGuest UserJuly 30, 2021Hypothermia, Cardiac ArrestComment

An Uncommon Cause of Shortness of Breath in the Emergency department: Acute Mitral Regurgitation

By: Russell Prichard MD and Melanie Lippman MD

CASE

The patient is a 52 year-old female with a past medical history of hypertension, hyperlipidemia, hypothyroidism, and a 2 pack a day smoking history who presented to the emergency department in respiratory distress.

When EMS arrived to the patient’s home, she was hypoxemic with a pulse oximetry reading of 70s on room air and hypotensive with systolic blood pressures in the 80s. She was placed on nasal cannula with improvement in her saturations and she was given aspirin, fentanyl, and nitroglycerin without relief.

Upon arrival her vitals were significant for respiratory rate of 34, pulse oximetry of 98% on 6L NC. She was noted to be in acute distress.

The patient was placed on positive pressure ventilation via BiPAP and broad blood work, chest X-ray and electrocardiogram (ECG) were obtained.

Critical Care, Community EM, Respiratory, Resuscitation, Ultrasound, CardiologyGuest UserDecember 18, 2020cardiology, Critical Care, RespiratoryComment

Kawa-shocky

The patient is a 5-year-old female with a past medical history significant only for torticollis who presented to the emergency department with fever, emesis, diarrhea, fatigue, and rash. The patient began having fevers to 102 degrees Fahrenheit five days prior to arrival. The patient’s mother reported that four days ago, the patient began having diarrhea and non-bloody, non-bilious emesis. Two days ago, she began having decreased PO intake, continued fevers and emesis, anuria, and bilateral neck pain. The morning of arrival, the patient’s mother noted a rash on the patient’s back and bilateral conjunctival injection. She brought the patient to her pediatrician’s office, who sent her to the ED for further evaluation and management…

Pediatrics, Cardiology, Critical Care, ResuscitationLindsay MillerSeptember 28, 2020Kawasaki, Rash, Shock, PediatricsComment

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