https://wikem.org/w/api.php?action=feedcontributions&feedformat=atom&user=Jgrimsman 2026-05-13T13:28:51Z User contributions MediaWiki 1.38.2 https://wikem.org/w/index.php?title=Ultrasound:_in_shock_and_hypotension&diff=9520 2012-04-21T18:45:11Z

<p>Jgrimsman: /* Pulmonary */</p> <hr /> <div>Rapid Ultrasound for Shock and Hypotension (RUSH) using the HI-MAP approach<br /> <br /> ==Heart==<br /> *Pericardial Effusion<br /> **Parasternal long<br /> **Change in size &lt;30% between sys and dia = poor LV function<br /> *RV collapse<br /> **In 4-chamber view, RV should be &lt;60% of LV; if larger think RV failure<br /> *Hyperdynamicity<br /> **Walls move &gt;90% or touch at end of systole<br /> ***May indicate hypovolemia or sepsis<br /> <br /> ==IVC==<br /> *Measurae 2cm from RA-IVC junction<br /> *If IVC &lt;1.5cm and collapses on inspiration then CVP is low<br /> *If IVC &gt;2.5cm and noncollapsing then CVP is high<br /> **Suggests fluid unresponsive; pt requires inotropes<br /> <br /> ==Morison's==<br /> *Look for fluid at lung/diaphragm interface<br /> <br /> ==Aorta==<br /> *If &gt;5cm assume ruptured AAA until proven otherwise<br /> <br /> ==Pulmonary==<br /> *Assess for subpleural interstitial edema by scanning with the abdominal probe in the upper lateral chest bilaterally.<br /> **Look for multiple comet tail artifacts (a few, 3-4, are OK). If multiple are found, there is interstitial edema.<br /> **If you see any comet tail artifact, there is no PTX.<br /> *Assess for PTX separately by scanning longitudinally in anterior 3rd IC space, mid-clavicular line.<br /> **Look for lack of sliding or use M-mode to look for reassuring beach sign<br /> <br /> ==See Also==<br /> *[[Ultrasound (Main)]]<br /> *[[Shock]]<br /> <br /> ==Source==<br /> Weingart - http://emcrit.org/ultrasound/The%20RUSH%20Examfinal.htm<br /> <br /> [[Category:Airway/Resus]]<br /> [[Category:Cards]]<br /> [[Category:Rads]]</div>

Jgrimsman https://wikem.org/w/index.php?title=Pulseless_arrest&diff=9519 2012-04-21T18:30:23Z

<p>Jgrimsman: </p> <hr /> <div>==Immediate==<br /> #Start CPR<br /> #Give oxygen<br /> #Attach monitor/defibrilator<br /> #Rhythm shockable?<br /> <br /> == V-Fib and Pulseless V-Tach (Shockable) ==<br /> *Shock as quickly as possible and resume CPR immediately after shocking<br /> **Biphasic - 200J<br /> **Monophasic - 360 J<br /> *Give Epi 1mg if (shock + 2min of CPR) fails to convert the rhythm<br /> *Give antiarrhythmic if (2nd shock + 2min of CPR) again fails<br /> **1st line: [[Amiodarone]] 300mg IVP w/ repeat dose of 150mg as indicated<br /> **2nd line: [[Lidocaine]] 1-1.5 mg/kg then 0.5-0.75 mg/kg q5-10min<br /> **[[Magnesium]] 2g IV, followed by maintenance infusion<br /> ***Only for polymorphic V-tach<br /> <br /> == Asystole and PEA (Non-Shockable)==<br /> *Give [[epinephrine|Epi]] 1mg q3-5min<br /> *Consider H's and T's<br /> **Hypovolemia<br /> **Hypoxia<br /> **Hydrogen ion<br /> **Hypo/hyperkalemia<br /> **Hypothermia<br /> **Tension pneumo<br /> **Tamponade<br /> **Toxins<br /> **Thrombosis, pulmonary<br /> **Thrombosis, coronary<br /> <br /> See Also: [[ACLS (Treatable Conditions)]]<br /> <br /> ==General==<br /> *A (adjunct) - Place oropharyngeal airway<br /> *B (breathing) - place on [[Ventilator]] to assure slow ventilation rate (attach to BVM mask)<br /> **10-12 bpm, 500cc tidal volume, Fio2 100%<br /> *C (compressions) - Switch out providers q pulse check; use metronome<br /> *D - defibrillation<br /> **Ok to shock during compressions if wearing gloves and using biphasic device<br /> <br /> *A (advanced airway)<br /> **Use LMA (NOT ET tube - no break in compressions required)<br /> *B (advanced breathing)<br /> **Connect LMA to [[Ventilator]]<br /> ***Pressure control 20, RR 10, insp rate 1.5-2s<br /> *C (advanced circulation)<br /> **Place IO instead of central line<br /> *D (differential)<br /> **[[Ultrasound: In Shock and Hypotension]]<br /> <br /> ==See Also==<br /> *[[ACLS (Main)]]<br /> *[[Brain Death]]<br /> *[[Post Cardiac Arrest]]<br /> *[[Pediatric Pulseless Arrest]]<br /> <br /> ==Source==<br /> *AHA 2010 ACLS Guidelines<br /> *EMCrit Podcast #31<br /> <br /> [[Category:Airway/Resus]]<br /> [[Category:Cards]]</div>

Jgrimsman