Background Blood gas analysis is integral to assessing emergency department (ED) patients with acute respiratory or metabolic disease. Arterial blood gas (ABG) is the gold standard for oxygenation, ventilation, and acid–base status but is painful to obtain. Peripheral venous blood gas (VBG) is a valuable alternative as it is less painful and easy to collect. The comparability of ABG and VBG was studied in various conditions. But in hypotension, previous findings were inconsistent. So, we studied the correlation and agreement between ABG and VBG in hypotensive patients. Methodology The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Patients with hypotension above 18 years who satisfied the inclusion criteria were clinically evaluated. Patients who require ABG as a part of routine care were sampled. ABG was collected from the radial artery. VBG was obtained from the cubital or dorsal hand veins. Both samples were collected within 10 min and were analyzed. All ABG and VBG variables were entered in premade proforma. The patient was then treated and disposed of according to institutional protocol. Results A total of 250 patients were enrolled. The mean age was 53.25 ± 15.71 years. 56.8% were male. The study included 45.6% septic, 34.4% hypovolemic, 18% cardiogenic, and 2% obstructive shock patients. The study found a strong correlation and agreement for ABG and VBG pH, pCO2, HCO3, lactate, sodium, potassium, chloride, ionized calcium, blood urea nitrogen, base excess, and arterial/alveolar oxygen ratio. Hence, regression equations were made for the aforementioned. There was no correlation observed between ABG and VBG pO2 and SpO2. Our study concluded that VBG could be a reasonable alternative for ABG in hypotensive patients. We can also mathematically predict values of ABG from VBG using regression equations derived. Conclusions ABG sampling causes most unpleasant experiences to patients and is associated with complications like arterial injury, thrombosis, air or clotted-blood embolism, arterial occlusion, hematoma, aneurysm formation, and reflex sympathetic dystrophy. The study has shown strong correlations and agreements for most ABG and VBG parameters and can predict ABG mathematically using regression formulas formulated from VBG. This will decrease needle stick injury, consume less time, and make blood gas evaluation easy in hypotensive settings.

Background Blood gas analysis is integral to assessing emergency department (ED) patients with acute respiratory or metabolic disease. Arterial blood gas (ABG) is the gold standard for oxygenation, ventilation, and acid-base status but is painful to obtain. Peripheral venous blood gas (VBG) is a valuable alternative as it is less painful and easy to collect. The comparability of ABG and VBG was studied in various conditions. But in hypotension, comparability is still a concern. So, we studied the correlation and agreement between ABG and VBG in hypotensive patients. Methodology: The study was conducted at the emergency department of a tertiary healthcare center in Northern India. Patients with hypotension above 18 years of age who satisfied the inclusion criteria were clinically evaluated. Patients who require ABG as a part of routine care were sampled. ABG was collected from the radial artery at the wrist level. VBG was obtained from the cubital or dorsal hand veins. Both samples were collected within 10 minutes and were analyzed. All ABG and VBG variables were entered in premade proforma. The patient was then treated and disposed of according to institutional protocol. Results Two hundred fifty patients were enrolled. The mean age was 53.25 ± 15.71 years. 56.8% were male. The study included 45.6% septic, 34.4% hypovolemic, 18% cardiogenic, and 2% obstructive shock patients. The study found a strong correlation and agreement for ABG and VBG pH, pCO2, HCO3, lactate, sodium, potassium, chloride, ionized calcium, blood urea nitrogen, base excess, and arterial/alveolar oxygen ratio. Hence, regression equations were made for the aforementioned. There was no correlation observed between ABG and VBG pO2 and SpO2. Our study concluded that VBG could be a reasonable alternative for ABG in hypotensive patients. We can also mathematically predict values of ABG from VBG using regression equations derived. Conclusions The study has shown strong correlations and agreements for most ABG and VBG parameters except pO2 and SO2. The study can predict an ABG mathematically using regression formulas formulated from a VBG. This will decrease needle stick injury, consume less time, and make blood gas evaluation easy in hypotensive settings.

Background: One significant cause of morbidity and mortality in patients undergoing endotracheal intubation is the aspiration of gastric contents. Its prevalence is more in the emergency than in elective settings. Point-of-care gastric ultrasound (GUS) is a non-invasive bedside ultrasonogram that provides both qualitative and quantitative information about the stomach contents. The diagnostic accuracy of GUS in terms of gastric parameters (measured antral diameters, antral cross-sectional area, and calculated gastric volume) to predict aspiration is yet unknown. We aim to determine this in the patients undergoing urgent emergency intubation (UEI) in the emergency department. Methodology: A prospective observational study was conducted at the emergency department of a tertiary healthcare center in India. Patients requiring UEI were identified and a bedside gastric ultrasound was done in the right lateral decubitus position using low frequency curved array probe. The qualitative data and the antral diameters (anteroposterior and craniocaudal) were assessed. The patient's clinical parameters and history regarding the last meal were noted. The cross-sectional area of gastric antrum was calculated using CSA = (AP×CC) π/4. The gastric volume is estimated using Perla's formula: GV = 27.0 + 14.6(RLD CSA) − 1.28(age). Results: A hundred patients requiring urgent endotracheal intubation were enrolled in the study. Visible aspiration was more in participants with a distended gastric status (χ2 = 16.880, p = < 0.001). The median gastric volume in the patients who aspirated was 146.37mL, and it ranged from 111.59mL-201.01mL. Using ROC analysis, a cut-off of CC diameter ≥ 2.35cm (sensitivity 88%, specificity 91%) and AP diameter ≥ 5.15cm (sensitivity 88%, specificity 87%) predicts aspiration. A calculated USG CSA cut-off ≥ 9.27cm² (sensitivity 100%, specificity 87%) and an USG gastric volume ≥ 111.594mL (sensitivity 100%, a specificity 92%) predicts aspiration. Conclusion: Point-of-care gastric ultrasound is an useful non-invasive bedside tool for risk stratification for aspiration in busy emergency rooms. We present threshold gastric antral parameters that can be used to predict aspiration along with its diagnostic accuracy. This can help the treating ED physician take adequate precautions, decide on intubation techniques and treatment modifications to aid in better patient management.

Background: Atrial fibrillation with accessory pathway can present with confounding ECG findings leading to inaccurate diagnosis sometimes leading to fatal outcomes. Treatment with AV nodal blockers is contra-indicated in pre-excited atrial fibrillation as it can lead to fatal ventricular arrythmia. Case Presentation: A 72-year-old female presenting with acute onset palpitations, chest discomfort, shortness of breath and light-headedness with similar past episodes was initially diagnosed to have atrial fibrillation. An ECG after metoprolol administration revealed the features of pre-excitation and Wolff-Parkinson-White syndrome. A repeat episode of tachyarrhythmia was terminated with electrical cardioversion and patient was followed-up in cardiology for radiofrequency ablation. Conclusion: A bizarre ECG with irregular wide complex tachycardia with QRS of varied shape and amplitude and sustained rates surpassing 200 beats per minute, suspicion of WPW syndrome with pre-excited AF should be considered. It is difficult to distinguish from polymorphic ventricular tachycardia, although electrical cardioversion is the primary therapy when hemodynamically unstable.

Background: One significant cause of morbidity and mortality in patients undergoing endotracheal intubation is the aspiration of gastric contents. Its prevalence is more in the emergency than in elective settings. Point-of-care gastric ultrasound (GUS) is a non-invasive bedside ultrasonogram that provides both qualitative and quantitative information about the stomach contents. The diagnostic accuracy of GUS in terms of gastric parameters (measured antral diameters, antral cross-sectional area, and calculated gastric volume) to predict aspiration is yet unknown. We aim to determine this in the patients undergoing urgent emergency intubation (UEI) in the emergency department. Methodology: A prospective observational study was conducted at the emergency department of a tertiary healthcare center in India. Patients requiring UEI were identified and a bedside gastric ultrasound was done in the right lateral decubitus position using low frequency curved array probe. The qualitative data and the antral diameters (anteroposterior and craniocaudal) were assessed. The patient's clinical parameters and history regarding the last meal were noted. The cross-sectional area of gastric antrum was calculated using CSA = (AP×CC) π/4. The gastric volume is estimated using Perla's formula: GV = 27.0+14.6(RLD CSA) –1.28(age). Results: A hundred patients requiring urgent endotracheal intubation were enrolled in the study. Visible aspiration was more in participants with a distended gastric status (χ2=16.880, p=<0.001). The median gastric volume in the patients who aspirated was 146.37mL, and it ranged from 111.59mL-201.01mL. Using ROC analysis, a cut-off of CC diameter ≥2.35cm (sensitivity 88%, specificity 91%) and AP diameter ≥5.15cm (sensitivity 88%, specificity 87%) predicts aspiration. A calculated USG CSA cut-off ≥9.27cm² (sensitivity 100%, specificity 87%) and an USG gastric volume ≥111.594mL (sensitivity 100%, a specificity 92%) predicts aspiration. Conclusion: Point-of-care gastric ultrasound is an useful non-invasive bedside tool for risk stratification for aspiration in busy emergency rooms. We present threshold gastric antral parameters that can be used to predict aspiration along with its diagnostic accuracy. This can help the treating ED physician take adequate precautions, decide on intubation techniques and treatment modifications to aid in better patient management.