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2013 Mar;34(3):115-24; quiz 125. Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM; American Thyroid Association Task Force on Thyroid Hormone Replacement. An ultrasound and thyroid antibodies may also be helpful to confirm diagnosis. Pediatric neck masses.
VS abnormalities can drive this as well Strongly consider reversal of AC (this will typically come after control) Stopping the Bleeding PPE: these things bleed like stink. Laryngoscope 2013; 123: 2928-9. Posterior epistaxis: clinical features and acute complications. Acad Emerg Med 1995; 25(5): 592-6.
Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. Most studies examine undifferentiated ACS cohorts, with only a handful providing separate data. References: 1.
This week we’re looking at the other ACS, the surgical ACS, the old abdominal compartment syndrome. This week we’re looking at the other ACS, the surgical ACS, the old abdominal compartment syndrome. These are all very nice and should all be reflected upon and followed when appropriate in your ACS.
Click here for Direct Download of the Podcast Paper: Aykan AC et al. Am J Cardiol 2013. PMID: 23102885 Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. Clin Exp Emerg Med 2023.
mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,
Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. References: Ross RK, Kinlaw AC, Herzog MM, Funk MJ, Gerber JS. Nearly 400,000 prescriptions were written and 22% were found to be inappropriate based on clinical guidelines.
References Meltzer AC, Baumann BM, Chen EH, Shofer FS, Mills AM. 2013 Aug 1;62(2):126-31. If discharging, give strong worsening statements and explain uncertainty about the diagnosis and need for review if symptoms change. Poor sensitivity of a modified Alvarado score in adults with suspected appendicitis. Annals of emergency medicine.
Because there was proven thrombus (ACS) but the troponin never went above the 99% reference range (and therefore cannot be called MI -- definition of MI requires rise and/or fall of troponin with at least one value above the 99% reference range), this is UNSTABLE ANGINA with ST Elevation.
Here is an article I wrote: Updates on the ECG in ACS. Was this: 1) ACS with ischemia and spontaneous reperfusion? Also, anterior MI could result from 1) ACS, but also from 2) severe ischemia due to combination of a hemodynamically significant LAD stenosis + severe hypotension during cardiac arrest. References : 1.
Smith: If this is ACS (a big if), t his is just the time when one should NOT use "upstream" dual anti-platelet therapy ("upstream" means in the ED before angiography). History sounds concerning for ACS (could be critical stenosis, triple vessel), but differential also includes dissection, GI bleed, etc. Anything more on history?
2013): 403-412. 2013): 788. ACS omega , 7 (24), pp.20441-20456. New England Journal of Medicine , 387 (23), pp.2159-2170. Barton, James C. “Hemochromatosis and iron overload: from bench to clinic.” ” The American journal of the medical sciences 346.5 Mackenzie, E.L., Iwasaki, K. and Tsuji, Y., Butler, Thomas.
Anecdotally, had there been symptoms unequivocally consistent with ACS then one could justifiably make the case for a potential D1 occlusion. Given such findings, serial ECG’s are prudent to consider, and carry significant impact moving forward, which has been demonstrated in previous posts. 2] Surawicz, B.
But if they do present: The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion , though it might be due to sub total LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. They will add up in varying magnitudes resulting in a variety of ECG presentations.
Two prehospital 12-lead ECGs looked similar to this ED ECG: This shows diffuse ST depression (I, II, III, aVL, aVF, V3-V6) with reciprocal ST elevation in lead aVR. This ECG is diagnostic of diffuse subendocardial ischemia.
References: Heffner AC et al. Resuscitation 2013; 84(11): 1500 – 4. 2013): 71-78. Incidence and factors associated with cardiac arrest complicating emergency airway management. PMID: 23911630 Kim WY et al. actors Associated with the Occurrence of Cardiac Arrest after Emergency Tracheal Intubation in the Emergency Department.
Although this is considered a "STEMI equivalent" and the ACC/AHA guidelines even approve of thrombolytics for ACS with this ECG, the usual criteria used to alert the cath lab team of an inbound Code STEMI are not met by this ECG. For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS. Circulation 1970;41:623-627 9.
This was formerly an indication for cath lab activation, but was abandoned in the 2013 guidelines because of poor specificity. Here is an algorithm that is very useful in such cases, published by Cai and Sgarbossa in 2013. Excessively discordant STE, as defined by at least 1 mm and with an ST/S ratio of 25% or more.
You must understand this and the dynamic nature of ACS to provide excellent care for such patients. One year later: EKG#5 (one year later) Inferior Q waves persist, as do inferior T wave inversions. Learning Points: The ECG can pass through normal or near-normal on its way from occlusion to reperfusion, or vice versa.
8 , 9 The most recent American College of Cardiology and American Heart Association ST-elevation myocardial infarction (STEMI) guidelines (2013) give no direction on diagnosing occlusion myocardial infarction in patients with ventricular paced rhythm.
2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Card 1999; 34:748-753. O'Gara et al. Circulation. mm in ≥ 1 posterior lead and has few false positives. (6)
Posterior STEMI" may not even technically exist according to the current (2013) ACC/AHA STEMI guidelines, as it is not described as a "STEMI equivalent" and the only relevant statement in the guidelines is: "In addition, ST depression in 2 precordial leads (V1-V4) may indicate transmural posterior injury."
Critical Care Medicine 41(12):p A191, December 2013. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. 2013 Jan-Mar;16(1):91-5. Epub 2013 Aug 7. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 0.4
Published 2013 Dec 9. doi:10.1186/1756-0500-6-524 Ross SM, McManus IC, Harrison V, Mason O: Neurobehavioral problems following low-level exposure to organophosphate pesticides: a systematic and meta-analytic Crit Rev Toxicol 43: 21, 2013. Parenteral organophosphorus poisoning in a rural emergency department: a case report. 2013;6:524.
2023 May;182(5):2013-2026 QuantiFERON-TB Gold Plus Performance in Children: A Narrative Review. De Alwis AC, et al. N Engl J Med. 2023 May 11;388(19):1755-1766. Guidelines and best evidence Analgesia and sedation in critically ill pediatric patients: an update from the recent guidelines and point of view. Mondardini MC, et al.
saline (NS) solutions are both isotonic crystalloids widely used for intravenous fluid resuscitation across many contexts and disease states ( Myburgh 2013 ). Paper: Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. PMID: 28106307 Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. Lactated Ringer (LR) and 0.9% JAMA Intern Med.
Patients with suspected ACS should be evaluated with echocardiography. Incidence and Prognosis of Pericarditis After ST-Elevation Myocardial Infarction (from the Acute Coronary Syndrome Israeli Survey 2000 to 2013 Registry Database). Perhaps not all readers of this blog are experienced evaluating echo images. References: [1] Lador, A.
After completing the ACS algorithm with amiodarone and lidocaine, there are diminishing returns on further treatments. Or was it out of proportion, perhaps worsened by the sympathetic surge? We will never know for certain. In addition to profound acute heart failure, the patient suffered from electrical storm. SanzRuiz, R., Solis, J., &
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