Dr. Smith's ECG Blog

NOVEMBER 4, 2022

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. Knotts et al.

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ACS Coronary STEMI ALS 52

REBEL EM

NOVEMBER 6, 2024

PMID: 32644703 Robinson PM, Griffiths E, Watts AC. PMID: 27227986 Glover NM, Black AC, Murphy PB. Commentary on an article by Marc Schnetzke, MD, et al.: “Determination of Elbow Laxity in a Sequential Soft-Tissue Injury Model. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Simple elbow dislocation. 2023 Nov 5.

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EMDocs

JUNE 7, 2023

References: Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure. 2013; 6:524. Published 2013 Dec 9. doi:10.1186/1756-0500-6-524 Muñoz-Quezada MT, Lucero BA, Iglesias VP, et al. Published 2013 Dec 9. Clin Toxicol (Phila) 51: 838, 2013.

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FOAMfrat

OCTOBER 20, 2023

And according to a paper from Russotto et al. Of note, in the paper by Russotto et al., Heffner et al, 2012, reports a study that "demonstrated pre-RSI systolic pressures less than 140 as independently associated with post-intubation hypotension, but SI was not included in this analysis" [14]. Sackles et al. Brown, C.A.

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Pediatric EM Morsels

AUGUST 18, 2023

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. PMID: 27940800 Hersch AL, Gerber JS, Hicks LA, Pavia AT. Pediatrics. 147(6):e202003316. 38 (3):268-270.

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EMDocs

JUNE 14, 2023

Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure. Published 2013 Dec 9. PMID: 23163581] Muñoz-Quezada MT, Lucero BA, Iglesias VP, et al. doi:10.1080/10773525.2015.1123848 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L.

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Dr. Smith's ECG Blog

AUGUST 9, 2019

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. Widimsky P et al. Knotts et al. TIMI 0/1 flow).(61,62)

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Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

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.

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E-9-1-1 Coronary ACS BLS 119

EMS 12-Lead

APRIL 2, 2022

Anecdotally, had there been symptoms unequivocally consistent with ACS then one could justifiably make the case for a potential D1 occlusion. 4] Baranchuk, A, et al. 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.

ALS 130

ALS STEMI Coronary OR 130

EMDocs

SEPTEMBER 25, 2023

References: Heffner AC et al. Resuscitation 2013; 84(11): 1500 – 4. PMID: 23911630 Kim WY et al. PMID: 23911630 Kim WY et al. PMID: 25402500 Forsythe SM et al. PMID: 10631227 Mosier JM et al. 2013): 71-78. Riker RR, Shehabi Y, Bokesch PM, et al. Lowe J B, Yoo M J, Patrick J O, et al.

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ED Emergency Department ALS Paramedic 65

Dr. Smith's ECG Blog

MAY 8, 2023

The ACC likely made this new recommendation for the MSC in ventricular paced rhythm in large part due to the "PERFECT" Study (Meyers is an author, and Smith was the senior author): Dodd et al. Electrocardiographic Diagnosis of Acute Coronary Occlusion Myocardial Infarction in Ventricular Paced Rhythm Using the Modified Sgarbossa Criteria.

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STEMI Coronary ED ACS 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

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. Taglieri N, Marzocchi A, Saia F, et al.

Coronary 52

Coronary ACS ALS STEMI 52

Dr. Smith's ECG Blog

DECEMBER 12, 2022

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.

OR 52

OR ACS STEMI Coronary 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

Matetzky S, Friemark D, Feinberg MS, et al. O'Gara et al. 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. O'Gara et al. Wang T, Zhang M, Fu Y, et al. Circulation.

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STEMI E-9-1-1 Coronary ALS 52

Don't Forget the Bubbles

SEPTEMBER 18, 2023

Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, et al. Frost HM, Bizune D, Gerber JS, Hersh AL, Hicks LA, Tsay SV. Tonsillitis Baker MG, Gurney J, Oliver J, Moreland NJ, Williamson DA, Pierse N, et al. 2013 Sep 1;88(5):338–40. Addo-Yobo E, Chisaka N, Hassan M, Hibberd P, Lozano JM, Jeena P, et al.

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Emergency Department E-9-1-1 ALS OR 143

EMDocs

FEBRUARY 12, 2024

References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. 11) Webb RK, Ralston AC, Runciman WB. 2013 May;14(3):212-7. doi: 10.1136/emermed-2013-202879. Epub 2013 Oct 17. Peripheral venous and arterial blood gas analysis in adults: are they comparable? PMID: 11685301. (10)

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Emergency Department E-9-1-1 ED ICU 93