Dr. Smith's ECG Blog

JULY 3, 2018

The AHA/ACC guidelines recommend emergent cardiac catheterization for patients with concern for ACS and refractory chest pain despite maximum medical therapy defined as aspirin + clopidogrel/ticagrelor + heparin/enoxaparin. link] He was admitted to the cardiology unit for serial troponin measurements and concern for possible ACS.

ACS 52

ACS STEMI Coronary CAD 52

EM Didactic

OCTOBER 7, 2018

ACS and Aortic Dissection - For ACS and Dissection, the higher CRP levels, the worse prognosis. It is not used to diagnose ACS/Dissection. 2014 Jan 1;3(1):1-5. Utility of CRP 1. Increased CRP levels were independently associated with mortality. References Su YJ. The value of C-reactive protein in emergency medicine.

Emergency Department 40

Emergency Department ACS Critical Care Coronary 40

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. link] Published January 2014. Epub 2014 Dec 4. An additional tool that can be used to risk stratify patients presenting with dizziness who may be experiencing posterior circulation stroke is an ABCD2 score. 2012;43(6):1484-1489.

EMS 97

EMS ALS OR ACS 97

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. Heart 2011; 97 : 838-843 [link] 14.

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

JANUARY 2, 2016

Journal of Electrocardiology 47 (2014) 655–660. In this paper, Dr. Birnbaum writes: "In patients with ACS without LVH, ST depression with negative T waves in the lateral leads is a sign of sub-endocardial ischemia and is an independent predictor of adverse outcome [11 – 13]. Echo showed massive concentric LVH.

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STEMI ACS ALS OR 52

ACEP Now

NOVEMBER 7, 2023

Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Emmerson AC, Whitbread M, Fothergill RT. Marco is professor of emergency medicine at Penn State Health-Milton S. Hershey Medical Center and associate editor of ACEP Now. References Go AS, Mozaffarian D, Roger VL, et al. Circulation.

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Defibrillator E-9-1-1 ALS Epinephrine 52

Dr. Smith's ECG Blog

MARCH 8, 2021

Echo immediate: 35% EF with anterior, septal, and apical wall motion abnormalities Echo convalescent, 2 months later: Better, with EF up to 45-50% I posted this in 2014: Is the LAD really completely occluded when there are de Winter's waves? Peak troponin I (contemporary) was 101.0

STEMI 52

STEMI ACS Critical Care OR 52

ACEP Now

FEBRUARY 11, 2024

Deerfield, Illinois: Takeda Pharmaceuticals America Inc; 2014. ACS chemical neuroscience molecule spotlight on Contrave. ACS Chem Neurosci. Accessed January 11, 2024. Contrave (naltrexone HCl/bupropion HCl) prescribing information. 2011;2(9):484-486. Azer SA, Sankararaman S. Steatorrhea. In: StatPearls [Internet].

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Overdose ACS Plasma ALS 52

Dr. Smith's ECG Blog

OCTOBER 13, 2022

The emergency physician wasn’t sure what to make of the changes from one ECG to the next but was concerned about ACS. CMAJ 2014. Int J Cardiol 2014. == MY Comment by K EN G RAUER, MD ( 10/13/2022 ): == I suspect most cases of acute OMI that occur in association with WPW — are overlooked! What do you think? Am J Emerg Med 1999.

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STEMI Coronary OR ACS 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

It encompasses the complete range of ACS, including OMI, NOMI, and coronary thromboses that have the potential to rapidly propagate and become OMI and therefore has no specificity. Circulation 2014 7. -- McLaren JTT, Meyers HP, Smith SW, Chartier LB. This shows that "NSTEMI" is a worthless term.

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STEMI Coronary ALS ACS 52

Dr. Smith's ECG Blog

MARCH 11, 2019

Here is data from a study we published in 2014 for type II NonSTEMI: Sandoval Y. An angiogram confirmed ACS as the etiology. Here is the patient's troponin I profile: These were interpreted as due to demand ischemia, or type II MI. First was 2.9 ng/mL and subsequentle dropped to 1.5 Murakami M. He was discharged and returned again.

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OR ACS ICU STEMI 52

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Both the outdated 2014 AHA/ACC guidelines and the updated 2023 ESC guidelines recommend immediate invasive management of patients with uncontrolled chest pain. Smith : As Willy states, ACS with persistent symptoms is a guideline recommended indication for ＜2 hour angio (both ACC/AHA and ESC). Kontos, M. Levine, G. Liebson, P.

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E-9-1-1 ACS Coronary STEMI 123

REBEL EM

MARCH 2, 2023

REBEL Cast Ep114 – High Flow O2, Suspected ACS, and Mortality? PMID: 33653685 Clinical Question: Is there an association between high flow supplementary oxygen and 30-day mortality in patients presenting with a suspected acute coronary syndrome (ACS)? Click here for Direct Download of the Podcast Paper: Stewart, RAH et al.

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ACS Coronary STEMI Ambulance 52

ALiEM

SEPTEMBER 16, 2024

doi: 10.21037/acs.2016.05.04. 2014 Jul; 3(4):351-67. Ann Cardiothorac Surg. 2016 May; 5(3):256. 2016.05.04. PMID: 27386417; PMCID: PMC4893534. Gargiulo M, Bianchini Massoni C, Gallitto E, Freyrie A, Trimarchi S, Faggioli G, Stella A. Lower limb malperfusion in type B aortic dissection: a systematic review. Ann Cardiothorac Surg.

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ACS Coronary OR 152

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. 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. CHEST 2010. Am J Cardiol 2013.

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ALS ACS OR CPR 136

EMDocs

SEPTEMBER 25, 2023

References: Heffner AC et al. PLoS One 2014; 9(11): e112779. Epub 2014 Feb 17. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation 2013; 84(11): 1500 – 4. PMID: 23911630 Kim WY et al. PMID: 25402500 Forsythe SM et al. J Intensive Care Med. 2015 Dec;30(8):499-504.

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ED Emergency Department ALS Paramedic 91

Dr. Smith's ECG Blog

OCTOBER 24, 2018

Thelin et al. Mokhtari et al. JACC 2016;67:1531. sensitivity, 99.5% My Comment , by K EN G RAUER, MD ( 10/24/2018 ): = Important teaching points are made in this post by Dr.

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E-9-1-1 STEMI ACS Coronary 40

Don't Forget the Bubbles

JUNE 30, 2023

A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. 2014 Sep;45(9):1287-95. There is evidence for using balanced ratios in children, but this comes from retrospective case note reviews. This generated a sample of 1233 paediatric trauma patients who had received at least 1 unit PRBC and FFP.

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E-9-1-1 FFP Plasma Emergency Department 139

ECG & Echo Learning

OCTOBER 2, 2022

J Cardiovasc Pharmacol Therap (2014). Gordon AC, Mason AJ, Thirunavukkarasu N, et al. Inotropes and Vasopressors: Review of Physiology and Clinical Use in Cardiovascular Disease. Circulation 2011. Jentzer et al. Pharmacotherapy Update on the Use of Vasopressors and Inotropes in the Intensive Care Unit. Vasopressors for shock.

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E-9-1-1 ALS Coronary Epinephrine 52

Don't Forget the Bubbles

MAY 3, 2023

Garabon JJW, Gunz AC, Ali A, Lim R. examined how closely clinicians followed the National Heart, Lung and Blood Institute (NHLBI) 2014 guidelines for treating vaso-occlusive pain episodes (VOE) in sickle cell disease (SCD). Prehosp Emerg Care. 2023;27(2):221-226. doi:10.1080/10903127.2022.2072553 What’s it about? Am J Hematol.

CPR 52

CPR Emergency Department ALS ICU 52

AAEM RSA

APRIL 1, 2021

1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 ACS TQIP Best Practice Guidelines. 248(3):447-58.

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E-9-1-1 Plasma ACS ALS 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She did not receive any opioids (which would mask her pain without affecting any underlying ACS). J of National Association of EMS Physicians 2014. By the time the patient arrived at our facility, she had received aspirin and nitroglycerin, and her pain had apparently completely resolved. Meisel et al.

STEMI 52

STEMI ALS ACS ICU 52

The Curious Clinicians

OCTOBER 4, 2023

In 2014, he developed shortness of breath and an echocardiogram showed severe aortic insufficiency and prosthetic valve deterioration. Listen to the episode [link] Credits & Citatio n Episode and shot notes written by Tony Breu Audio edited by Clair Morgan of nodderly.com Breu AC, Abrams HR, Cooper AZ. Valve Privilege.

ALS 52

ALS OR ACS 52

EMDocs

FEBRUARY 12, 2024

2014 Feb;19(2):168-175. Epub 2014 Jan 3. 2014 Apr;21(2):81-8. 11) Webb RK, Ralston AC, Runciman WB. 2014 Jul;20(4):236-40. 2014 Oct;31(e1):e46-9. doi: 10.1136/emermed-2014-204326. Epub 2014 Dec 31. References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS.

Emergency Department 98

Emergency Department E-9-1-1 ED ICU 98

EMDocs

JANUARY 6, 2024

You review his chart and note that he had a heart transplant in 2014 but has not followed up with a cardiologist for at least 3 years. 15 Patients with a heart transplant can have ACS though they are unlikely to present with classic, crushing chest pain due to transplant-induced changes in cardiac innervation.

EMS 88

EMS E-9-1-1 ACS Coronary 88

Don't Forget the Bubbles

SEPTEMBER 18, 2023

Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, et al. McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, et al. 2014 May;133(5):e1121-1127. References Acute otitis media Csonka P, Palmu S, Heikkilä P, Huhtala H, Korppi M. Outpatient Antibiotic Prescribing for 357,390 Children With Otitis Media.

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

EMDocs

NOVEMBER 4, 2024

54 It is vital to consider dangerous epigastric pain mimickers like acute coronary syndrome (ACS), hepatobiliary disease, or pancreatitis. doi:10.1136/heartjnl-2014-306362 LeWinter MM. Pain can be gnawing, aching, burning, and located in the upper abdomen. Pain can be improved or exacerbated with meals. Curr Opin Support Palliat Care.

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ED E-9-1-1 Emergency Department ALS 106

EMDocs

JUNE 14, 2023

Iran Red Crescent Med J 16: e5072, 2014. doi:10.1080/10773525.2015.1123848 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L. Section 15: Toxicology: 1301-1303. Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure. Pesticides and Cholinergics.

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E-9-1-1 Emergency Department Plasma ED 95

EMDocs

JUNE 27, 2024

Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. 2014 Feb;69(2):144-51. -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 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1

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E-9-1-1 ICU ACS EMS 97

EMDocs

JUNE 7, 2023

Iran Red Crescent Med J 16: e5072, 2014. 12784 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L. Titrate atropine therapy to pulmonary secretions/bronchospasm, not to the other cholinergic findings. PMID: 25031861] Malla G, Basnet B, Vohra R, Lohani SP, Yadav A, Dhungana V. BMC Res Notes. 2013; 6:524. Toxicology.

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Dr. Smith's ECG Blog

MARCH 8, 2025

After completing the ACS algorithm with amiodarone and lidocaine, there are diminishing returns on further treatments. Note characteristic ballooning of the apex and hypercontractility of the base during cardiac cath ( Figure excerpted from Grauer K: ECG-2014- Expanded ePub, KG/EKG Press ). = We will never know for certain.

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E-9-1-1 OR Defibrillator Coronary 75

EMDocs

JULY 19, 2023

7 We are commonly taught that metals are not amenable to treatment with activated charcoal (AC).However, In short, there is not a whole lot of evidence to support this, but if patient has had a recent ingestion and is not altered, you can consider gastrointestinal decontamination with AC. 2014 Jun 2;22(1):46. N Engl J Med.

ACS 91

ACS Plasma OR ED 91

Don't Forget the Bubbles

JULY 5, 2023

Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. Older children and adults usually present with ACS 2-3 days after hospitalisation due to pulmonary infarction (in situ sickling), hypoventilation due to rib infarction (which may be exacerbated by recent narcotic administration) or fat embolism.

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E-9-1-1 ACS OR ICU 126

EMDocs

JANUARY 6, 2025

link] Hummell AC, Cummings M. Accessed October 5, 2024. link] Centers for Disease Control and Prevention (U.S.). History and Physical: Refugee Health Domestic Guidance.; Accessed October 5, 2024. Role of the nutrition-focused physical examination in identifying malnutrition and its effectiveness. 2022;37(1):41-49. doi:10.1002/ncp.10797

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