2014 ACS Coronary 
REBEL EM
MARCH 2, 2023
Background: Historically, we have treated acute coronary syndrome with supplemental oxygen regardless of the patient ’ s oxygen saturation. More recent evidence, however, demonstrates that too much oxygen could be harmful ( AVOID Trial ) by causing coronary vasoconstriction and increasing oxidative stress. Low O2 protocol: 3.1%
Dr. Smith's ECG Blog
DECEMBER 11, 2023
For the same reason, you should not delay coronary angiography because pain resolves with morphine. Both the outdated 2014 AHA/ACC guidelines and the updated 2023 ESC guidelines recommend immediate invasive management of patients with uncontrolled chest pain. 2023 ESC guidelines for the management of acute coronary syndromes.
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Dr. Smith's ECG Blog
APRIL 18, 2024
The ECG is just a test: a Bayesian approach to acute coronary occlusion If a patient with a recent femur fracture has sudden onset of pleuritic chest pain, shortness of breath, and hemoptysis, the D-dimer doesn’t matter: the patient’s pre-test likelihood for PE is so high that they need a CT. Circulation 2014 2. But does this matter?
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. Anything more on history?
Dr. Smith's ECG Blog
DECEMBER 27, 2023
Note that as many as 7% of patients with acute coronary syndrome have chest pain reproducible on palpation [Lee, Solomon]. which reduces the pre-test probability of acute coronary syndrome by less than 30% [McGee]. The note also says "slight lateral ST elevations noted, likely early repolarization since unchanged compared to 2014."
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.
Dr. Smith's ECG Blog
DECEMBER 14, 2016
We could not rule out acute epicardial coronary (large artery) occlusion. Learning Point Acute coronary occlusion may occur with no ECG findings whatsoever. This is from the 2014 ACC/AHA guidelines. Patients with ACS and hemodynamic instability 2. Patients with ACS and acute pulmonary edema 3. This includes: 1.
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