Dr. Smith's ECG Blog

DECEMBER 14, 2016

I delved into his reasons for arriving so late after onset, thinking that perhaps the pain had only recently increased, or that it had been intermittent until now, but he confirmed that it was 14 hours of constant pain and it was his significant other who insisted that he go to the ED. This is from the 2014 ACC/AHA guidelines.

ACS 52

ACS STEMI Coronary OR 52

EMDocs

JUNE 14, 2023

These are send-out labs with turn-around times that make them unlikely to affect the ED course. This prevents ongoing exposure to the patient and ED staff. Iran Red Crescent Med J 16: e5072, 2014. In: Mattu A and Swadron S, ed. 3 However, may be helpful in diagnosing the chronic toxicity forms. CorePendium.

E-9-1-1 70

E-9-1-1 Emergency Department Plasma ED 70

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour Post TW, ed. link] Published January 2014. Epub 2014 Dec 4. hour IV thrombolytic window.

EMS 74

EMS ALS OR ACS 74

EMDocs

SEPTEMBER 25, 2023

However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). While RSI should remain the gold standard in the vast majority of patients in the ED, FI presents an additional technique to mitigate anatomic or physiologic risk. To date, ketamine has been the agent of choice (12).

ED 65

ED Emergency Department ALS OR 65

Dr. Smith's ECG Blog

JANUARY 3, 2022

A prospective validation of STEMI criteria based on the first ED ECG found it was only 21% sensitive for Occlusion MI, and disproportionately missed inferoposterior OMI.[1] Circulation 2014 7. -- McLaren JTT, Meyers HP, Smith SW, Chartier LB. From STEMI to Occlusion MI: paradigm shift and ED quality improvement.

STEMI 52

STEMI Coronary ALS ACS 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." The note also says "slight lateral ST elevations noted, likely early repolarization since unchanged compared to 2014." We therefore need to assume and rule "out" ACS — more than having to rule it "in".

E-9-1-1 120

E-9-1-1 OR Coronary ACS 120

EMDocs

JANUARY 6, 2024

A 64-year-old male presents by EMS to the ED with shortness of breath. 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 Consider ACS in the differential for transplant patients and have a low threshold for ordering screening ECG/troponin.

EMS 63

EMS E-9-1-1 ACS Coronary 63

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. Figure-1: The first 2 ECGs shown in this case ( See text ). == C OMMENT : As per Dr. Smith — E CG # 1 was the initial tracing on this patient who presented to the ED already intubated for respiratory failure.

OR 52

OR ACS ICU STEMI 52

EMDocs

JULY 19, 2023

This would be a send-out test and would be unlikely to help us acutely in the ED. 7 We are commonly taught that metals are not amenable to treatment with activated charcoal (AC).However, 2014 Jun 2;22(1):46. 6 Urine heavy metals screens are not recommended for asymptomatic patients. N Engl J Med. 2003 Oct 30;349(18):1731-7.

ACS 66

ACS Plasma OR ED 66

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED. 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.

Coronary 52

Coronary ACS ALS STEMI 52

Don't Forget the Bubbles

JUNE 30, 2023

All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. Back in ED with Ranulf, and pack two has gone through.

E-9-1-1 139

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

ACEP Now

NOVEMBER 7, 2023

A 67-year-old man presents to the emergency department (ED) in cardiac arrest. On ED presentation, he is unresponsive and the monitor shows ventricular fibrillation. Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Emmerson AC, Whitbread M, Fothergill RT. Circulation.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 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.

E-9-1-1 52

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). She was asymptomatic at the time of this ECG recorded on arrival to our ED: What do you think? J of National Association of EMS Physicians 2014. What will you do for this asymptomatic patient??? Meisel et al.

STEMI 52

STEMI ALS ACS OR 52

Don't Forget the Bubbles

JULY 5, 2023

Haematology specialist clinics are key to manage the chronic side of the disease, while ED doctors should be able to act rapidly on the common acute emergencies. with thanks A 15-month-old Kenyan boy presents to ED with right hand swelling. A 10-year-old boy with known SCA presents to ED due to severe pain in the legs.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

Don't Forget the Bubbles

MAY 3, 2023

This single-centre academic urban institution in the United States (US) undertook a 10-year retrospective observational study of paediatric intubation and bougie use in their emergency department (ED). During a 6-month period, paediatric patients (< 18 years old) who underwent tracheal intubation in their ED were included in the study.

CPR 52

CPR Emergency Department ALS ICU 52