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?

Coronary 52

Coronary ACS STEMI ALS 52

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

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 40

Coronary ACS ALS STEMI 40

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

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

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 95

ED Emergency Department ALS Paramedic 95

Dr. Smith's ECG Blog

DECEMBER 11, 2023

The neighbor recorded a systolic blood pressure again above 200 mm Hg and advised her to come to the ED to address her symptoms. Both the outdated 2014 AHA/ACC guidelines and the updated 2023 ESC guidelines recommend immediate invasive management of patients with uncontrolled chest pain. She contacted her neighbor, a nurse, for help.

E-9-1-1 122

E-9-1-1 Coronary ACS STEMI 122

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

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

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

EMDocs

NOVEMBER 4, 2024

Jafar Mahmood, MD (Pain Medicine Attending, Paincare Medical Practice) // Reviewed by: Jessica Pelletier, DO, MHPE (EM Attending, APD, University of Missouri-Columbia), Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic); Brit Long, MD (@long_brit) Introduction: Pain management in the ED can be a unique challenge.

ED 106

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

EMDocs

FEBRUARY 12, 2024

As the only respiratory therapist in the ED has been paged and is starting BiPAP for this patient, an overhead call for two incoming trauma alerts from a multivehicle collision sounds. Because the RT responsible for drawing arterial blood gases is busy caring for these patients, ABGs will be delayed.

Emergency Department 98

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

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 93

EMS E-9-1-1 ACS Coronary 93

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 97

E-9-1-1 Emergency Department Plasma ED 97

EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. 768: Epidemiology of Hospital Based ED Visits due to Sickle Cell Crisis and Acute Chest Syndrome in Kids. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. C or 100.4

E-9-1-1 98

E-9-1-1 ICU ACS EMS 98

EMDocs

JUNE 7, 2023

F, HR 48, RR 28, BP 104/62, SPO2 88% on non-rebreather mask The patient’s friend who brought her to the ED tells you the patient made suicidal statements earlier in the day and was found in her yard shed. These are send-out labs with turn-around times that make them unlikely to affect the ED course or guide treatment. BMC Res Notes.

E-9-1-1 98

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

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 95

ACS Plasma OR ED 95

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

EMDocs

JANUARY 6, 2025

ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. Labs Laboratory workup in the ED is notable for a leukocytosis of 41,000/L, hemoglobin of 6.5 She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI.

ED 75

ED E-9-1-1 ALS Emergency Department 75