2014, ACS and ICU - Paramedicine Now

EM@3AM: Basilar Artery Occlusion

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay. Epub 2014 Dec 4.

EMS

EMS ALS OR ACS

A Patient with Respiratory Failure and a Computer "Normal" ECG

Dr. Smith's ECG Blog

MARCH 11, 2019

The patient was managed in the ICU and had serial troponins. Here is data from a study we published in 2014 for type II NonSTEMI: Sandoval Y. An angiogram confirmed ACS as the etiology. He had no more ECGs recorded. Here is the patient's troponin I profile: These were interpreted as due to demand ischemia, or type II MI.

OR

OR ACS ICU STEMI

Beyond Ketamine: When to use Facilitated Intubation in the ED

EMDocs

SEPTEMBER 25, 2023

Despite the risk of hypotension and bradycardia, propofol has been shown in the ICU setting to be a safe and effective monotherapy intubation agent for hemodynamically unstable patients (19). References: Heffner AC et al. PLoS One 2014; 9(11): e112779. Epub 2014 Feb 17. Resuscitation 2013; 84(11): 1500 – 4.

ED

ED Emergency Department ALS Paramedic

Penetrating chest trauma

Don't Forget the Bubbles

JUNE 30, 2023

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. 2014 Sep;45(9):1287-95.

E-9-1-1

E-9-1-1 FFP Plasma Emergency Department

The 70th Bubble Wrap – DFTB x MSc in PEM

Don't Forget the Bubbles

MAY 3, 2023

Garabon JJW, Gunz AC, Ali A, Lim R. This explorative review described insertion success rates, time to first insertion, and duration of IO function (time from insertion to IO failure, IV access insertion, transfer to ICU, or death). Prehosp Emerg Care. 2023;27(2):221-226. doi:10.1080/10903127.2022.2072553 What’s it about? Am J Hematol.

CPR

CPR Emergency Department ALS ICU

Inotropes and Vasopressors: Doses, indications, contraindications and effects

ECG & Echo Learning

OCTOBER 2, 2022

Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). J Cardiovasc Pharmacol Therap (2014). Gordon AC, Mason AJ, Thirunavukkarasu N, et al. Several endogenous and synthetic agents exist and are frequently combined to achieve the desired hemodynamic outcome.

E-9-1-1

E-9-1-1 ALS Coronary Epinephrine

Resident Journal Review: Massive Transfusion Protocols (MTPs) in Traumatic Hemorrhage

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

E-9-1-1 Plasma ACS ALS

What will you do for this patient transferred to you who is now asymptomatic?

Dr. Smith's ECG Blog

MARCH 6, 2019

She did not receive any opioids (which would mask her pain without affecting any underlying ACS). If for some reason the angiogram is delayed, they should receive maximal medical therapy in an ICU setting with continuous 12-lead ST segment monitoring under the close attention of a practitioner with advanced ECG interpretation training.

STEMI

STEMI ALS ACS ICU

ABG Versus VBG in the Emergency Department

EMDocs

FEBRUARY 12, 2024

In this situation, an ABG should be obtained periodically for correlation, though this is more relevant for the intensive care unit (ICU) setting than in routine ED care (5, 9). 2014 Feb;19(2):168-175. Epub 2014 Jan 3. 2014 Apr;21(2):81-8. 11) Webb RK, Ralston AC, Runciman WB. A systematic review and meta-analysis.

Emergency Department

Emergency Department E-9-1-1 ED ICU

EM@3AM: Cardiac Transplant Complications

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

EMS E-9-1-1 ACS Coronary

emDOCs Revamp – Acute Chest Syndrome

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

E-9-1-1

E-9-1-1 ICU ACS EMS

ToxCard: Acute Organophosphate Toxicity

EMDocs

JUNE 7, 2023

Disposition is often admission to an intensive care unit (ICU) setting. Further management and resuscitation were required, and she had a lengthy ICU stay of 21 days until she was extubated. Iran Red Crescent Med J 16: e5072, 2014. 12784 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L. BMC Res Notes.

E-9-1-1

E-9-1-1 ICU Emergency Department ED

Sickle Cell Disease Module

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.

E-9-1-1

E-9-1-1 ACS OR ICU

ED care of refugee populations from sub-Saharan Africa

EMDocs

JANUARY 6, 2025

84 All patients with severe malaria need inpatient admission, ideally to the intensive care unit (ICU). link] Hummell AC, Cummings M. Severe malaria is typically caused by P. Uncomplicated malaria patients who are able to access prescription medication can be discharged home. Accessed October 5, 2024. Accessed October 5, 2024.

ED

ED E-9-1-1 ALS Emergency Department

Paramedicine Now

EM@3AM: Basilar Artery Occlusion

A Patient with Respiratory Failure and a Computer "Normal" ECG

Trending Sources

Beyond Ketamine: When to use Facilitated Intubation in the ED

Penetrating chest trauma

The 70th Bubble Wrap – DFTB x MSc in PEM

Inotropes and Vasopressors: Doses, indications, contraindications and effects

Resident Journal Review: Massive Transfusion Protocols (MTPs) in Traumatic Hemorrhage

What will you do for this patient transferred to you who is now asymptomatic?

ABG Versus VBG in the Emergency Department

EM@3AM: Cardiac Transplant Complications

emDOCs Revamp – Acute Chest Syndrome

ToxCard: Acute Organophosphate Toxicity

Sickle Cell Disease Module

ED care of refugee populations from sub-Saharan Africa

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