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emDOCs Revamp – Acute Chest Syndrome

EMDocs

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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ABG Versus VBG in the Emergency Department

EMDocs

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.

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ToxCard: Acute Organophosphate Toxicity

EMDocs

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.

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EM@3AM: Basilar Artery Occlusion

EMDocs

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.

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Inotropes and Vasopressors: Doses, indications, contraindications and effects

ECG & Echo Learning

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.

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

Dr. Smith's ECG Blog

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.

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EM@3AM: Cardiac Transplant Complications

EMDocs

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.

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