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

EMDocs

JUNE 27, 2024

Left lower lung field end demonstrates expiratory wheezing on auscultation. Other lung fields unremarkable. 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 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 mg/kg, max 0.4 C or 100.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The note also says "slight lateral ST elevations noted, likely early repolarization since unchanged compared to 2014." As a result, even before looking at this patient's initial ECG — he falls into a high -prevalence likelihood group for ACS ( for an A cute C oronary S yndrome ). (This patient was not one of the lucky 6.4%

E-9-1-1 120

E-9-1-1 OR Coronary ACS 120

EM Didactic

OCTOBER 7, 2018

ACS and Aortic Dissection - For ACS and Dissection, the higher CRP levels, the worse prognosis. It is not used to diagnose ACS/Dissection. 2014 Jan 1;3(1):1-5. Utility of CRP 1. Increased CRP levels were independently associated with mortality. CRP is an independent biomarker of severity in community-acquired pneumonia.

Emergency Department 40

Emergency Department ACS Critical Care Coronary 40

EMDocs

OCTOBER 21, 2023

More common in the setting of atherosclerotic lesions than emboli, which typically occur with sudden onset of symptoms. Symptoms may range from days to months prior to stroke onset. As many as two-thirds of patients with BAO experience prodromal symptoms, including TIAs, minor strokes, or other symptoms.

EMS 74

EMS ALS OR ACS 74

ACEP Now

FEBRUARY 11, 2024

Given the fact that he has not had these headaches before and has diffuse symptoms including weakness, lab work and head imaging are obtained. There were no acute findings on head CT. His lab values demonstrate no anemia, leukocytosis, or electrolyte abnormalities except for an elevated creatinine.

Overdose 52

Overdose ACS Plasma ALS 52

Dr. Smith's ECG Blog

DECEMBER 14, 2016

This is from the 2014 ACC/AHA guidelines. Here are the European Guidelines : Timing of invasive strategy: Immediate invasive strategy (less than 2 h) in Very-high-risk NSTE-ACS patients (i.e. It was not relieved by anything. The pain was not positional, pleuritic, or reproducible. He had no previous medical history. mm STE in one lead.

ACS 52

ACS STEMI Coronary OR 52

EMDocs

JUNE 14, 2023

He has a glove and stocking pattern of numbness to his extremities. Motor and sensory findings are symmetrical. Patellar reflexes are 1+. He has no saddle anesthesia or back pain and denies any difficulty urinating or issues with defecation. Paraquat Influenza vaccine Methanol Organophosphate Are his symptoms reversible?

E-9-1-1 70

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

EMDocs

JUNE 7, 2023

Questions: What is the most likely causative xenobiotic that led to these findings? Influenza vaccine Methanol Organophosphate Paraquat Are her symptoms reversible? Yes No What therapy or therapies are critical for this patient? The exposure can be either intentional or unintentional. 7, 9 Often have absence of excessive cholinergic stimulation.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

The Curious Clinicians

OCTOBER 4, 2023

The 1960s saw the emerging use of these homografts. But the success of these human valves and their advantages over plastic or mechanical led to the realization that limited availability would preclude their wide use; as with any human organ or tissue transplant, demand outstrips supply. There were also issues raised about size mismatch.

ALS 52

ALS OR ACS 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

The patient was given sublingual nitroglycerine and his symptoms greatly improved, and another ECG was recorded: Now there is much less ST Elevation If you had not seen the prior ECG, you might have called this normal variant STE, or early repolarization --there are well-formed J-waves. Suppose you had used the formula? Thelin et al. Mokhtari et al.

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 52

Dr. Smith's ECG Blog

JANUARY 3, 2022

It encompasses the complete range of ACS, including OMI, NOMI, and coronary thromboses that have the potential to rapidly propagate and become OMI and therefore has no specificity. Circulation 2014 7. -- McLaren JTT, Meyers HP, Smith SW, Chartier LB. This shows that "NSTEMI" is a worthless term.

STEMI 52

STEMI Coronary ALS ACS 52

Dr. Smith's ECG Blog

JANUARY 2, 2016

Journal of Electrocardiology 47 (2014) 655–660. In this paper, Dr. Birnbaum writes: "In patients with ACS without LVH, ST depression with negative T waves in the lateral leads is a sign of sub-endocardial ischemia and is an independent predictor of adverse outcome [11 – 13]. Echo showed massive concentric LVH. Birnbaum Y and Mahboob A.

STEMI 52

STEMI ACS OR ALS 52

ECG & Echo Learning

OCTOBER 2, 2022

J Cardiovasc Pharmacol Therap (2014). Several endogenous and synthetic agents exist and are frequently combined to achieve the desired hemodynamic outcome. Most agents exhibit both vasopressor and inotropic effects (Figure 1). μg/kg/min Safe for peripheral use ++ ++ 0 Potent vasoconstrictor with mild inotropic effect. Circulation 2011.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 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. You do NOT see this in normal variant STE, nor in pericarditis. The only time you see this without ischemia is when there is an abnormal QRS, such as LVH, LBBB, LV aneurysm (old MI with persistent STE) or WPW."

OR 52

OR ACS ICU STEMI 52

Don't Forget the Bubbles

SEPTEMBER 18, 2023

However, symptoms may also be non-specific, including irritability, headache, poor feeding, vomiting, or diarrhoea. The diagnosis is clinical and can be made by directly visualising erythema or bulging of the tympanic membrane. Treatment is mainly symptomatic with analgesia. A throat culture is the gold standard for confirming a bacterial infection.

Emergency Department 142

Emergency Department E-9-1-1 ALS OR 142

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 63

EMS E-9-1-1 ACS Coronary 63

EMDocs

JULY 19, 2023

7 We are commonly taught that metals are not amenable to treatment with activated charcoal (AC).However, In short, there is not a whole lot of evidence to support this, but if patient has had a recent ingestion and is not altered, you can consider gastrointestinal decontamination with AC.

ACS 66

ACS Plasma OR ED 66

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: 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]. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

ALS 136

ALS ACS OR CPR 136

EMDocs

SEPTEMBER 25, 2023

Notable Physical Exam: General: Tripoding, severe respiratory distress. However, emergency physicians have recently faced a multitude of patients requiring ETI with anatomically and physiologically difficult airways; these patients increase the risk of a can’t intubate/can’t oxygenate scenario or significant hypoxemia, hypercarbia, or acidemia.

ED 65

ED Emergency Department ALS OR 65

Don't Forget the Bubbles

JUNE 30, 2023

You ask your anaesthetist to get ready to sedate or intubate depending on their status – Significant risk to the department – you make sure security is aware And your patient arrives. Ranulf is quite a sweet, round-faced boy, accompanied by his traumatised-looking mother as he is wheeled to your trauma bay.

E-9-1-1 139

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

Dr. Smith's ECG Blog

OCTOBER 13, 2022

The emergency physician wasn’t sure what to make of the changes from one ECG to the next but was concerned about ACS. In this case there are tall R waves in precordial leads (from a left sided accessory pathway), which are followed by discordant ST depression and T wave inversion. WPW can mimic old MI with persisting Q wave.

STEMI 52

STEMI Coronary OR ACS 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

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. 2 The astute paramedic recognized this possibility and announced a CODE STEMI.

Coronary 52

Coronary ACS ALS STEMI 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 in the 1:1:1 group vs. 17.0% vs. 14.6%, p=0.03).

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

ACEP Now

NOVEMBER 7, 2023

Heart disease and stroke statistics—2014 update: a report from the American Heart Association. Emmerson AC, Whitbread M, Fothergill RT. Out-of-hospital cardiac arrest unfortunately occurs relatively commonly and emergency physicians must be equipped to diagnose and treat this rapidly. References Go AS, Mozaffarian D, Roger VL, et al.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 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). By the time the patient arrived at our facility, she had received aspirin and nitroglycerin, and her pain had apparently completely resolved. She was asymptomatic at the time of this ECG recorded on arrival to our ED: What do you think?

STEMI 52

STEMI ALS ACS OR 52

Don't Forget the Bubbles

JULY 5, 2023

This process of sickling and unsickling goes on and off until the erythrocyte membrane is no longer flexible. Irreversible sickle cells undergo either intravascular haemolysis or extravascular removal by the reticulo-endothelial system resulting in anaemia and splenic sequestration. Blood culture is pending. How would you evaluate this child’s pain?

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

Don't Forget the Bubbles

MAY 3, 2023

Garabon JJW, Gunz AC, Ali A, Lim R. Every month we ask some of our friends from PERUKI (Paediatric Emergency Research in the UK and Ireland) to point out something that has caught their eye. This time the PEM MSc team from QML , in association with DFTB, are taking over… Article 1: Insulin infusion in paediatric DKA – high or low?

CPR 52

CPR Emergency Department ALS ICU 52