EMDocs

MARCH 25, 2024

Video 3: Coronary approach to the gallbladder POCUS Findings Sonographically, the gallbladder is situated in the right upper quadrant as an elongated pear-shaped organ on the inferior surface of the liver. Ross M, Brown M, McLaughlin K, et al. Dumbrava BD, Bass GA, Jumean A, et al. New York, NY: The McGraw-Hill Companies; 2014.

ALS 87

ALS Coronary Emergency Department ED 87

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Hgb 11g/dL (110g/L) and leukocytosis, and a mildly elevated troponin (36 ng/L, with normal 1mm STE in aVR due to ACS will require coronary artery bypass surgery for revascularization, the infarct artery is often not the LM, but rather the LAD or severe 3-vessel disease. Harhash AA, Huang JJ, Reddy S, et al. Knotts et al.

Coronary 52

Coronary ACS STEMI ALS 52

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). μg/kg/min + + + ++ Low dose dopamine stimulates D1 receptors and induces vasodilation in coronary, renal, cerebral and mesenteric vessels. Increases coronary blood flow. Coronary flow enhanced.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

EMDocs

OCTOBER 21, 2023

A 68-year-old male with a past medical history of hypertension, diabetes mellitus, and coronary artery disease with a drug eluting stent placed 2 months ago presents with dizziness and vomiting that began 3 hours ago. References: Gaillard F, Glick Y, Tatco V, et al. 61.4.496 Navi BB, Kamel H, Shah MP, et al. Epub 2014 Dec 4.

EMS 73

EMS ALS OR ACS 73

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Note that as many as 7% of patients with acute coronary syndrome have chest pain reproducible on palpation [Lee, Solomon]. which reduces the pre-test probability of acute coronary syndrome by less than 30% [McGee]. The note also says "slight lateral ST elevations noted, likely early repolarization since unchanged compared to 2014."

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E-9-1-1 OR Coronary ACS 122

Dr. Smith's ECG Blog

JANUARY 3, 2022

It was a 60yo with a history of stents to the circumflex and right coronary arteries, who presented with 9 hours of fluctuating central chest pain. This is step 4 : relying on the first troponin level to rule out acute coronary occlusion. 4] CT revealed no dissection but extensive coronary atherosclerosis. J of Emerg Med 2021.

STEMI 52

STEMI Coronary ALS ACS 52

REBEL EM

FEBRUARY 22, 2023

et al, Emergency Medicine Clinical Essentials ed 2. Eye Emergencies, in Tintinalli J et al (eds): Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, Seventh Edition New York City: McGraw-Hill 2016 (Ch) 241 Guluma K, Lee JE. Ophthalmology, in Marx J et al (eds): Rosens Emergency Medicine: Concepts and Practice, ed 9.

Emergency Department 52

Emergency Department ALS ED Coronary 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58).

Coronary 52

Coronary ACS ALS STEMI 52

Dr. Smith's ECG Blog

OCTOBER 13, 2022

WPW, previous Q wave MI, and acute coronary occlusion Depending on the location of the accessory pathway, WPW pattern can mimic ventricular hypertrophy (including RVH or LVH) or myocardial infarction (including anterior, inferior, lateral or posterior MI) [1]. Rosner et al. CMAJ 2014. Am J Emerg Med 1999. Chang and Liu.

STEMI 52

STEMI Coronary OR ACS 52

Dr. Smith's ECG Blog

APRIL 22, 2022

Backus BE, Six AJ, Kelder JC, et al. Moumneh T, Sun BC, Baecker A, et al. Identifying patients with low risk for acute coronary syndrome without troponin testing: validation of the HEAR score. Shah ASV, Anand A, Sandoval Y, et al. Patel J, Alattar F, Koneru J, et al. Case Rep Emerg Med 2014 7. Lancet 2015 6.

E-9-1-1 52

E-9-1-1 STEMI ALS ED 52

EM Didactic

OCTOBER 7, 2018

Other possible reasons for higher levels could be: Pregnancy Coronary Artery Disease Viral Infections (10–40 mg/L) Bacterial infection (>40mg/dL) Malignancy, Obstructive Sleep Apnea, Connective Tissue Disorders Serial CRP measurements may be helpful to monitor a patient’s response to medical intervention. 2014 Jan 1;3(1):1-5.

Emergency Department 40

Emergency Department ACS Critical Care Coronary 40

Dr. Smith's ECG Blog

JUNE 18, 2013

I want all to know that, with the right mind preparation, and the use of the early repol/LAD occlusion formula, extremely subtle coronary occlusion can be detected prospectively, with no other information than the ECG. It is not a missed STEMI, but it is a missed coronary occlusion. Fesmire et al. Wang T, Zhang M, Fu Y, et al.

STEMI 52

STEMI Coronary ALS CAD 52

Dr. Smith's ECG Blog

JULY 22, 2023

The patient proceeded to cath where all coronaries were described as normal with no evidence of any CAD, spasm, or any other abnormality. In the largest study looking at this topic by Mizusawa et al., Recently the rate of true arrhythmic events related to fevers in the classic Brugada Type 1 syndrome was explored by Michowitz et al.

E-9-1-1 75

E-9-1-1 CAD OR STEMI 75

AAEM RSA

AUGUST 27, 2020

1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Nielsen N, Wetterslev J, Cronberg T et al. By the time of the study by Nielsen et al. Kirkegaard et al.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

The patient would not have been diagnosed with acute coronary syndrome and would not have had an angiogram, would have been discharged (or perhaps had a stress test, which would be negative), and would be at great risk of another event, possibly resulting in death or heart failure. Thelin et al. Mokhtari et al.

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 52

Dr. Smith's ECG Blog

MARCH 6, 2019

Patel et al., Krucoff et al.) Patel et al. Krucoff et al. The Portable Programmable Microprocessor-Driven Real-Time 12-Lead Electrocardiographic Monitor: A Preliminary Report of a New Device for the Noninvasive Detection of Successful Reperfusion or Silent Coronary Reocclusion. Schomig et al. Heart 1996.

STEMI 52

STEMI ALS ACS OR 52

Dr. Smith's ECG Blog

SEPTEMBER 21, 2022

This is most consistent with ischemia/infarction in the distribution of the left circumflex coronary artery. Meyers, Bracey, Smith, et al. Figure-1: Illustration of the rational for the Mirror Test ( Figure excerpted from Grauer K: ECG-2014 Pocket Brain ePub ). This may be due to "posterior reperfusion T-waves", maybe not.

STEMI 52

STEMI ED Coronary OR 52

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. 3,10 Coronary Allograft Vasculopathy Nicknamed “The Achilles Heel of Heart Transplantation,” this accounts for the majority of patient mortality in the 5-10 year range.

EMS 63

EMS E-9-1-1 ACS Coronary 63

Dr. Smith's ECG Blog

JULY 19, 2024

of very high risk NSTEMI patients underwent angiography in less than 2 hours in accordance with the 2014 ACC/AHA guidelines. Lupu et al. Immediate and early percutaneous coronary intervention in very high risk and high risk non-ST segment elevation myocardial infarction patients. Clinical Cardiology. Am Heart J [Internet].

Coronary 107

Coronary STEMI OR ALS 107

EMDocs

NOVEMBER 4, 2024

54 It is vital to consider dangerous epigastric pain mimickers like acute coronary syndrome (ACS), hepatobiliary disease, or pancreatitis. 2014.01.015 Motov S, Strayer R, Hayes BD, et al. 2018.01.020 Motov S, Rockoff B, Cohen V, et al. 0b013e328348bf6f Murphy CE, Raja AS, Baumann BM, et al. May 2014;32(5):421-31.

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

EMDocs

NOVEMBER 13, 2023

2 Outcomes of patients presenting with ischemic stroke who received MRI as initial imaging modality have demonstrated similar outcomes to those with initial CTA, with Kim et al. In a study of 17,903 CTAs ordered in the ED, Tu et al. 8 The data in Mayer et al. 9 A later assessment of the VAN score in Beume et al.

E-9-1-1 86

E-9-1-1 ALS Emergency Department ED 86

Core EM

DECEMBER 12, 2023

Frost JJ et al., Contraceptive Needs and Services, 2014 Update, New York: Guttmacher Institute, 2016, [link] Chernick, Lauren S et al. 2014 Jan 29;(1):CD003987. Glasier A, Cameron ST, Blithe D, et al. John’s wort Rifampin Refer to the CDC U.S. References Finer, Lawrence B. and Zolna, Mia R. 2016;374:843-852.

Emergency Department 130

Emergency Department OR ALS Coronary 130