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. Incidence of an acute coronary occlusion. link] Harhash AA et al.

ACS 52

ACS Coronary STEMI ALS 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Coronaries were normal, as was serial troponin. I sent the initial ECG of both cases without any context to my colleague Mazen El-Baba, a senior EM resident with an interest in ECG interpretation, and he responded: “RBBB with first degree AV block” for the first (ie no acute coronary occlusion), and “RBBB and superimposed OMI” for the second.

STEMI 73

STEMI Paramedic Coronary ED 73

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.

STEMI 52

STEMI Coronary ALS ACS 52

Dr. Smith's ECG Blog

MAY 16, 2023

Emergent CT coronary angio also likely has a role in such cases. Like they would for any other acute arterial occlusion syndrome (such as suspicion of acute large vessel stroke), they take the patient across the hall and perform an immediate CT (coronary) angiogram, showing patent coronaries.

Coronary 52

Coronary STEMI ED OR 52

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. New York, NY: The McGraw-Hill Companies; 2014. Often, you will see bowel gas, which is an indication you are too inferior.

ALS 87

ALS Coronary Emergency Department ED 87

EMDocs

FEBRUARY 7, 2024

GLP-1 agonists are also associated with improved ejection fraction, coronary blood flow, and cardiac output while reducing the risk of cardiovascular events, infarction size, and all-cause mortality. 2014 Fall-Winter;11(3-4):202-30. FDA Approves New Drug Treatment for Chronic Weight Management, First Since 2014. Rev Diabet Stud.

Allergic Reaction 74

Allergic Reaction ALS CAD OR 74

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]. CMAJ 2014. Am J Emerg Med 1999. Chang and Liu. Chang and Liu.

STEMI 52

STEMI Coronary OR ACS 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

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

REBEL EM

JANUARY 29, 2024

CHEST 2010. PMID: 19741062 Kucher N et al. Randomized, Controlled Trial of Ultrasound-Assisted Catheter-Directed Thrombolysis for Acute Intermediate-Risk Pulmonary Embolism. PMID: 24226805 Piazza G et al.

ALS 137

ALS ACS OR CPR 137

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. link] Published January 2014. Epub 2014 Dec 4. We’ll keep it short, while you keep that EM brain sharp.

EMS 73

EMS ALS OR ACS 73

Dr. Smith's ECG Blog

DECEMBER 14, 2016

We could not rule out acute epicardial coronary (large artery) occlusion. Learning Point Acute coronary occlusion may occur with no ECG findings whatsoever. This is from the 2014 ACC/AHA guidelines. A bedside echo showed good LV function but was inadequate to assess wall motion. Earlier versions are more specific. "A

ACS 52

ACS STEMI Coronary OR 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

REBEL EM

FEBRUARY 22, 2023

Open angle Closed angle Definitions Increased resistance to aqueous outflow through the trabecular meshwork.

Emergency Department 52

Emergency Department ALS ED Coronary 52

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. Wang T, Zhang M, Fu Y, et al. Marti D et al.

STEMI 52

STEMI Coronary ALS CAD 52

Dr. Smith's ECG Blog

APRIL 22, 2022

Identifying patients with low risk for acute coronary syndrome without troponin testing: validation of the HEAR score. High-sensitivity cardiac troponin I at presentation in patients with suspected acute coronary syndrome: a cohort study. Case Rep Emerg Med 2014 7. Moumneh T, Sun BC, Baecker A, et al. Am J Med 2021 5.

E-9-1-1 52

E-9-1-1 STEMI ALS ED 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. Imagine if you had only recorded the 2nd ECG. Thelin et al.

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 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. Figure-1: Illustration of the rational for the Mirror Test ( Figure excerpted from Grauer K: ECG-2014 Pocket Brain ePub ). Regional wall motion abnormality-inferior base ( this is the posterior wall ).

STEMI 52

STEMI ED Coronary OR 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. KEY Point: A number of conditions other than Brugada Syndrome may temporarily produce a Brugada-1 ECG pattern ( World J Cardiol 6(3):81-86, 2014 ). PM Cardio digitized version.

E-9-1-1 70

E-9-1-1 CAD OR STEMI 70

ALiEM

SEPTEMBER 16, 2024

A 94-year-old female with a past medical history of hypertension, coronary artery disease, chronic venous stasis, and permanent pacemaker placement initially presented to triage complaining of left hip pain in the setting of a fall shortly prior to arrival. 2014 Jul; 3(4):351-67. Ann Cardiothorac Surg. doi: 10.3978/j.issn.2225-319X.2014.07.05.

ACS 152

ACS Coronary OR 152

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. The trial was conducted in 25 ICUs in France between 2014 and 2018. C to a goal of 36.5 C over 24 hours.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 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

MARCH 6, 2019

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. J of National Association of EMS Physicians 2014. American Journal of Cardiology 1990. Meisel et al.

STEMI 52

STEMI ALS ACS OR 52

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. Immediate and early percutaneous coronary intervention in very high risk and high risk non-ST segment elevation myocardial infarction patients. Lupu et al. Clinical Cardiology. Am Heart J [Internet].

Coronary 103

Coronary STEMI OR ALS 103

EMDocs

NOVEMBER 13, 2023

40 The American Academy of Emergency Medicine (AAEM) released a position statement in 2014 advocating for the use of CTA in place of LP when LP cannot be done or has equivocal results. J Neurosurg 2014, 121 (1), 24-31. Biomed Res Int 2014, 2014 , 934947. DOI: 10.1155/2014/934947 From NLM. (66) DOI: 10.3171/2014.3.Jns132239

E-9-1-1 86

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

EMDocs

NOVEMBER 4, 2024

54 It is vital to consider dangerous epigastric pain mimickers like acute coronary syndrome (ACS), hepatobiliary disease, or pancreatitis. doi:10.1136/heartjnl-2014-306362 LeWinter MM. Comparison of factors associated with atypical symptoms in younger and older patients with acute coronary syndromes. 12 2019;13(4):402-407.

ED 98

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

Core EM

DECEMBER 12, 2023

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

Emergency Department 130

Emergency Department OR ALS Coronary 130