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

DECEMBER 14, 2016

I delved into his reasons for arriving so late after onset, thinking that perhaps the pain had only recently increased, or that it had been intermittent until now, but he confirmed that it was 14 hours of constant pain and it was his significant other who insisted that he go to the ED. This is from the 2014 ACC/AHA guidelines.

ACS 52

ACS STEMI Coronary OR 52

Dr. Smith's ECG Blog

SEPTEMBER 21, 2022

A 40-something woman with diabetes and peripheral vascular disease who frequently needs the ED for chronic pain called 911 for sudden severe chest pain. Because of this, it was very difficult to record an ED ECG, but eventually it became possible: What do you think? The patient was very agitated and could not hold still.

STEMI 52

STEMI ED Coronary OR 52

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]. Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present."

E-9-1-1 120

E-9-1-1 OR Coronary ACS 120

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

JANUARY 6, 2024

A 64-year-old male presents by EMS to the ED with shortness of breath. 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 The exact incidence or acute coronary syndrome in heart transplant patients is not well characterized.

EMS 63

EMS E-9-1-1 ACS Coronary 63

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED. The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. In the cath lab, the patient’s blood pressure remained low.

Coronary 52

Coronary ACS ALS STEMI 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

JULY 22, 2023

An ECG was performed in the ED at 1554: Original image unavailable, this is the only recorded scanned ECG available. QOH Interpretation: The initial troponin I (older generation) at the first ED was barely positive at 0.06 He denied chest pain or shortness of breath. See below for PM Cardio digitized version of this.

E-9-1-1 70

E-9-1-1 CAD OR STEMI 70

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. This was my thought: if this patient presented to the ED with chest pain, then this is an LAD occlusion. Asymmetric.

STEMI 52

STEMI Coronary ALS CAD 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She was asymptomatic at the time of this ECG recorded on arrival to our ED: What do you think? 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. Meisel et al.

STEMI 52

STEMI ALS ACS OR 52

EMDocs

NOVEMBER 13, 2023

The use of CTA (computed tomography angiography) in the emergency department (ED) has increased dramatically in the past 20 years. of all patients in the ED for over 800 different stated indications. 5, 6 Further, any use of imaging prolongs ED stays, which by extension increases ED wait times for other patients.

E-9-1-1 87

E-9-1-1 ALS Emergency Department ED 87

Core EM

DECEMBER 12, 2023

Promoting Reproductive Health in the ED In the post Roe v. Emergency medicine providers should be familiar and comfortable with prescribing both long-term and emergency contraception in the ED, ultimately reducing the burden of unintended pregnancy and its subsequent disparities on vulnerable patient populations. and Zolna, Mia R.

Emergency Department 130

Emergency Department OR ALS Coronary 130