REBEL EM

MARCH 2, 2023

Background: Historically, we have treated acute coronary syndrome with supplemental oxygen regardless of the patient ’ s oxygen saturation. More recent evidence, however, demonstrates that too much oxygen could be harmful ( AVOID Trial ) by causing coronary vasoconstriction and increasing oxidative stress. Low O2 protocol: 3.1%

ACS 52

ACS Coronary STEMI Ambulance 52

Dr. Smith's ECG Blog

DECEMBER 16, 2024

Cardiology wanted a CT of the aorta to rule out dissection, presumably partly due to the very high blood pressure readings, but also because it is hard for people to believe that a 20-something woman could have acute thrombotic coronary artery. They also recommended a NTG drip, after which she reported complete resolution of pain. Denies SOB.

STEMI 88

STEMI Coronary Critical Care ED 88

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. The effects of GLP-1 agonists are associated with the dose. Higher doses of GLP-1 agonists are associated with weight loss.

Allergic Reaction 74

Allergic Reaction ALS CAD OR 74

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.

Coronary 52

Coronary ACS STEMI ALS 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Coronaries were normal, as was serial troponin. Written by Jesse McLaren Two patients in their 70s presented to the ED with chest pain and RBBB. Do either, both, or neither have occlusion MI? Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths.

STEMI 77

STEMI Paramedic Coronary ED 77

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. It was not relieved by anything. The pain was not positional, pleuritic, or reproducible. He had no previous medical history. The blood pressure was 110/60. mm STE in one lead.

ACS 52

ACS STEMI Coronary OR 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 40

Coronary ACS ALS STEMI 40

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

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. We’ll keep it short, while you keep that EM brain sharp. Symptoms may range from days to months prior to stroke onset.

EMS 73

EMS ALS OR ACS 73

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]. See these 5 cases of WPW mimicking and/or obscuring acute OMI Take home 1.

STEMI 52

STEMI Coronary OR ACS 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

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. I immediately responded: "cool fake!

Coronary 52

Coronary STEMI ED 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

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

REBEL EM

FEBRUARY 22, 2023

Open angle Closed angle Definitions Increased resistance to aqueous outflow through the trabecular meshwork. Most common type of glaucoma Occurs with obstruction to aqueous outflow, usually from the iris. Most common cause: pupillary block. Symptoms Generally painless, asymptomatic. May have blurred vision or decreased visual acuity.

Emergency Department 52

Emergency Department ALS ED Coronary 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. Written by Pendell Meyers A man in his 70s with no cardiac history presented with acute weakness, syncope, and fever. He denied chest pain or shortness of breath. PM Cardio digitized version.

E-9-1-1 69

E-9-1-1 CAD OR STEMI 69

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. Suppose you had used the formula? Thelin et al.

E-9-1-1 40

E-9-1-1 STEMI ACS Coronary 40

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. Backus BE, Six AJ, Kelder JC, et al. Int J Cardiol 2013 2.

E-9-1-1 52

E-9-1-1 STEMI ALS ED 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 ). What is the “Mirror” Test?

STEMI 52

STEMI ED Coronary OR 52

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. Interventions during the acute phase of treatment post return of spontaneous circulation (ROSC) are therefore critical.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

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. Echo showed anterior septal, anterior wall, and apical wall motion abnormalities, as well as an EF of 45%. Patel et al.,

STEMI 52

STEMI ALS ACS OR 52

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. Neuro : Awake, alert, oriented x 3. g/dL, 41.5%

ACS 152

ACS Coronary OR 152

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 104

Coronary STEMI OR ALS 104

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

EMDocs

NOVEMBER 13, 2023

He also reports associated photophobia, nausea, and a single episode of vomiting in the lobby. He denies a history of similar headaches in the past. He denies any medical history, significant family history, or recreational drug use. Vital signs: Temperature 99.5F, HR 98 bpm, BP 162/86 mmHg, RR 14 per minute, oxygen saturation 99% on room air.

E-9-1-1 86

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

EMDocs

NOVEMBER 4, 2024

The pain is worse with deep breaths, coughing, or certain movements, and improves with rest and nonsteroidal anti-inflammatory drugs (NSAIDs). A 45-year-old male presents to the ED after a motor vehicle collision where he was the restrained driver. He reports severe, localized chest pain, worsened by breathing, coughing, and movement.

ED 98

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

Core EM

DECEMBER 12, 2023

There are currently three methods available for combined hormonal contraception: combined oral contraceptive pills transdermal patch vaginal ring Oral Contraceptive Pills The pill is taken every day for three weeks (or for longer in an extended pill pack), and then either a placebo or low-dose pill is taken for one week to allow menstruation.

Emergency Department 130

Emergency Department OR ALS Coronary 130