REBEL EM

MARCH 22, 2023

Valsalva maneuvers Have patient bear down as if they are having a bowel movement Have patient blow as hard as they can into a straw Syringe technique Postural Modification Success rate: 43% vs. 17% (standard Valsalva) (Appleboam 2015) Details of technique found at the St. Lancet 2015. PMID: 2022022 Appleboam A et al. Louis, Mosby, Inc.,

ALS 52

ALS EMS ED OR 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

Sent by anonymous, written by Pendell Meyers, reviewed by Smith and Grauer A man in his 40s presented to the ED with HTN, DM, and smoking history for evaluation of acute chest pain. The angiogram showed completely normal coronary arteries. Triage ECG: What do you think? Meyers alludes to in his excellent discussion.

STEMI 123

STEMI ED OR Coronary 123

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. Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour

EMS 74

EMS ALS OR ACS 74

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

Case submitted by Magnus Nossen MD, written by Pendell Meyers A previously healthy man in his 40s presented to the ED with epigastric abdominal pain off and on for several days. While exceptions always exist — this clinical setting sounds like a lower prevalence presentation for acute coronary disease. Vitals were within normal limits.

ED 52

ED OR STEMI Coronary 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

It is our job to identify this entity and ensure these patients receive the same care they would for a STEMI in any other coronary artery territory. Therein lies the limitation of electrocardiography in diagnosing acute coronary occlusion. Tips for recognizing Acute Posterior STEMI: 1. Neth Heart J. 2007; 15: 16-21. Wung SF, Drew BJ.

STEMI 52

STEMI E-9-1-1 Coronary ALS 52

Dr. Smith's ECG Blog

MARCH 9, 2023

Relationship between an in-farct related artery, acute total coronary occlusion, and mortality in patients with ST-segment and non-ST-segment myocardial infarction. Karwowski et al showed that only 64% of 4581 STEMIs had TIMI 0 flow on angiogram. [25] 25] Stone et al found that 72% have TIMI 0 or 1 flow. [26] Pol Arch Intern Med.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 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

JUNE 2, 2023

Despite otherwise normal vital signs, she was appropriately triaged to the critical care area of the ED. They are rare and hard to find in normal practice in the ED. She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think?

ED 78

ED OR ALS CAD 78

EMS 12-Lead

APRIL 2, 2022

He reported a history of ischemic cardiomyopathy with coronary stent placement approximately 10 years prior, but could not recall the specific artery involved. Chou’s Electrocardiography in Clinical Practice, 6th ed. Goldberger’s Clinical Electrocardiography: A Simplified Approach, 9th ed. Attached is the first ECG.

ALS 130

ALS STEMI Coronary OR 130

Dr. Smith's ECG Blog

MAY 19, 2022

Written by Pendell Meyers, edits by Smith and Grauer A man in his late 20s with history of asthma presented to the ED with a transient episode of chest pain and shortness of breath after finishing a 4-mile run. At the time of evaluation in the ED, his symptoms were resolved. Ct coronary angiogram showed normal coronary arteries.

E-9-1-1 52

E-9-1-1 Coronary OR ED 52

Don't Forget the Bubbles

AUGUST 21, 2023

“Hi, phoning from ED with a referral. The ED team helpfully did a gas while you headed down to review, and as you scan the numbers, you see that the baby has a severe mixed respiratory/lactic acidosis. In: Nichols, DG and Shaffner, DH (eds.) So far, so common on your typical paediatric on-call shift. 34; 963 – 969. Bouziri A.,

ALS 98

ALS Critical Care ED OR 98

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. Lancet 2015 6. It was obtained ~2 months prior to this patient's presentation in the ED.

E-9-1-1 52

E-9-1-1 STEMI ALS ED 52

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

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. 2015 91(3): 217-225.

Emergency Department 130

Emergency Department OR ALS Coronary 130

Dr. Smith's ECG Blog

APRIL 8, 2015

Summary of ED Approach to Syncope Please excuse the formatting problems, which I have not been able to fix! Annotated Bibliography For an excellent overview of ED Syncope management , see this article by Kessler C et al. Any ED systolic blood pressure less than 90 or greater than 180 mm Hg (+1) 4. h/o heart disease (+1) 3.

Emergency Department 52

Emergency Department E-9-1-1 ED OR 52