AAAM

JANUARY 12, 2024

I have been using AIS since 2016, when I joined the trauma world. The most rewarding aspect of trauma data and analytics is knowing that my team and I are doing our part to support ACS verification here at our hospital. How long have you been using AIS? What inspired you to obtain CAISS credentials?

EMR 52

EMR ACS OR 52

ACEP Now

MARCH 14, 2024

Current can be alternating current (AC) or direct current (DC) with AC typically more dangerous as it is more likely to cause tetanic contractions and increase contact time with the electrical source. 2,3,5 Except for laundry or electrical car outlets (240 V AC), all U.S. household outlets are rated at 120 V AC.

Operating Room 52

Operating Room ACS Critical Care Coronary 52

ACEP Now

DECEMBER 11, 2023

Many conditions outside of acute coronary syndrome (ACS) mimic ST-elevation myocardial infarction (STEMI), but only a handful of cases have reported ST-elevations (STE) in the setting of pancreatic inflammation where underlying ACS was excluded. Emergency Medicine Reports website.Published June 1, 2016. Click to enlarge.)

STEMI 52

STEMI Coronary ACS Critical Care 52

EMDocs

JUNE 27, 2024

Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. 2016 Dec;91(12):1185-1190. Epub 2016 Oct 3. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02 mg/kg, max 0.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

EMS 12-Lead

JUNE 1, 2022

In isolation, however, syncope does not hold significant weight for OMI – as opposed to something like crushing chest discomfort, for example – although stereotypical ACS might become blurry in both the elderly and diabetic populations. This is important because we must rely on the ECG to further elucidate the story when the patient cannot.

Coronary 130

Coronary ALS Firefighter OR 130

EMS 12-Lead

APRIL 8, 2022

Smith and Meyers found that patients presenting with high-risk ACS and any ST-depression, even less than 1 mm, maximal in leads V1-V4 to be 97% specific for OMI and 96% specific for OMI requiring emergent PCI. [5] 1] Driver, B. Posterior wall reperfusion T-waves: Wellens’ syndrome of the posterior wall. Emergency Medicine Journal, 1-5. [2]

STEMI 130

STEMI ALS Coronary CAD 130

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. doi: 10.1136/neurintsurg-2016-012515. Epub 2016 Jul 15. Neurocrit Care 24, 172–179 (2016). 1% of patients with a score of 3 or less had a diagnosis of stroke, whereas those with a score of 6-7 had stroke in 27% of cases.

EMS 74

EMS ALS OR ACS 74

Dr. Smith's ECG Blog

JULY 27, 2023

I did not think it was due to ACS, but we ordered an ED ECG immediately: What do you think? But in this case the clinical scenario is not right for acute ACS with OMI, and there is very high voltage, and the patient is very young, (though beware of young patients , even 29 year olds!! There is profound "inferior" ST Depression.

Coronary 52

Coronary ACS Naloxone Plasma 52

Dr. Smith's ECG Blog

DECEMBER 19, 2023

Because there was proven thrombus (ACS) but the troponin never went above the 99% reference range (and therefore cannot be called MI -- definition of MI requires rise and/or fall of troponin with at least one value above the 99% reference range), this is UNSTABLE ANGINA with ST Elevation.

E-9-1-1 122

E-9-1-1 Coronary ACS BLS 122

Dr. Smith's ECG Blog

JUNE 8, 2023

As recurrent ischaemia is the principle event reduced by early intervention in NSTE-ACS, these are important endpoint events occurring with delayed angiography and there is a consistent signal for harm now from two data sources.”[5] Int J Cardiol 2016 3. Busk et al. Eur Heart J 2009 4 Lemkes et al.

STEMI 62

STEMI Coronary Paramedic ALS 62

EMDocs

FEBRUARY 12, 2024

Epub 2016 Jun 9. 11) Webb RK, Ralston AC, Runciman WB. 2016 Feb;33(2):152-4. Correlation of Venous Blood Gas and Pulse Oximetry With Arterial Blood Gas in the Undifferentiated Critically Ill Patient. J Intensive Care Med. 2018 Mar;33(3):176-181. doi: 10.1177/0885066616652597. PMID: 27283009; PMCID: PMC5885755. (8) 10) Jubran A.

Emergency Department 94

Emergency Department E-9-1-1 ED ICU 94

Don't Forget the Bubbles

JULY 22, 2024

The most recent meta-analysis , published in 2016 (comparing eleven studies from 1986 to 2009), struggled to reach a consensus because the trials were too heterogeneous to make robust conclusions. 2016 Aug;51(8):868–76. 2016 May;67(5):593-601.e3. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

ECG & Echo Learning

OCTOBER 2, 2022

Gordon AC, Mason AJ, Thirunavukkarasu N, et al. JAMA 2016; 316:509. Vasopressin for treatment of vasodilatory shock: an ESICM systematic review and meta-analysis. Intensive Care Med 2012; 38:9. Effect of Early Vasopressin vs Norepinephrine on Kidney Failure in Patients With Septic Shock: The VANISH Randomized Clinical Trial.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Studies without IRB approval Studies older than 2016 Intervention: Administration of <30 mL/kg IV crystalloid fluids within three hours of sepsis identification. References: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM.

E-9-1-1 113

E-9-1-1 ALS ACS ICU 113

Dr. Smith's ECG Blog

AUGUST 3, 2017

More comments by Smith Isolated precordial ST depression (without ST elevation) in ACS Isolated precordial ST depression (STD) may be due to either subendocardial ischemia (usually V4-V6) or be reciprocal to posterior ST Elevation (maximal STD in V1-V4). July 2016. O'Gara et al. Circulation. J Cardiol 1987 Apr 1;59(8):782-7.

STEMI 52

STEMI E-9-1-1 Coronary ALS 52

Don't Forget the Bubbles

SEPTEMBER 18, 2023

Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, et al. McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, et al. 2016 Aug;16(8):e139–52. 2016 Sep 1;170(9):848. References Acute otitis media Csonka P, Palmu S, Heikkilä P, Huhtala H, Korppi M. Pediatr Infect Dis J. 2022 Dec;41(12):947–52.

Emergency Department 142

Emergency Department E-9-1-1 ALS OR 142

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Methods : The PERFECT study (#NCT02765477) is a retrospective, 16 center, international investigation of ED patients from 1/2008 - 12/2016 with VPR on the ECG and symptoms of acute coronary syndrome (ACS). Data from ten sites are presented here. Acute myocardial infarction (AMI) was defined by the Third Universal Definition of AMI.

Coronary 52

Coronary STEMI Paramedic ALS 52

EMDocs

JANUARY 6, 2024

Answer : Cardiac Transplant Complications Epidemiology: There were over 3,000 heart transplants in North America in 2016. 15 Patients with a heart transplant can have ACS though they are unlikely to present with classic, crushing chest pain due to transplant-induced changes in cardiac innervation.

EMS 63

EMS E-9-1-1 ACS Coronary 63

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. PMID: 23102885 Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. Clin Exp Emerg Med 2023. PMID: 15262836 Sharifi M et al.

ALS 133

ALS ACS OR CPR 133

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

Some providers were worried about ACS because of this ECG. My answer alleviated their concern for ACS and no further workup was done for ACS. showed that , when T-waves are inverted in precordial leads, if they are also inverted in lead III and V1, then pulmonary embolism is far more likely than ACS. Kosuge et al.

E-9-1-1 52

E-9-1-1 ACS ALS OR 52

EMS 12-Lead

APRIL 2, 2022

Anecdotally, had there been symptoms unequivocally consistent with ACS then one could justifiably make the case for a potential D1 occlusion. Given such findings, serial ECG’s are prudent to consider, and carry significant impact moving forward, which has been demonstrated in previous posts. & Knilans, T. 3] Smith, S.

ALS 130

ALS STEMI Coronary OR 130

AAEM RSA

APRIL 1, 2021

1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 ACS TQIP Best Practice Guidelines. 248(3):447-58.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

Don't Forget the Bubbles

JUNE 30, 2023

A recent review was conducted on Trauma Quality Improvement Program data between 2014 and 2016. Joint statement from the American College of Surgeons Committee on Trauma (ACS COT) and the American College of Emergency Physicians (ACEP) regarding the clinical use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA).

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

ACEP Now

NOVEMBER 7, 2023

8-12 A recent scoping review published in The American Journal of Emergency Medicine reviewed articles between 2016 and 2019, and found 18 observational studies, which failed to demonstrate sufficient evidence for widespread implementation of DSED. Emmerson AC, Whitbread M, Fothergill RT. Canadian Journal of Emergency Medicine.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

REBEL EM

FEBRUARY 2, 2023

Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). PMID: 36115743 Clinical Question: What is the effectiveness of IV amiodarone vs IV digoxin used as second line therapy in critically ill emergency department patients with atrial fibrillation/flutter where first-line BB use has failed?

Emergency Department 52

Emergency Department ALS Critical Care ED 52

EMDocs

SEPTEMBER 25, 2023

References: Heffner AC et al. 2016 Sep;117 Suppl 1:i9-i13. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation 2013; 84(11): 1500 – 4. PMID: 23911630 Kim WY et al. ” Journal of the American College of Emergency Physicians Open 2.1 2021): e12373. Kelly FE, Cook TM.

ED 65

ED Emergency Department ALS OR 65

REBEL EM

JULY 14, 2022

Epub 2016 Jun 28. PMID: 30060961 Koller AC, et al. Admission of out-of-hospital cardiac arrest victims to a high volume cardiac arrest center is linked to improved outcome. Resuscitation. PMID: 27368428 Elmer J, et al. Long-Term Outcomes of Out-of-Hospital Cardiac Arrest Care at Regionalized Centers. Ann Emerg Med. Epub 2018 Jul 4.

ICU 52

ICU ALS OR CPR 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Finally, much of this correlates well with The new Canadian Syncope Arrhythmia Risk Score , just published in 2016, results of which are given below in the Annotated Bibliography. These premonitory symptoms were negative predictors of adverse outcomes in EGSYS. 2) Boston syncope rule: J Emerg Med. 2007 Oct; 33(3): 233–239.

Emergency Department 52

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