Dr. Smith's ECG Blog

DECEMBER 5, 2023

A final ECG was perfomed on hospital day 2: Persistent ST elevation in the inferior leads with slight reciprocal ST depression in aVL Teaching points - It is essential to consider ACS in all age groups. While ACS may be less common in the pediatric population, it is important to consider risk factors that may make OMI more likely (e.g.,

Coronary 112

Coronary CAD ACS ALS 112

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.

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E-9-1-1 ALS ACS ICU 122

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.

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E-9-1-1 ALS ACS ED 105

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?

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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.)

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STEMI Coronary ACS Critical Care 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

Click here to sign up for Queen of Hearts Access Given the lack of intracranial hemorrhage, the patient was administered aspirin for suspected ACS and cardiology was consulted. 2016 Nov;34(11):2182-2185. Epub 2016 Aug 27. Version 2 = 0.0272. Both highly negative. Lee DH, Walsh B, Smith SW. Am J Emerg Med. doi: 10.1016/j.ajem.2016.08.053.

STEMI 97

STEMI Coronary Emergency Department OR 97

This Podcast Will Kill You

SEPTEMBER 24, 2024

2016): 86-101. ACS omega , 7 (24), pp.20441-20456. . “The evolutionary adaptation of the C 282 Y mutation to culture and climate during the European Neolithic.” ” American Journal of Physical Anthropology 160.1 Cianciosi, D., and Capanoglu, E., Iron absorption: factors, limitations, and improvement methods.

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ALS ACS 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

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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.

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Coronary ALS ACS ED 130

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.

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ALS ACS OR CPR 137

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

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.

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E-9-1-1 ACS ALS OR 52

ACEP Now

OCTOBER 11, 2024

References Webb AC, Wheeler A, Ricci A, et al. Buckets associated home drowning in Indian infants and toddlers: an analysis of 18 fatalities from 2016-2022. Making affordable, culturally appropriate, and accessible interventions available to this population is key. South Med J. 2021;114(5):266-270. 2022;17(11):e0276374.

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ALS Emergency Department Emergency Medical Services ED 52

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.

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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.

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E-9-1-1 Coronary ACS BLS 118

Dr. Smith's ECG Blog

OCTOBER 24, 2019

Angie Lobo ( @aloboMD ) (For open-access reviews of this literature, see Saw 2016 , Saw 2017 , or Hayes 2018.) SCAD isn’t rare, especially in women Historically SCAD had been identified in 22% of ACS cases in women. Pregnancy is not a common cause of SCAD When ACS occurs in the peripartum period, SCAD is responsible in 43% of cases.

Coronary 52

Coronary CAD ACS STEMI 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

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

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.

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ALS STEMI Coronary OR 130

ALiEM

SEPTEMBER 16, 2024

2016 Jun;21(3):264-73. Epub 2016 Feb 8. 2016 May; 5(3):256. doi: 10.21037/acs.2016.05.04. Crawford TC, Beaulieu RJ, Ehlert BA, Ratchford EV, Black JH 3rd. Malperfusion syndromes in aortic dissections. doi: 10.1177/1358863X15625371. PMID: 26858183; PMCID: PMC4876056. Harris C, Croce B, Cao C. Type A aortic dissection.

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ACS Coronary OR 152

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).

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

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

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

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.

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ED Emergency Department ALS Paramedic 65

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

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

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 143

Emergency Department E-9-1-1 ALS OR 143

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.

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Defibrillator E-9-1-1 ALS Epinephrine 52

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 63

STEMI Coronary Paramedic ALS 63

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

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/tsaco-2016-000064 Zink KA, Mayberry JC, Peck EG, Schreiber MA. CDC Guideline for Prescribing Opioids for Chronic Pain–United States, 2016. Trauma Surg Acute Care Open.

ED 98

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

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 ALS 52