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

EMDocs

JUNE 27, 2024

Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK. Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. 2016 Dec;91(12):1185-1190. Epub 2016 Oct 3. C or 100.4 mg/kg, max 0.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

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. References: Gaillard F, Glick Y, Tatco V, et al. doi: 10.1136/neurintsurg-2016-012515. Epub 2016 Jul 15. 61.4.496 Navi BB, Kamel H, Shah MP, et al. link] Burns JD, Rindler RS, Carr C, et al. J Neurointerv Surg.

EMS 74

EMS ALS OR ACS 74

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] Kontos et al. Welsh et al. Int J Cardiol 2016 3. Busk et al.

STEMI 63

STEMI Coronary Paramedic ALS 63

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

ECG & Echo Learning

OCTOBER 2, 2022

References Overgaard, Dzavik et al. Jentzer et al. Müllner M, Urbanek B, Havel C, et al. Lherm T, Troché G, Rossignol M, et al. Gattinoni L, Brazzi L, Pelosi P, et al. Gregory JS, Bonfiglio MF, Dasta JF, et al. MacGregor DA, Smith TE, Prielipp RC, et al. Hannemann L, Reinhart K, Grenzer O, et al.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 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-9-1-1 123

E-9-1-1 Coronary ACS BLS 123

Don't Forget the Bubbles

JULY 22, 2024

Compare this with the Panickar et al. 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. Fortunately, Lee et al. Lee B, Turner S, Borland M, Csonka P, Grigg J, Guilbert TW, et al.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

Dr. Smith's ECG Blog

AUGUST 3, 2017

Matetzky S, Friemark D, Feinberg MS, et al. O'Gara et al. O'Gara et al. 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).

STEMI 52

STEMI E-9-1-1 Coronary ALS 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. Uchel et al’s contribution (21% weight) indicates that ≥30cc/kg IVF is linked to 2.5

E-9-1-1 120

E-9-1-1 ALS ACS ICU 120

EMDocs

FEBRUARY 12, 2024

References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. Epub 2016 Jun 9. 11) Webb RK, Ralston AC, Runciman WB. 2016 Feb;33(2):152-4. Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis. J Intensive Care Med.

Emergency Department 94

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

Don't Forget the Bubbles

SEPTEMBER 18, 2023

Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, et al. Frost HM, Bizune D, Gerber JS, Hersh AL, Hicks LA, Tsay SV. Tonsillitis Baker MG, Gurney J, Oliver J, Moreland NJ, Williamson DA, Pierse N, et al. Community-acquired pneumonia Addo-Yobo E, Anh DD, El-Sayed HF, Fox LM, Fox MP, MacLeod W, et al.

Emergency Department 142

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

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Khan AR, Golwala H, Tripathi A, et al. 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). In normal conduction , (i.e., Data from ten sites are presented here.

Coronary 52

Coronary STEMI Paramedic ALS 52

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. References: Jaff MR et al. PMID: 21422387 Wan S et al. PMID: 15262836 Sharifi M et al. PMID: 27422214 Wang C et al. PMID: 19741062 Kucher N et al. PMID: 24226805 Piazza G et al. PMID: 26315743 Tapson VF et al.

ALS 136

ALS ACS OR CPR 136

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

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. 4] Baranchuk, A, et al. Given such findings, serial ECG’s are prudent to consider, and carry significant impact moving forward, which has been demonstrated in previous posts. 2] Surawicz, B.

ALS 130

ALS STEMI Coronary OR 130

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. References Go AS, Mozaffarian D, Roger VL, et al. Margey R, Browne L, Murphy E, et al.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

EMDocs

SEPTEMBER 25, 2023

References: Heffner AC et al. PMID: 23911630 Kim WY et al. PMID: 23911630 Kim WY et al. PMID: 25402500 Forsythe SM et al. PMID: 10631227 Mosier JM et al. Riker RR, Shehabi Y, Bokesch PM, et al. Lowe J B, Yoo M J, Patrick J O, et al. Li, Timmy, et al. Resuscitation 2013; 84(11): 1500 – 4.

ED 65

ED Emergency Department ALS OR 65

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 Holcomb JB, Tilley BC, Baraniuk S, et al.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

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. Kosuge et al. 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.

E-9-1-1 52

E-9-1-1 ACS ALS OR 52

REBEL EM

FEBRUARY 2, 2023

Paper: Mason JM, et al. These results were corroborated with other another study by Gritensko et al. Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). References Mason JM, et al. 2018, PMID: 30571262 Gritsenko, Diana, et al. Link to Paper Here Shojaee M, et al. Am J Emerg Med. Am J Emerg Med.

Emergency Department 52

Emergency Department ALS Critical Care ED 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

REBEL EM

JULY 14, 2022

Paper: Nassal MMJ, et al. REFERENCES: Nassal MMJ, et al. PMID: 34968531 Rittenberger JC, et al. PMID: 21756969 Coppler PJ, et al. PMID: 25636896 Schober A, et al. Epub 2016 Jun 28. PMID: 27368428 Elmer J, et al. PMID: 30060961 Koller AC, et al. Resuscitation. 2022 Mar; 17. Resuscitation.

ALS 52

ALS ICU OR CPR 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Also consider non-hemorrhagic volume depletion, dehydration : orthostatic vitals may uncover this [see Mendu et al. (3)]. 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. Del Rosso A, et al.

Emergency Department 52

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