Don't Forget the Bubbles

JULY 5, 2023

Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. Older children and adults usually present with ACS 2-3 days after hospitalisation due to pulmonary infarction (in situ sickling), hypoventilation due to rib infarction (which may be exacerbated by recent narcotic administration) or fat embolism.

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E-9-1-1 ACS OR ICU 126

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. 2017 Sep-Oct;50(5):561-569. Epub 2017 Apr 19. Version 2 = 0.0272. Both highly negative. J Electrocardiol. doi: 10.1016/j.jelectrocard.2017.04.005.

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STEMI Coronary Emergency Department OR 98

REBEL EM

NOVEMBER 6, 2024

PMID: 32644703 Robinson PM, Griffiths E, Watts AC. 2017 Jul;9(3):195-204. PMID: 27227986 Glover NM, Black AC, Murphy PB. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Simple elbow dislocation. Shoulder Elbow. PMID: 28588660 Donohue KW, Mehlhoff TL. Chronic Elbow Dislocation: Evaluation and Management. 2023 Nov 5.

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E-9-1-1 ACS OR Emergency Department 59

This Podcast Will Kill You

SEPTEMBER 24, 2024

ACS omega , 7 (24), pp.20441-20456. 2017): 809. .” American Journal of Physical Anthropology 160.1 2016): 86-101. Cianciosi, D., and Capanoglu, E., Iron absorption: factors, limitations, and improvement methods. 20441-20456. Hodgskiss, Malcolm SW, et al. “A productivity collapse to end Earth’s Great Oxidation.”

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ALS ACS 52

EMDocs

AUGUST 17, 2023

mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1% vs 48.4% (OR 3.4, vs 48.4% (OR 3.4,

Overdose 66

Overdose ACS Critical Care OR 66

EMDocs

JUNE 27, 2024

2017 Dec 1;30(4):191-201. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. -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 Am J Emerg Med.

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ACEP Now

OCTOBER 11, 2024

A pediatric submersion score was developed and validated in 2017 identifying five factors that, if present, suggest safe discharge from the ED after an eight-hour observation period. References Webb AC, Wheeler A, Ricci A, et al. 9,11 As with many pediatric issues, prevention is key. South Med J. 2021;114(5):266-270.

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ALS Emergency Department Emergency Medical Services ED 52

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. Eur Heart J 38, 1872–1882 (2017). Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. To start with there are apparently 5 types of cardiorenal syndrome. I’ll let that sink in. – Mullens, W.,

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Critical Care ACS OR ALS 96

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.

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Coronary ACS Naloxone Plasma 52

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 Firefighter ACS 130

ECG & Echo Learning

OCTOBER 2, 2022

Gordon AC, Mason AJ, Thirunavukkarasu N, et al. N Engl J Med 2017. N Engl J Med 2017. N Engl J Med 2017; 377:419. Intensive Care Med 2004; 30:597. Polito A, Parisini E, Ricci Z, et al. Vasopressin for treatment of vasodilatory shock: an ESICM systematic review and meta-analysis. Intensive Care Med 2012; 38:9.

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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.

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Coronary CAD ACS STEMI 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

3) RV Failure leads to hypotension but NOT pulmonary edema (unlike LV failure) 4) Repeat ECGs, right sided ECG and bedside echo may be helpful in making a diagnosis of ACS. 21, 2017 ). Smith's book : Learning points: 1) OMI can be very subtle and RV infarction may manifest poorly on the standard ECG.

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STEMI OR ACS ALS 96

REBEL EM

FEBRUARY 2, 2023

Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). Epub 2017 Jan 10. Lastly, there is a substantial amount of data missing, specifically the underlying cause of the Atrial Fibrillation with RVR (ie. Journal of Emergency and Critical Care Medicine , vol. 2, 2018, pp. Link to Paper Here Shojaee M, et al. Emerg (Tehran).

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Emergency Department ALS Critical Care ED 52

Dr. Smith's ECG Blog

DECEMBER 6, 2022

S yncope is an uncommon presentation of ACS, but anginal equivalents are more likely in older patients with diabetes 2. The highest risk group are patients with a cardiac cause of their syncope, in whom 1-year mortality can reach 33% ( Koene et al: J Arrhythm 33(6):533-544, 2017 ). Take home 1.

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STEMI ACS Coronary OR 52

EMDocs

SEPTEMBER 25, 2023

References: Heffner AC et al. 2017 Dec;10(1):1. Epub 2017 Jan 25. 2017, 43:226-8. Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation 2013; 84(11): 1500 – 4. PMID: 23911630 Kim WY et al. Int J Emerg Med. doi: 10.1186/s12245-017-0129-8. Epub 2014 Feb 17.

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ED Emergency Department ALS Paramedic 65

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. The cardiologists felt that the ECG did not represent ACS, and thought it was more likely pericarditis, so they did not take him to the cath lab. 15-9/6/2017 ).

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ACEP Now

NOVEMBER 14, 2023

References Deshwal H, Sinha A, Mehta AC. Published April 3, 2017. He is an assistant professor at the University of Toronto, division of emergency medicine, and the education innovation lead at the Schwartz/Reisman Emergency Medicine Institute. He is the founder and host of Emergency Medicine Cases podcast and website.

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EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. 2017 Aug;9(8):722-726. An additional tool that can be used to risk stratify patients presenting with dizziness who may be experiencing posterior circulation stroke is an ABCD2 score. J Neurointerv Surg. doi: 10.1136/neurintsurg-2016-012515.

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EMS ALS OR ACS 73

Don't Forget the Bubbles

JUNE 30, 2023

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). 2017 Dec;83(6):1136-1141. Trauma Surg Acute Care Open. Trials 23, 384 (2022).

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

REBEL EM

JULY 14, 2022

PMID: 30060961 Koller AC, et al. Long-Term Outcomes of Out-of-Hospital Cardiac Arrest Care at Regionalized Centers. Ann Emerg Med. Epub 2018 Jul 4. Comparison of three cognitive exams in cardiac arrest survivors. Resuscitation.

ICU 52

ICU ALS OR CPR 52

Dr. Smith's ECG Blog

FEBRUARY 5, 2019

The clinicians later stated they had had no suspicion of ACS, but that the faculty wanted a troponin anyway. There actually was an old ECG from about 4 years prior (ECG-2), which I'm not sure anyone saw: Here the limb leads have much higher QRS voltage, without a correspondingly larger ST-T voltage. Sandoval Y et al.

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STEMI Emergency Department ED OR 52

ECG & Echo Learning

JANUARY 18, 2023

I C Glucose-lowering therapy should be considered in ACS patients with glucose levels >10 mmol/L (>180 mg/dL), while episodes of hypoglycaemia (defined as glucose levels <_3.9 European Heart Journal, Volume 39, Issue 2, 07 January 2018, Pages 119–177, [link] Published: 26 August 2017

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STEMI Coronary OR Defibrillator 40

Dr. Smith's ECG Blog

OCTOBER 3, 2018

European Heart Journal 38(41):3082-3089; November 1, 2017. 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.

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Coronary STEMI Paramedic ALS 52

ALiEM

OCTOBER 30, 2024

DOI: Papudesi BN, Malayala SV, Regina AC. 2017 Jun;32:660-6. This month in JAAD Case Reports: August 2023: Xylazine and skin necrosis. Journal of the American Academy of Dermatology. 2023 Aug 1;89(2):231. Xylazine toxicity. 2023 [book]. PMID 37603662 Rose L, Kirven R, Tyler K, Chung C, Korman AM. JAAD Case Reports. 2023 Jun 1;36:113-5.

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E-9-1-1 Naloxone Emergency Department ALS 161

Dr. Smith's ECG Blog

AUGUST 10, 2023

So now there was ACS + electrical instability, another indication for emergent angiogram. ACS with refractory ischemia and electrical instability are indications for emergent cath regardless of the ECG! The initial troponin was 5300 ng/L (normal < 17), which corresponded to the symptoms and confirmed subacute occlusion. Shroff, G.

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STEMI ACS Emergency Department ED 90

Don't Forget the Bubbles

SEPTEMBER 18, 2023

Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, et al. 2017 Sep 7 [cited 2022 Dec 28];2022(8). 2017 May 8;30(4):319–26. McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, et al. References Acute otitis media Csonka P, Palmu S, Heikkilä P, Huhtala H, Korppi M. Pediatr Infect Dis J.

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

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

J Electrocardiology 50(5):561-569; September/October 2017. consistent with LAD occlusion) This prompted serial ECGs: These dynamic changes confirmed ACS There was a large obtuse marginal 100% occlusion (surprisingly not LAD! Go here to find excel applets. you enter the [link] The closer the formula value is to the cutpoint of 18.2,

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STEMI Coronary OR ALS 52

EMDocs

FEBRUARY 12, 2024

2004 Nov;30(11):2017-20. 11) Webb RK, Ralston AC, Runciman WB. 2017 Dec;214(6):1067-1072. Epub 2017 Sep 18. Intensive Care Med. 2001 Oct;27(10):1606-13. doi: 10.1007/s001340101064. PMID: 11685301. (10) 10) Jubran A. Pulse oximetry. Intensive Care Med. doi: 10.1007/s00134-004-2399-x. Epub 2004 Jul 24. PMID: 15278272. (11)

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Emergency Department E-9-1-1 ED ICU 93

EMDocs

NOVEMBER 4, 2024

million patient complaints in 2017, making it the second most common ED complaint. 54 It is vital to consider dangerous epigastric pain mimickers like acute coronary syndrome (ACS), hepatobiliary disease, or pancreatitis. National Hospital Ambulatory Medical Care Survey (NHAMCS) 2017 Emergency Department Summary Tables (2017).

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

Dr. Smith's ECG Blog

APRIL 8, 2015

full text link) Presence of any one of these 8 criteria had 97% sensitivity and specificity of 62% for adverse outcomes: 1) Signs of Acute Coronary Syndrome (ACS), 2) conduction disease, 3) worrisome cardiac history, (eg. The most recent and probably best study is this: Canadian Syncope Arrhythmia Risk Score. Thiruganasambandamoorthy, V.,

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