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.

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Operating Room ACS Critical Care Coronary 52

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. Commentary on an article by Marc Schnetzke, MD, et al.: “Determination of Elbow Laxity in a Sequential Soft-Tissue Injury Model. Treasure Island (FL): StatPearls Publishing; 2024 Jan–.

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

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

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.

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E-9-1-1 ALS Coronary Epinephrine 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 ED 130

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. 2017 Dec 1;30(4):191-201. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. C or 100.4 mg/kg, max 0.4 2020 Feb 12;10(1):2470.

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ACEP Now

NOVEMBER 14, 2023

References Deshwal H, Sinha A, Mehta AC. Atchinson PRA, Hatton CJ, Roginski MA, et al. Ittrich H, Bockhorn M, Klose H, et al. Li H, Ding X, Zhai S, et al. Kathuria H, Hollingsworth HM, Vilvendhan R, et al. Published April 3, 2017. Fekri MS, Hashemi-Bajgani SM, Shafahi A, et al. 2021;42(1):145-159.

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E-9-1-1 ALS Emergency Department OR 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.,

Critical Care 96

Critical Care ACS OR ALS 96

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. Epub 2017 Jan 10.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

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

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. 2017 Dec;10(1):1. Epub 2017 Jan 25. Riker RR, Shehabi Y, Bokesch PM, et al. Lowe J B, Yoo M J, Patrick J O, et al. 2007): 748.

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ED Emergency Department ALS Paramedic 65

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. 2017 Aug;9(8):722-726. 61.4.496 Navi BB, Kamel H, Shah MP, et al. Goldmakher GV, Camargo EC, Furie KL, Singhal AB, Roccatagliata L, Halpern EF, et al. J Neurointerv Surg.

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EMS ALS OR ACS 73

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

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

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. PMID: 27368428 Elmer J, et al. PMID: 30060961 Koller AC, et al. Resuscitation. 2022 Mar; 17. Resuscitation. 2022 Mar; 17.

ICU 52

ICU ALS OR CPR 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.

STEMI 52

STEMI ACS Coronary OR 52

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. Laan DV, Vu TD, Thiels CA et al. Trauma Surg Acute Care Open.

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

ALiEM

OCTOBER 30, 2024

Multimodal medication options for fentanyl-xylazine withdrawal management in London et al. DOI: Papudesi BN, Malayala SV, Regina AC. PMID 35774687 D’Onofrio G, Chawarski MC, O’Connor PG, et al. 2017 Jun;32:660-6. PMID 28194688 D’Onofrio G, O’Connor PG, Pantalon MV, et al. D’Onofrio G, Hawk KF, Perrone J, et al.

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Dr. Smith's ECG Blog

OCTOBER 3, 2018

Khan AR, Golwala H, Tripathi A, et al. 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).

Coronary 52

Coronary STEMI Paramedic ALS 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. Sandoval Y et al. 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.

STEMI 52

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

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. 2017 Sep 7 [cited 2022 Dec 28];2022(8). Tonsillitis Baker MG, Gurney J, Oliver J, Moreland NJ, Williamson DA, Pierse N, et al. 2017 May 8;30(4):319–26. 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

Here is a video lecture of subtle LAD occlusion: One hour lecture on Subtle ECG Findings of Coronary Occlusion The 3-variable formula comes from this paper: Smith SW et al. The 4-variable formula is based on this paper: Driver, BE et al. J Electrocardiology 50(5):561-569; September/October 2017. 4-variable version still to come.

STEMI 52

STEMI Coronary OR ALS 52

EMDocs

FEBRUARY 12, 2024

References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. 2004 Nov;30(11):2017-20. 11) Webb RK, Ralston AC, Runciman WB. 2017 Dec;214(6):1067-1072. Epub 2017 Sep 18. Peripheral venous and arterial blood gas analysis in adults: are they comparable? Intensive Care Med.

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

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. 2014.01.015 Motov S, Strayer R, Hayes BD, et al. 2018.01.020 Motov S, Rockoff B, Cohen V, et al.

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

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)]. Annotated Bibliography For an excellent overview of ED Syncope management , see this article by Kessler C et al. Del Rosso A, et al. Thiruganasambandamoorthy, V., Sivilotti, M., Mukarram, M., Baumann, B.

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