Dr. Smith's ECG Blog

OCTOBER 12, 2024

EKG on arrival to the ED is shown below: What do you think? 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. or basilar ischemia. Version 2 = 0.0272.

STEMI 98

STEMI Coronary Emergency Department OR 98

ACEP Now

OCTOBER 11, 2024

ED treatment should focus on airway, breathing, and circulation with consideration for cervical spine protection depending on the circumstances surrounding the event. References Webb AC, Wheeler A, Ricci A, et al. Johnson MB, Boriack ED, McConnell CM, et al. 4 Another study cited only 2.3 South Med J. 2021;114(5):266-270.

ALS 52

ALS Emergency Department Emergency Medical Services ED 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 67

Overdose ACS Critical Care OR 67

EMS 12-Lead

JUNE 1, 2022

He advises, however, recurrent syncopal episodes for the past six months, some of which have resulted in ED admission, yet no identifying mechanism could be determined. Chou’s Electrocardiography in Clinical Practice (6th ed). Josephson’s Clinical Cardiac Electrophysiology: Techniques and Interpretations (6th ed). 2] Meyers, H.

Coronary 130

Coronary ALS Firefighter ED 130

EMDocs

JUNE 27, 2024

An 8-year old male with a history of sickle cell anemia presents to the ED for evaluation of fever for 2 days and “feeling like I can’t get a full breath”. 768: Epidemiology of Hospital Based ED Visits due to Sickle Cell Crisis and Acute Chest Syndrome in Kids. 2017 Dec 1;30(4):191-201. C or 100.4 mg/kg, max 0.4 PMID: 29648482.

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E-9-1-1 ICU ACS EMS 75

Dr. Smith's ECG Blog

JULY 27, 2023

On arrival to the ED, the patient was diaphoretic, tachycardic. I did not think it was due to ACS, but we ordered an ED ECG immediately: What do you think? He had a prehospital ECG that was worrisome to the medics, so they called me to see him at the door. and had dilated pupils. He was alert and oriented. both here and here ).

Coronary 52

Coronary ACS Naloxone Plasma 52

REBEL EM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). The average time to control HR in the IV amiodarone was 1.7h, which is usually the average time for disposition from the ED. Epub 2017 Jan 10. Paper: Mason JM, et al.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. References Deshwal H, Sinha A, Mehta AC. Published April 3, 2017. 6 Position the patient with the head of the bed at 30 to 45 degrees during intubation whenever possible, and use an 8.5

E-9-1-1 52

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

Dr. Smith's ECG Blog

OCTOBER 24, 2019

link] A 30 year-old woman was brought to the ED with chest pain. 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. This is written by Brooks Walsh.

Coronary 52

Coronary CAD ACS STEMI 52

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 ).

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 52

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour 2017 Aug;9(8):722-726. Post TW, ed. hour IV thrombolytic window. J Neurointerv Surg. Epub 2016 Jul 15.

EMS 73

EMS ALS OR ACS 73

Don't Forget the Bubbles

JUNE 30, 2023

All you know, back in ED, is that the ETA is 10 minutes, and there is a single stab wound to the chest. The ODP is caught up leaving theatres and has not yet made it down to ED. Back in ED with Ranulf, and pack two has gone through. 2017 Dec;83(6):1136-1141. The trauma call goes out. Trauma Surg Acute Care Open.

E-9-1-1 139

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

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. For clarity — I have combined in Figure-1 the first 2 ECGs done in the ED, as well as the prior tracing done on this patient. It is interesting to compare this prior ECG with the initial ECG done in the ED.

STEMI 52

STEMI Emergency Department ED OR 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

For some reason unknown to me, the interventionalist was in the ED. 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

ALiEM

OCTOBER 30, 2024

Our experience: Traditionally, ED physicians do not like ordering urine drug screens (UDS). In our study, we used COWS alone in the ED, which does utilize restlessness, anxiety, and tachycardia as part of the formula, as the sole evaluation tool for tranq dope withdrawal. Some patients require re-dosing in the ED. 2023 [book].

E-9-1-1 161

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

REBEL EM

JULY 14, 2022

PMID: 30060961 Koller AC, et al. Neuroresuscitation in the ED is often as simple as making sure the vent is keeping the patient oxygenated and not over ventilating them and then starting pressors to keep some MAP threshold where you think that a patient is perfusing their brain (the specific BP number is controversial). Ann Emerg Med.

ICU 52

ICU ALS OR CPR 52

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.

STEMI 90

STEMI ACS Emergency Department ED 90

EMDocs

FEBRUARY 12, 2024

As the only respiratory therapist in the ED has been paged and is starting BiPAP for this patient, an overhead call for two incoming trauma alerts from a multivehicle collision sounds. Because the RT responsible for drawing arterial blood gases is busy caring for these patients, ABGs will be delayed.

Emergency Department 94

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

EMDocs

NOVEMBER 4, 2024

Jafar Mahmood, MD (Pain Medicine Attending, Paincare Medical Practice) // Reviewed by: Jessica Pelletier, DO, MHPE (EM Attending, APD, University of Missouri-Columbia), Marina Boushra, MD (EM-CCM Attending, Cleveland Clinic); Brit Long, MD (@long_brit) Introduction: Pain management in the ED can be a unique challenge.

ED 98

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

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

J Electrocardiology 50(5):561-569; September/October 2017. This is the initial ED ECG of a 46 year old male with chest pain: The QTc was 420 ST Elevation at 60 ms after the J-point in lead V3 = 2.5 Go here to find excel applets. you enter the [link] The closer the formula value is to the cutpoint of 18.2, the more accurate.

STEMI 52

STEMI Coronary OR ALS 52

Dr. Smith's ECG Blog

APRIL 8, 2015

Summary of ED Approach to Syncope Please excuse the formatting problems, which I have not been able to fix! Annotated Bibliography For an excellent overview of ED Syncope management , see this article by Kessler C et al. Any ED systolic blood pressure less than 90 or greater than 180 mm Hg (+1) 4. Thiruganasambandamoorthy, V.,

Emergency Department 52

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