EMS 12-Lead

APRIL 21, 2022

Such aggressive investigation was particularly warranted in this case because of symptoms compatible with ACS, as well as an equally frightening revelation of family history. Readers interested in a more robust discussion of STD vectors, and their implications in OMI, are encouraged to read this phenomenal post at the Smith ECG Blog.

Coronary 130

Coronary ALS OR ACS 130

EMDocs

FEBRUARY 12, 2024

2018 Mar;33(3):176-181. 11) Webb RK, Ralston AC, Runciman WB. Epub 2018 Mar 7. 2018 Jul;36(7):1253-1256. Epub 2018 Mar 23. PMID: 17652681; PMCID: PMC2660085. (7) 7) Zeserson E, Goodgame B, Hess JD, Schultz K, Hoon C, Lamb K, Maheshwari V, Johnson S, Papas M, Reed J, Breyer M. J Intensive Care Med. Epub 2016 Jun 9.

Emergency Department 94

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

Dr. Smith's ECG Blog

OCTOBER 24, 2018

My Comment , by K EN G RAUER, MD ( 10/24/2018 ): = Important teaching points are made in this post by Dr. JACC 2016;67:1531. My Comment , by K EN G RAUER, MD ( 10/24/2018 ): = Important teaching points are made in this post by Dr. Although still present in ECG #2 — note how much less prominent these J waves are after presumed reperfusion.

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 52

Dr. Smith's ECG Blog

AUGUST 17, 2022

V5, 6) is 97% specific for OMI in a patient population at high risk of ACS. For review — GO TO: The June 4, 2018 post ( LA-LL reversal ). The July 29, 2018 post ( LA-RA reversal ). The November 4, 2018 post ( Leads V1,V2 misplacement ). The February 11, 2020 post ( LA-RA reversal ).

Coronary 52

Coronary ACS OR 52

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

For examples of this phenomenon — See My Comment in the February 14, 2018 — July 21, 2020 — and December 22, 2022 posts in Dr. Smith's ECG Blog ). The emergency physician was skeptical and believed the ECG to be a mimic, a false positive. So they looked into the patient's chart.

E-9-1-1 110

E-9-1-1 Coronary EMS ED 110

EMDocs

JUNE 7, 2023

7 Check out ToxCard: Nerve Agents by Dr. Sahi & Dr. Santos from July 2018 Organophosphates exert their toxic effects by inhibiting acetylcholinesterase within the synaptic cleft, which leads to accumulation of acetylcholine, with subsequent overstimulation of postsynaptic nicotinic and muscarinic receptors, and a predominant cholinergic effect.

E-9-1-1 83

E-9-1-1 ICU Emergency Department ED 83

ECG & Echo Learning

OCTOBER 2, 2022

JAMA 2018; 319:1889. Gordon AC, Mason AJ, Thirunavukkarasu N, et al. Crit Care 2018; 22:131. Association of Vasopressin Plus Catecholamine Vasopressors vs Catecholamines Alone With Atrial Fibrillation in Patients With Distributive Shock: A Systematic Review and Meta-analysis. Albanèse J, Leone M, Delmas A, Martin C.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

Dr. Smith's ECG Blog

JULY 31, 2018

Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. In middle age women, it accounts for 22-35% of all ACS presentations 1,3 , and the reported incidence of ST-elevation myocardial infarction in this subset of patients is variable, but estimated to be between 24-50% 4.

Coronary 52

Coronary ACS STEMI OR 52

Dr. Smith's ECG Blog

MAY 8, 2023

10 In 2018, the European Society of Cardiology guidelines 11 and the fourth universal definition of myocardial infarction 12 suggested utilizing the original Sgarbossa criteria (Figures 1A to 1C) for diagnosis of occlusion myocardial infarction in both left bundle branch block 13 , 14 and ventricular paced rhythm.15,

STEMI 52

STEMI Coronary ED ACS 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

The axiom of "type 1 (ACS, plaque rupture) STEMIs are not tachycardic unless they are in cardiogenic shock" is not applicable outside of sinus rhythm. This case represents the same physiologic event as OMI in terms of the result on the myocardium, therefore with identical ECG features, however there may not be ACS!

STEMI 52

STEMI ACS CAD OR 52

Dr. Smith's ECG Blog

MAY 3, 2024

RBBB + LAFB in the setting of ACS is very bad. Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenic shock or impending shock. Patients with ACS and RBBB/LAFB usually have a left main vs. proximal LAD. Learning Points: 1.

ACS 117

ACS ED Coronary EMS 117

Don't Forget the Bubbles

SEPTEMBER 18, 2023

Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, et al. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2018 [cited 2022 Dec 28]. 2018 Oct;47(10):420–3. McMullan BJ, Andresen D, Blyth CC, Avent ML, Bowen AC, Britton PN, et al. 2018 Apr;43(2):718–21. 2018 Jul;110:123–9.

Emergency Department 142

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

Dr. Smith's ECG Blog

NOVEMBER 24, 2018

There was no ACS here. There are well-formed R-waves -- Comment by K EN G RAUER, MD ( 11/24/2018 ): -- Excellent case — with the challenge being to interpret the initial ECG without any history ( TOP tracing in Figure-1 ). And it turns out that this was the baseline ECG. It has a slower upstroke than downstroke -- it is asymmetric.

ACS 52

ACS OR Coronary 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

As a result, even before looking at this patient's initial ECG — he falls into a high -prevalence likelihood group for ACS ( for an A cute C oronary S yndrome ). We therefore need to assume and rule "out" ACS — more than having to rule it "in". The "onus of proof" remains on us as medical providers to objectively rule out ACS.

E-9-1-1 119

E-9-1-1 OR Coronary ACS 119

Dr. Smith's ECG Blog

FEBRUARY 6, 2020

Abdominal pain can of course be a symptom of ACS, but it was brief and seemed to have resulted in a vasovagal event. For another case in which marked ST elevation in leads V1 and V2 could easily be mistaken for a hyperacute change — See the Figure I drew in My Comment at the bottom of the December 27, 2018 post on Dr. Smith’s ECG Blog.

ACS 52

ACS ED Coronary STEMI 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Here is our abstract from SAEM 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). We are writing the manuscript right now, with more patients enrolled.

Coronary 52

Coronary STEMI Paramedic ALS 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

Learning Points: The myocardium doesn't know the etiology of OMI (ACS, spasm, dissection, embolus, etc.), That said, ACS is by far the most common and treatable cause. and all acute coronary occlusion causes may cause the same ECG findings and progression of OMI.

Coronary 52

Coronary Defibrillator ACS CAD 52

Don't Forget the Bubbles

JULY 22, 2024

The 2018 PREVIEW trial reported a significant reduction in length of stay (LOS) in children given prednisolone in Australia (24-71 months, mean 41 months) compared to placebo. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Fernandes RM, Wingert A, Vandermeer B, Featherstone R, Ali S, Plint AC, et al.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

EMDocs

JANUARY 6, 2024

10 Although this is not the same pathophysiology seen in ACS from an acute plaque rupture leading to coronary artery occlusion, patients can have relatively abrupt coronary ischemia causing ACS due to acute, concentric vessel narrowing. 3 Many will experience vague, nonspecific symptoms such as weakness or fatigue.

EMS 63

EMS E-9-1-1 ACS Coronary 63

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.

E-9-1-1 52

E-9-1-1 ACS ALS OR 52

Dr. Smith's ECG Blog

MARCH 27, 2023

This is now further confirmation of ACS. The ACC/AHA guidelines mandate less than 2 hours cath for patients with ACS with refractory pain, pulmonary edema, or electrical or hemodynamic instability. Another ECG was recorded at 160 minutes: There is evolution, with worsening of ischemia.

ACS 52

ACS STEMI OR 52

EMDocs

JULY 19, 2023

7 We are commonly taught that metals are not amenable to treatment with activated charcoal (AC).However, In short, there is not a whole lot of evidence to support this, but if patient has had a recent ingestion and is not altered, you can consider gastrointestinal decontamination with AC. 2018, February 1). Resources: S.

ACS 66

ACS Plasma OR ED 66

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. 5] Walsh, B. 6] Goldberger, A.

ALS 130

ALS STEMI Coronary OR 130

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. JACC Cardiovasc Interv 2018. 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.

ALS 133

ALS ACS OR CPR 133

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

STEMI 40

STEMI Coronary OR Defibrillator 40

REBEL EM

FEBRUARY 2, 2023

Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). 2018, PMID: 30571262 Gritsenko, Diana, et al. 2018, PMID: 30571262 Gritsenko, Diana, et al. 2, 2018, pp. Lastly, there is a substantial amount of data missing, specifically the underlying cause of the Atrial Fibrillation with RVR (ie. Circulation , 5 Nov.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

EMDocs

AUGUST 31, 2023

However, in 2015 crotalidae equine immune F(ab’) 2 (ANAVIP®) was approved by the FDA for rattlesnake envenomations, and distribution of this antivenom began in 2018. Published online January 2018. link] Li Z, Krippendorff BF, Sharma S, Walz AC, Lavé T, Shah DK. 1,2 Discussion: F(ab) vs. Published online April 2021.

Allergic Reaction 72

Allergic Reaction Plasma ALS EMS 72

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Am J Cardiol 2018; 122(8):1303-1309. consistent with LAD occlusion) This prompted serial ECGs: These dynamic changes confirmed ACS There was a large obtuse marginal 100% occlusion (surprisingly not LAD! In summary: At a cutpoint of 17.0, it is 97% sensitive. At a cutpoint of 19.0, it is 97% specific. mm R-wave amplitude in V4 = 4.5

STEMI 52

STEMI Coronary OR ALS 52