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. Compare this with the Panickar et al. Fortunately, Lee et al. Lee B, Turner S, Borland M, Csonka P, Grigg J, Guilbert TW, et al. study from 200 9.

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E-9-1-1 ALS ACS ED 105

REBEL EM

FEBRUARY 12, 2024

Read More First10EM: Imaging for Renal Colic SGEM : SGEM XTRA: COME TOGETHER, RIGHT NOW – OVER RENAL COLIC References Chang, Helena, et al. ” The Journal of Urology 199.4S (2018): e683-e684. Moore CL, Carpenter CR, Heilbrun ME, et al. Smith-Bindman R, Aubin C, Bailitz J, et al. Am J Emerg Med. 2021 Sep;47:70-73.

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Emergency Department ALS ACS EMS 85

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.

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ALS ACS OR CPR 137

FOAMcast

MARCH 27, 2023

References: Metlay JP, Waterer GW, Long AC, et al. 2018 Apr;44(4):474-477. ESCAPe found no benefit in their trial of a continuous infusion of methylprednisolone in severely ill patients with CAP). In this podcast episode, we review a new multicenter randomized trial of hydrocortisone in severe CAP. Intensive Care Med.

Critical Care 52

Critical Care ACS ALS 52

Pediatric EM Morsels

AUGUST 18, 2023

Wirth 2018) One study including 4.4 Meesters 2018) Resistance is growing (likely from inappropriate / overuse)! References: Ross RK, Kinlaw AC, Herzog MM, Funk MJ, Gerber JS. PMID: 27940800 Hersch AL, Gerber JS, Hicks LA, Pavia AT. 451 pediatric patients were included. There was an increased risk of tendon rupture (1.9

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E-9-1-1 ACS OR ALS 130

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Smith: If this is ACS (a big if), t his is just the time when one should NOT use "upstream" dual anti-platelet therapy ("upstream" means in the ED before angiography). History sounds concerning for ACS (could be critical stenosis, triple vessel), but differential also includes dissection, GI bleed, etc. Knotts et al.

Coronary 52

Coronary ACS STEMI ALS 52

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

2018 Aug;46(3):144-151. Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK. Epub 2018 Oct 17. 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. C or 100.4 mg/kg, max 0.4

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E-9-1-1 ICU ACS EMS 75

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. 2, 2018, pp. Link to Paper Here Shojaee M, et al.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

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

APRIL 18, 2024

Non-STEMI guidelines call for “urgent/immediate invasive strategy is indicated in patients with NSTE-ACS who have refractory angina or hemodynamic or electrical instability,” regardless of ECG findings.[1] Amsterdam et al. Alencar et al. Lupu et al. Herman, Meyers, Smith et al. But only 6.4% link] References 1.

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STEMI Coronary ALS CAD 117

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.

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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

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al. 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 ). per 100,000 to 11 per 100,000 [Rosso].

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E-9-1-1 OR Coronary ACS 116

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

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

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 7, 2024

Lemkes et al. Eur Heart J 2018. No wall motion abnormality This shows that significant ACS can have ZERO WMA!! The Proximal LAD thrombus lysed or partially lysed, restoring flow. Here it is not at all clear that they recognized that this was a transient OMI. Full text link. Normal left ventricular cavity size.

STEMI 112

STEMI ACS Critical Care OR 112

Dr. Smith's ECG Blog

MAY 13, 2020

Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS. The ECG only tells you there is ischemia, not the etiology of it. Nevertheless, the clinical situation made other etiologies unlikely.

Coronary 52

Coronary ACS EMS STEMI 52

FOAMfrat

OCTOBER 20, 2023

And according to a paper from Russotto et al. Of note, in the paper by Russotto et al., Heffner et al, 2012, reports a study that "demonstrated pre-RSI systolic pressures less than 140 as independently associated with post-intubation hypotension, but SI was not included in this analysis" [14]. Sackles et al. 2013.07.022.

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E-9-1-1 ALS ACS OR 52

Dr. Smith's ECG Blog

JANUARY 17, 2023

The January 30, 2018 post — for arterial pulsation artifact. Additional review of ECG artifacts by Pérez-Riera et al ( Ann Noninvasic Electrocardiol 23:e12494, 2018 ) VT Artifact — by Knight et al: NEJM 341:1270-1274, 1999. Brief review by Tom Bouthillet on some common causes of artifact.

ALS 52

ALS ACS OR ED 52

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.

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

Dr. Smith's ECG Blog

OCTOBER 24, 2018

Thelin et al. Mokhtari et al. 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. Smith. JACC 2016;67:1531. sensitivity, 99.5%

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E-9-1-1 STEMI ACS Coronary 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She did not receive any opioids (which would mask her pain without affecting any underlying ACS). Patel et al., Krucoff et al.) Patel et al. Krucoff et al. Schomig et al. Krucoff et al.) ) to disastrous consequences that may deteriorate before the patient can be rushed to the cath lab. Heart 1996.

STEMI 52

STEMI ALS ACS OR 52

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. Epub 2018 Jul 4. PMID: 30060961 Koller AC, et al. Resuscitation. 2022 Mar; 17. Resuscitation.

ICU 52

ICU ALS OR CPR 52

Dr. Smith's ECG Blog

MAY 8, 2023

The ACC likely made this new recommendation for the MSC in ventricular paced rhythm in large part due to the "PERFECT" Study (Meyers is an author, and Smith was the senior author): Dodd et al. Electrocardiographic Diagnosis of Acute Coronary Occlusion Myocardial Infarction in Ventricular Paced Rhythm Using the Modified Sgarbossa Criteria.

STEMI 52

STEMI Coronary ED ACS 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). Laan DV, Vu TD, Thiels CA et al. Trauma Surg Acute Care Open. Emerg Med J. 2021 Jul;38(7):488-494.

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

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Khan AR, Golwala H, Tripathi A, et al. 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). In normal conduction , (i.e.,

Coronary 52

Coronary STEMI Paramedic ALS 52

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. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2018 [cited 2022 Dec 28].

Emergency Department 143

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

Dr. Smith's ECG Blog

OCTOBER 6, 2018

See the proof for yourself in the literature below: Schmitt et al. From AM et al. Pride et al. JACC 2010 Post hoc analysis of the TRITON-TIMI-38 randomized controlled trial comparing prasugrel with clopidogrel among ACS patients undergoing cardiac catheterization. From: Giannitsis et al. mm for women, 2.0

STEMI 52

STEMI Coronary ALS OR 52

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. 2018.07.022 Pothuru S, Chan WC, Goyal A, et al. J Heart Lung Transplant.

EMS 63

EMS E-9-1-1 ACS Coronary 63

EMDocs

JANUARY 20, 2024

Rosh Review Website Link Further Reading Further FOAMed: [link] [link] References: Ahmad SA, Brito D, Khalid N, et al. doi:10.25122/jml-2018-0067 Takotsubo syndrome. Additional fluids will not improve her condition and may worsen it. Takotsubo Cardiomyopathy. Updated 2023 Jan 9]. In: StatPearls [Internet]. ESC Heart Fail. J Med Life.

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E-9-1-1 EMS Coronary ACS 74

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. Bush SP, Ruha AM, Seifert SA, et al. Accessed May 7, 2022.

Allergic Reaction 72

Allergic Reaction Plasma ALS EMS 72

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

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. Am J Cardiol 2018; 122(8):1303-1309. 4-variable version still to come. it is 97% sensitive.

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. 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. Peripheral venous and arterial blood gas analysis in adults: are they comparable?

Emergency Department 93

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

EMDocs

NOVEMBER 4, 2024

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. 0b013e328348bf6f Murphy CE, Raja AS, Baumann BM, et al. May 2014;32(5):421-31.

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