2018, ACS and E-9-1-1 - Paramedicine Now

emDOCs Revamp – Acute Chest Syndrome

EMDocs

JUNE 27, 2024

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? 2022 Jul 5;328(1):57-68. 2018 Aug;46(3):144-151.

E-9-1-1

E-9-1-1 ICU ACS EMS

Fluoroquinolone Use In Children

Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Which is a risk of 1 event for 62.5 Wirth 2018) One study including 4.4 Meesters 2018) Resistance is growing (likely from inappropriate / overuse)! Arthropathy was seen in 13.7%

E-9-1-1

E-9-1-1 OR ACS ALS

ABG Versus VBG in the Emergency Department

EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). However, ABGs have many drawbacks compared to VBGs.

Emergency Department

Emergency Department E-9-1-1 ED ICU

ToxCard: Acute Organophosphate Toxicity

EMDocs

JUNE 7, 2023

1-5 Farmers also treat sheep for parasites using OPs and may become symptomatic after exposure, an illness called Dipper’s Flu. 8 Intermediate syndrome Occurs 1 to 5 days after acute exposure in up to 40% on individuals. 7, 9 Often have absence of excessive cholinergic stimulation. 7 May lead to respiratory failure.

E-9-1-1

E-9-1-1 ICU Emergency Department ED

How important are old ECGs in Non-obvious cases of potential OMI?

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Learning Point: 1. 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 ). For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ).

E-9-1-1

E-9-1-1 Coronary EMS ED

Inotropes and Vasopressors: Doses, indications, contraindications and effects

ECG & Echo Learning

OCTOBER 2, 2022

Most agents exhibit both vasopressor and inotropic effects (Figure 1). μg/kg/min Bolus : 1 mg IV every 3 to 5 min (max 0.2 mg/kg) IM: (1:1000): 0.1 mg (max 1 mg) Safe for peripheral use ++ + N/A Beta-effect more pronounced at low doses. De Backer D, Creteur J, Silva E, Vincent JL. Kill C, Wranze E, Wulf H.

E-9-1-1

E-9-1-1 ALS Coronary Epinephrine

Is this a STEMI? No, not by definition! Why not? Why is this Important?

Dr. Smith's ECG Blog

OCTOBER 24, 2018

A 40-something male presented with dyspnea and left arm numbness, and perhaps some chest tightness, for 1 1/2 hours. 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. Here is his triage ECG: There is massive STE in V3-V6, and also STE in II, III, aVF.

E-9-1-1

E-9-1-1 STEMI ACS Coronary

Acute OMI or "Benign" Early Repolarization?

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. ECG 1 What do you think? Grines, C.

E-9-1-1

E-9-1-1 OR Coronary ACS

Steroids in preschool wheeze

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. study from 200 9. Castro-Rodriguez JA, Beckhaus AA, Forno E. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al.

E-9-1-1

E-9-1-1 ALS ACS ED

Antibiotics in the paediatric emergency department

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]. Community-acquired pneumonia Addo-Yobo E, Anh DD, El-Sayed HF, Fox LM, Fox MP, MacLeod W, et al. 2007 Feb 1;24(2):128–9. 2018 Oct;47(10):420–3.

Emergency Department

Emergency Department E-9-1-1 ALS OR

Penetrating chest trauma

Don't Forget the Bubbles

JUNE 30, 2023

He has already climbed Ben Nevis in Scotland, visited the Gobi desert (possibly from the comfort of his parents 4 x 4, but who’s judging) and has his bronze D of E nailed. She calls out her findings: A – OK B – 1 puncture mark to the anterior left chest wall, covered with a three-sided dressing. Actively oozing.

E-9-1-1

E-9-1-1 FFP Plasma Emergency Department

EM@3AM: Cardiac Transplant Complications

EMDocs

JANUARY 6, 2024

1 Indications for transplant include: Non-ischemic cardiomyopathy (49%) Ischemic cardiomyopathy (35%) Restrictive cardiomyopathy (4%) Retransplantation following failed prior transplant (3%) Hypertrophic cardiomyopathy (3%) Congenital heart disease (3%) Valvular cardiomyopathy (3%) The median survival after heart transplant is over 12 years.

EMS

EMS E-9-1-1 ACS Coronary

Are these Wellens' waves?

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. 4 important features that indicate acute right hear strain: 1. looked at consecutive patients with PE, ACS, or neither. Tachycardia (or nearly) 2. Poor R-wave progression 4.

E-9-1-1

E-9-1-1 ACS ALS OR

Optimizing Hemodynamics Prior to RSI

FOAMfrat

OCTOBER 20, 2023

As reported within the 6th edition Manual of Emergency Airway Management, there are cardiac arrest rates between 1% and 4%, with other complications (mostly hypoxemia and hypotension) as high as 30% in patients with first-pass success [1, pg 29; 4-10]. Recommendations : 1. Why is Physiologic Optimization Important?

E-9-1-1

E-9-1-1 ALS ACS OR

Sickle Cell Disease Module

Don't Forget the Bubbles

JULY 5, 2023

Figure 1: Clinical manifestations and long-term consequences of sickle cell disease Training and education on sickle cell disease: Training and education are crucial to improve morbidity and mortality. Investigations : Bloods show Hb of 8 g/L, White cell count 13x 10 9 /L, Platelets 570 x10 9 /L, CRP 35mg/L.

E-9-1-1

E-9-1-1 ACS OR ICU

EM@3AM: Takotsubo Cardiomyopathy

EMDocs

JANUARY 20, 2024

She describes the pain as left-sided, non-radiating, and 9/10 in severity. Answer: Takotsubo Cardiomyopathy 1-18 Background: Also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, stress cardiomyopathy, Gebrochenes-Herz syndrome, and broken-heart syndrome.

E-9-1-1

E-9-1-1 EMS Coronary ACS

Paramedicine Now

emDOCs Revamp – Acute Chest Syndrome

Fluoroquinolone Use In Children

Trending Sources

ABG Versus VBG in the Emergency Department

ToxCard: Acute Organophosphate Toxicity

How important are old ECGs in Non-obvious cases of potential OMI?

Inotropes and Vasopressors: Doses, indications, contraindications and effects

Is this a STEMI? No, not by definition! Why not? Why is this Important?

Acute OMI or "Benign" Early Repolarization?

Steroids in preschool wheeze

Antibiotics in the paediatric emergency department

Penetrating chest trauma

EM@3AM: Cardiac Transplant Complications

Are these Wellens' waves?

Optimizing Hemodynamics Prior to RSI

Sickle Cell Disease Module

EM@3AM: Takotsubo Cardiomyopathy

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