ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. 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

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. Anything more on history?

Coronary 52

Coronary ACS STEMI ALS 52

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.

E-9-1-1 116

E-9-1-1 OR Coronary ACS 116

Don't Forget the Bubbles

SEPTEMBER 18, 2023

This blog post aims to help familiarise you with some of the most common reasons for prescribing antibiotics in the paediatric emergency department. Antibiotic Use for Common Infections in Pediatric Emergency Departments: A Narrative Review. Davidson L, Foley DA, Clifford P, Blyth CC, Bowen AC, Hazelton B, et al.

Emergency Department 143

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

EMDocs

JUNE 27, 2024

2018 Aug;46(3):144-151. Epub 2018 Oct 17. Am J Emerg Med. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective.

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

Don't Forget the Bubbles

JULY 5, 2023

Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. A 6-year-old girl from Saudi Arabia was referred by her General Practitioner to the local emergency department. Mechanical or non-invasive ventilation : children with ACS may require ventilatory support.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

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. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

EMDocs

FEBRUARY 12, 2024

Correlation and agreement between arterial and venous blood gas analysis in patients with hypotension-an emergency department-based cross-sectional study. Int J Emerg Med. The role of venous blood gas in the emergency department: a systematic review and meta-analysis. Eur J Emerg Med. Emerg Med J.

Emergency Department 93

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

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. 1] European guidelines add "regardless of biomarkers". But only 6.4%

STEMI 117

STEMI Coronary ALS CAD 117

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. New insights into the use of the 12 Lead Electrocardiogram for diagnosing Acute Myocardial Infarction in the emergency department. link] [1] Mirand, D.

Coronary 130

Coronary ALS OR ACS 130

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

FOAMfrat

OCTOBER 20, 2023

2018 Apr;46(4):532-539. Heffner AC, Swords DS, Neale MN, Jones AE. Incidence and factors associated with cardiac arrest complicating emergency airway management. Peri-intubation cardiac arrest in the Emergency Department: A National Emergency Airway Registry (NEAR) study. Intern Emerg Med.

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

Don't Forget the Bubbles

JUNE 30, 2023

Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. b) Emergency thoracotomy Let’s be clear: YOU will not be doing any of this. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality.

E-9-1-1 139

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

Dr. Smith's ECG Blog

OCTOBER 3, 2018

Here is our abstract from SAEM 2018. The Smith-Modified Sgarbossa Criteria Accurately Diagnose Acute Coronary Occlusion in Emergency Department Patients With Ventricular Paced Rhythm. We are writing the manuscript right now, with more patients enrolled. Dodd1 , Deborah L. Zvosec2 , Michael A.

Coronary 52

Coronary STEMI Paramedic ALS 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. A 63-year-old man presents to the emergency department for dyspnea on exertion.

EMS 63

EMS E-9-1-1 ACS Coronary 63

ECG & Echo Learning

JANUARY 18, 2023

IIa C Pre-hospital logistics Management Recommendation Level of evidence The pre-hospital care of STEMI patients should be organized regionally (including all components from the emergency medical dispatch to catheterization laboratory) in order to provide reperfusion therapy as early as possible. mmol/L or <_ 70 mg/dL) should be avoided.

STEMI 40

STEMI Coronary OR Defibrillator 40

EMDocs

JANUARY 20, 2024

Takotsubo syndrome is often exceedingly difficult to distinguish from acute myocardial infarction in the emergency department, as there is significant overlap in many clinical and diagnostic features. She reports worsening dyspnea on exertion for the past 2 days and a recent diarrheal illness that resolved without treatment 4 days ago.

E-9-1-1 74

E-9-1-1 EMS Coronary ACS 74

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Am J Cardiol 2018; 122(8):1303-1309. consistent with LAD occlusion) This was not recognized, repeat ECG at 69 minutes showed new Q-waves in V2-V4 that were not appreciated, and patient waited for a prolonged period in the emergency department before STEMI was diagnosed. In summary: At a cutpoint of 17.0, it is 97% sensitive.

STEMI 52

STEMI Coronary OR ALS 52

EMDocs

NOVEMBER 4, 2024

54 It is vital to consider dangerous epigastric pain mimickers like acute coronary syndrome (ACS), hepatobiliary disease, or pancreatitis. The Treatment of Acute Pain in the Emergency Department: A White Paper Position Statement Prepared for the American Academy of Emergency Medicine. J Emerg Med. Acad Emerg Med.

ED 98

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