Dr. Smith's ECG Blog

DECEMBER 19, 2023

Because there was proven thrombus (ACS) but the troponin never went above the 99% reference range (and therefore cannot be called MI -- definition of MI requires rise and/or fall of troponin with at least one value above the 99% reference range), this is UNSTABLE ANGINA with ST Elevation. After all, there is no S wave in lead V3.

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E-9-1-1 Coronary ACS BLS 123

EMS 12-Lead

APRIL 8, 2022

Smith and Meyers found that patients presenting with high-risk ACS and any ST-depression, even less than 1 mm, maximal in leads V1-V4 to be 97% specific for OMI and 96% specific for OMI requiring emergent PCI. [5] 1] Driver, B. Posterior wall reperfusion T-waves: Wellens’ syndrome of the posterior wall. Emergency Medicine Journal, 1-5. [2]

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STEMI ALS Coronary CAD 130

Pediatric EM Morsels

AUGUST 18, 2023

Etminan 2019) In Belgium between 2010 – 2013, of the 262 children treated with fluroquinolones while hospitalized, only 17% were used for labelled indications. References: Ross RK, Kinlaw AC, Herzog MM, Funk MJ, Gerber JS. PMID: 27940800 Hersch AL, Gerber JS, Hicks LA, Pavia AT. Pediatrics. 147(6):e202003316. 38 (3):268-270.

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EMDocs

JUNE 27, 2024

Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK. 2019 Jan 24;14:263-292. 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 2020 Feb 12;10(1):2470.

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Dr. Smith's ECG Blog

JUNE 8, 2023

As recurrent ischaemia is the principle event reduced by early intervention in NSTE-ACS, these are important endpoint events occurring with delayed angiography and there is a consistent signal for harm now from two data sources.”[5] Kontos et al. Welsh et al. Busk et al. Eur Heart J 2009 4 Lemkes et al.

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STEMI Coronary Paramedic ALS 63

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. Circulation 139, e840–e878 (2019). Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. To start with there are apparently 5 types of cardiorenal syndrome. I’ll let that sink in. – Mullens, W.,

Critical Care 96

Critical Care ACS OR ALS 96

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. Today’s Post by Dr.

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Coronary ACS EMS ALS 52

EMDocs

FEBRUARY 12, 2024

References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. 11) Webb RK, Ralston AC, Runciman WB. Journal of Trauma and Injury 2019; 32(4): 238-242. Epub 2019 Dec 30. Epub 2019 Jul 18. Epub 2019 Jul 18. Epub 2019 Dec 19. A systematic review and meta-analysis.

Emergency Department 94

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

EMDocs

JUNE 14, 2023

Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure. PMID: 23163581] Muñoz-Quezada MT, Lucero BA, Iglesias VP, et al. doi:10.1080/10773525.2015.1123848 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L. References: Tintinalli, J.

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E-9-1-1 Emergency Department Plasma ED 70

Dr. Smith's ECG Blog

JANUARY 3, 2022

It encompasses the complete range of ACS, including OMI, NOMI, and coronary thromboses that have the potential to rapidly propagate and become OMI and therefore has no specificity. References 1. -- Hillinger P, Strebel I, Abacherli R, et al. Int J Cardiol 2019 2. -- Meyers HP, Bracey, Smith et al. J of Emerg Med 2021.

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STEMI Coronary ALS ACS 52

EMDocs

JUNE 7, 2023

References: Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure. doi:10.1186/1756-0500-6-524 Muñoz-Quezada MT, Lucero BA, Iglesias VP, et al. 12784 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L. Otherwise, provide supportive care.

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

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

3–8 Shi et al. Sandoval Y, Smith SW, Sexter A, et al. Shi S, Qin M, Shen B, et al. Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). Association of Coronavirus Disease 2019 (COVID-19) With Myocardial Injury and Mortality.

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E-9-1-1 STEMI Coronary ALS 52

Don't Forget the Bubbles

JULY 22, 2024

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. Future of Pre-School Wheeze Whilst Lee et al. References BTS_SIGN Guideline for the management of asthma 2019.pdf. Cronin JJ, McCoy S, Kennedy U, An Fhailí SN, Wakai A, Hayden J, et al.

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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. 2019 Nov 15;16(22):4515. Addo-Yobo E, Chisaka N, Hassan M, Hibberd P, Lozano JM, Jeena P, et al.

Emergency Department 142

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

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Kuttab et al’s findings, constituting 45% of the review’s weight, suggest that administering <30cc/kg IVF is associated with increased odds of mortality, delayed hypotension, and increased ICU utilization. times more intubations and 2.15

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E-9-1-1 ALS ACS ICU 120

Dr. Smith's ECG Blog

JULY 11, 2019

When in doubt, record serial ECGs and watch out for signs of ischemia despite medical management. == Comment by K EN G RAUER, MD ( 7/11/2019 ): == Our thanks to Drs. CLICK HERE — for a brief article by Rowlands et al that explains these concepts in more detail. Mogul, Meyers and Smith for this illustrative case.

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STEMI ACS CAD ED 52

Dr. Smith's ECG Blog

FEBRUARY 14, 2020

This pattern in isolation would signify diffuse supply/demand mismatch without focal complete occlusion, which would be a very large differential of anything causing severe global supply demand mismatch, including ACS and various other processes. However, there is STE in V1 with a large area T-wave which is hyperacute.

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STEMI ACS OR ED 52

Don't Forget the Bubbles

SEPTEMBER 13, 2023

doi:10.1093/tropej/fmz071 Expert Panel on Pediatric Imaging, Trofimova A, Milla SS, et al. 2019-0134 Hirtz D, Ashwal S, Berg A, et al. Riviello JJ Jr, Ashwal S, Hirtz D, et al; American Academy of Neurology Subcommittee; Practice Committee of the Child Neurology Society. J Trop Pediatr. 2020;66(3):299-314. Pediatr Rev.

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Dr. Smith's ECG Blog

MARCH 6, 2019

She did not receive any opioids (which would mask her pain without affecting any underlying ACS). I believe this is by far the most common outcome for this patient around the world in 2019. Patel et al., Krucoff et al.) Patel et al. Krucoff et al. What will you do for this asymptomatic patient??? Heart 1996.

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STEMI ALS ACS OR 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. Lindahl et al. From Gue at al.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

EMDocs

SEPTEMBER 25, 2023

References: Heffner AC et al. PMID: 23911630 Kim WY et al. PMID: 23911630 Kim WY et al. PMID: 25402500 Forsythe SM et al. PMID: 10631227 Mosier JM et al. Riker RR, Shehabi Y, Bokesch PM, et al. Lowe J B, Yoo M J, Patrick J O, et al. 2019, 64:617-28. Li, Timmy, et al. 2007): 748.

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ED Emergency Department ALS OR 65

ACEP Now

NOVEMBER 7, 2023

8-12 A recent scoping review published in The American Journal of Emergency Medicine reviewed articles between 2016 and 2019, and found 18 observational studies, which failed to demonstrate sufficient evidence for widespread implementation of DSED. References Go AS, Mozaffarian D, Roger VL, et al. Margey R, Browne L, Murphy E, et al.

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Defibrillator E-9-1-1 ALS Epinephrine 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. Brown, C.A.

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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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REBEL EM

FEBRUARY 2, 2023

Based on 2019 American Heart Association (AHA) guidelines, amiodarone and digoxin have been suggested as alternative options in controlling ventricular rate refractory to first-line BBs and non-DHP CCBs. Paper: Mason JM, et al. These results were corroborated with other another study by Gritensko et al. Am J Emerg Med.

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Emergency Department ALS Critical Care ED 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. 2019 Aug;31(4):683-687. Trauma Surg Acute Care Open.

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

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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Dr. Smith's ECG Blog

JANUARY 17, 2023

The September 27, 2019 post — for the Rowlands & Moore article with the above-noted formulas for recognizing the “culprit” extremity. 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. CLICK HERE.

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ALS ACS OR ED 52

EMDocs

JANUARY 20, 2024

Rosh Review Website Link Further Reading Further FOAMed: [link] [link] References: Ahmad SA, Brito D, Khalid N, et al. Takotsubo syndrome in Heart Failure and World Congress on Acute Heart Failure 2019: highlights from the experts. Additional fluids will not improve her condition and may worsen it. Takotsubo Cardiomyopathy.

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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. Sandoval Y et al. There actually was an old ECG from about 4 years prior (ECG-2), which I'm not sure anyone saw: Here the limb leads have much higher QRS voltage, without a correspondingly larger ST-T voltage.

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STEMI Emergency Department ED OR 52