2022, ACS and ALS - Paramedicine Now

High sensitivity cardiac troponins for ED chest pain evaluation (2022 ACC pathway)

ALiEM

FEBRUARY 9, 2024

The 2022 American College of Cardiology (ACC) pathway provides timely guidance [1]. Applying the 2022 ACC guideline Before delving into the specifics of the hs-cTn pathways, start with the ECG. The ACC 2022 pathway has a section dedicated to ECGs in ischemia [1], and FOAMcast has a great visual summary. J Am Coll Cardiol.

E-9-1-1

E-9-1-1 ED Coronary ALS

Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Studies such as those by Moise et al 14 and Ellis et al 39 have shown that the relative risk of developing an acute myocardial infarction in the territory supplied by an artery with a 70%. years, with the interval as long as 12 or 18 years in some studies. Nor was there a challenge to look for coronary spasm.

Coronary

Coronary ACS OR EMR

SGEM#370: Listen to your Heart (Score)…MACE Incidence in Non-Low Risk Patients with known Coronary Artery Disease

The Skeptics' Guide to EM

JULY 2, 2022

Date: June 30th, 2022 Reference: McGinnis et al. AEM June 2022. Date: June 30th, 2022 Reference: McGinnis et al. AEM June 2022. If we thought about ACS, we brought them in. Reference: McGinnis et al. AEM June 2022. He is also the CME editor for Academic Emergency Medicine.

Coronary

Coronary Heart Attack ACS CAD

Clinical Conundrum: Should a Troponin Routinely be Ordered in Patients with SVT?

REBEL EM

SEPTEMBER 21, 2023

What Your Gut Says: The patient has a tachydysrhythmia which may be the presentation of acute coronary syndrome (ACS) even though the patient has no ischemic symptoms. Up to 80% of patients will have at least one troponin sent ( Gabrielli 2022 ). SVT is not a presenting dysrhythmia consistent w/ ACS. Cardiol Rev.

Coronary

Coronary ACS ED OR

emDOCs Podcast – Episode 100: Acute Chest Syndrome Part 1

EMDocs

MAY 15, 2024

Other causes of sickling: acidosis, dehydration, inflammation, infection, fever, and blood stasis Sickling leads to vascular occlusion, end-organ ischemia, and decreased RBC lifespan, which, in turn, leads to pain crisis, acute anemia, sequestration, infection, and acute chest syndrome (ACS.) Each episode of ACS has a 9% mortality rate.

E-9-1-1

E-9-1-1 ACS ALS OR

emDOCs Podcast – Episode 101: Acute Chest Syndrome Part 2

EMDocs

MAY 28, 2024

Sickling leads to vascular occlusion, end-organ ischemia, and decreased RBC lifespan, which, in turn, leads to pain crisis, acute anemia, sequestration, infection, and acute chest syndrome (ACS). ACS is lung injury due to vaso-occlusion in the pulmonary vasculature; many with ACS will have a concomitant vaso-occlusive pain crisis.

ACS

ACS E-9-1-1 ALS OR

SGEM#367: GRACE2 – Low-Risk, Recurrent Abdominal Pain

The Skeptics' Guide to EM

MAY 28, 2022

Date: May 24th, 2022 Reference: Broder et al. Date: May 24th, 2022 Reference: Broder et al. Reference: Broder et al. AEM May 2022 This is an SGEMHOP episode which means we have the lead author on the show. In the context of recurrent chest pain, they made eight key recommendations.

Emergency Department

Emergency Department ACS ALS Coronary

Episode 152 Hemochromatosis: Ironing out the details

This Podcast Will Kill You

SEPTEMBER 24, 2024

Datz, Christian, et al. ACS omega , 7 (24), pp.20441-20456. Hodgskiss, Malcolm SW, et al. Moalem, Sharon, et al. Olejarz, Jason, et al. Algeo, Thomas J., and Jun Shen. “Theory and classification of mass extinction causation.” ” National Science Review 11.1 2024): nwad237. Olynyk, J.K. Girelli, D.,

ALS

ALS ACS

Bubble Wrap PLUS – June 2023

Don't Forget the Bubbles

JUNE 14, 2023

Lava SAG, et al. Hsiao W, et al. Mullaly R, et al. 2023 May 12:fetalneonatal-2022-324935. 2023 May 12:fetalneonatal-2022-324935. Puoti MG, et al. Stenson EK, et al. Bruinsma RA, et al. Rivetti G, et al. van Gameren-Oosterom HBM, et al. Lester TR, et al. Mansell H, et al.

ALS

ALS ACS ED OR

Steroids in preschool wheeze

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. Cronin JJ, McCoy S, Kennedy U, An Fhailí SN, Wakai A, Hayden J, et al. study from 200 9. The Lancet Respiratory Medicine [Internet].

E-9-1-1

E-9-1-1 ALS ACS ED

Bubble Wrap PLUS – May 2023

Don't Forget the Bubbles

MAY 17, 2023

Antonaci L, et al. Tritos NA, et al. Levi M, et al. Fishbein MH, et al. Cetinkaya PG, et al. Niu T, et al. Verkuijl SJ, et al. Varni JW, et al. Dias FC, et al. Peter C, et al. Ahlberg R, et al. Shir A, et al. Kuypers KLAM, et al. Hegeman EM, et al.

ALS

ALS ACS Emergency Department EMS

OMI in a pediatric patient? Teenagers do get acute coronary occlusion, so don't automatically dismiss the idea.

Dr. Smith's ECG Blog

DECEMBER 5, 2023

A final ECG was perfomed on hospital day 2: Persistent ST elevation in the inferior leads with slight reciprocal ST depression in aVL Teaching points - It is essential to consider ACS in all age groups. While ACS may be less common in the pediatric population, it is important to consider risk factors that may make OMI more likely (e.g.,

Coronary

Coronary CAD ACS ALS

Choosing Wisely – Investigations for seizures that have returned to baseline

Don't Forget the Bubbles

SEPTEMBER 13, 2023

An expert committee appraised the evidence behind recommendations to avoid imaging to inform the 2022 NICE guidance. 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. Published 2022 Jan 13. J Trop Pediatr. 2020;66(3):299-314. Pediatr Rev.

E-9-1-1

E-9-1-1 Emergency Department ALS OR

emDOCs Revamp – Acute Chest Syndrome

EMDocs

JUNE 27, 2024

2022 Jul 5;328(1):57-68. Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK. Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. 2022 Aug;58:235244. Epub 2022 Jun 11. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ.

E-9-1-1

E-9-1-1 ICU ACS EMS

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. Lindahl et al. From Gue at al. Most studies examine undifferentiated ACS cohorts, with only a handful providing separate data.

Coronary

Coronary E-9-1-1 STEMI ACS

Pediatric Submersion Injury Tips

ACEP Now

OCTOBER 11, 2024

References Webb AC, Wheeler A, Ricci A, et al. Pellegrino F, Raffaldi I, Rossi R, et al. Chotai PN, Manning L, Eithun B, et al. Kriz D, Piantino J, Fields D, et al. Bauman BD, Louiselle A, Nygaard RM, et al. Causey AL, Tilelli JA, Swanson ME. Cohen N, Capua T, Lahat S, et al. South Med J.

ALS

ALS Emergency Department Emergency Medical Services ED

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

In our opinion it should not be given in ACS unless you are committed to the cath lab. Learning Point: Any NSTEMI patient with active ongoing ACS symptoms refractory to medical management is supposed to go to the cath lab within 2 hours if available, per all guidelines in world, regardless of ECG findings. Published 2022 Feb 20.

ACS

ACS Coronary ALS CAD

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

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

Coronary ACS STEMI ALS

Elbow Dislocations

REBEL EM

NOVEMBER 6, 2024

2022 Aug 2. PMID: 32644703 Robinson PM, Griffiths E, Watts AC. PMID: 27227986 Glover NM, Black AC, Murphy PB. Commentary on an article by Marc Schnetzke, MD, et al.: “Determination of Elbow Laxity in a Sequential Soft-Tissue Injury Model. J Am Acad Orthop Surg. 1998 Jan-Feb;6(1):15-23. Anterior Elbow Dislocation.

E-9-1-1

E-9-1-1 ACS OR Emergency Department

75 year old dialysis patient with nausea, vomiting and lightheadedness

Dr. Smith's ECG Blog

AUGUST 19, 2023

But because the patient had no chest pain or shortness of breath, it was not deemed to be from ACS. They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS. Dialysis patients have a high rate of ACS without chest pain and high rate of delayed diagnosis and delayed reperfusion 2.

STEMI

STEMI ACS OR ALS

Is OMI an ECG Diagnosis?

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. Clin Cardiol 2022 4. Herman, Meyers, Smith et al.

STEMI

STEMI Coronary ALS CAD

Case Report: a High-Voltage Victim

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

Operating Room ACS Critical Care Coronary

Case Report: The Not So Normal, Normal EKG

ACEP Now

AUGUST 12, 2024

Considering hyperacute T-waves have been accepted as STEMI equivalents, it is possible that pseudonormalization could gain more recognition as an indicator of ACS. 2022 Nov, 80 (20) 1925–1960. 5 Studies looking at this phenomenon in the emergency department setting for patients presenting with chest pain are lacking. J Am Coll Cardiol.

Emergency Department

Emergency Department STEMI ACS ED

Acute OMI or "Benign" Early Repolarization?

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]. link] Lupu, L.,

E-9-1-1

E-9-1-1 OR Coronary ACS

emDOCs Podcast: Episode 108 – Unexplained Sinus Tachycardia Mental Model

EMDocs

OCTOBER 8, 2024

Lactate Troponin Could this be ACS or myocarditis? Treasure Island (FL): StatPearls Publishing; April 30, 2022. 2006.11.018 Gabayan GZ, Sun BC, Asch SM, et al. 2016.12.010 Brugada J, Katritsis DG, Arbelo E, et al. 2016.12.010 Brugada J, Katritsis DG, Arbelo E, et al. Is there additional imaging indicated?

E-9-1-1

E-9-1-1 Emergency Department ED ALS

A 30-something with Chest pain and SOB

Dr. Smith's ECG Blog

MARCH 4, 2023

MOREVER, the morphology of the TWI is just not right for ACS. S1Q3T3 This is a paper worth reading : Marchik et al. 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. inverted T-waves in V1 and V2, 1.8;

ACS

ACS ALS OR

Fluoroquinolone Use In Children

Pediatric EM Morsels

AUGUST 18, 2023

Morley 2022) This myth is: BUSTED. References: Ross RK, Kinlaw AC, Herzog MM, Funk MJ, Gerber JS. PMID: 27940800 Hersch AL, Gerber JS, Hicks LA, Pavia AT. Symptoms resolved within 24 hours of withdrawal of the medication. However, Fluroquinolone resistance is increasing, so they should only be used if absolutely necessary!

E-9-1-1

E-9-1-1 ACS OR ALS

Amiodarone Versus Digoxin for Acute Rate Control of Atrial Fibrillation in the Emergency Department

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. 2022 Sep 7. 2018, PMID: 30571262 Gritsenko, Diana, et al. Link to Paper Here Shojaee M, et al. 2, 2018, pp.

Emergency Department

Emergency Department ALS Critical Care ED

EM@3AM: Basilar Artery Occlusion

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. References: Gaillard F, Glick Y, Tatco V, et al. Updated 2022 Dec 22]. Updated 2022 Oct 15]. 61.4.496 Navi BB, Kamel H, Shah MP, et al. Goldmakher GV, Camargo EC, Furie KL, Singhal AB, Roccatagliata L, Halpern EF, et al.

EMS

EMS ALS OR ACS

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

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

Emergency Department E-9-1-1 Coronary STEMI

emDOCs Podcast – Episode 107: Eclampsia

EMDocs

SEPTEMBER 24, 2024

2022 Aug;58:223-228. Wilkerson RG, Ogunbodede AC. Brewer J, Owens MY, Wallace K, et al. High risk and low prevalence diseases: Eclampsia. Am J Emerg Med. Fishel Bartal M, Sibai BM. Eclampsia in the 21st century. American journal of obstetrics and gynecology. 2022;226(2S):S1237-S1253. Obstetrics and gynecology. 2013;208(6):468.e1-468.e6.

ED

ED OR ACS ALS

Diagnostic Errors, Revisited: Where Do We Go Wrong, and How Can We Change?

ACEP Now

MAY 9, 2024

Taking a different approach than the authors of the AHRQ report, Auerbach et al used a “look back” approach to perform both qualitative and quantitative evaluations of the types and frequencies of errors occurring in hospital settings. References Newman-Toker DE, Peterson SM, Badihian S, et al. Auerbach AD, Lee TM, Hubbard CC, et al.

Emergency Department

Emergency Department ICU ALS ACS

Compare these two ECGs. Do either, neither, or both show anything important?

Dr. Smith's ECG Blog

APRIL 17, 2023

He had no symptoms of ACS. His HEAR score (before troponin resulted) was documented at 3, with documentation stating "low suspicion for ACS." A troponin this high in a patient with no known chronic troponin elevation, and active acute ACS symptoms, has a very high likelihood of type 1 ACS regardless of the ECG.

OR

OR STEMI ACS Emergency Department

A 60 year old with chest pain

Dr. Smith's ECG Blog

JANUARY 17, 2023

In the December 5, 2022 post of Dr. Smith's ECG Blog — We show 4 additional cases of this pulse-tap artifact. Finally, as I discuss in My Comment in the August 26, 2022 post ( which applies the electrophysiologic principles of Rowlands & Moore: J. This is no longer the case! Why are the smallest artifactual deflections GREEN ?

ALS

ALS ACS OR ED

Popular Antiobesity Medications Bring New Challenges to Emergency Physicians

ACEP Now

FEBRUARY 11, 2024

Sodhi M, Rezaeianzadeh R, Kezouh A, et al. Ahmann AJ, Capehorn M, Charpentier G, et al. ACS chemical neuroscience molecule spotlight on Contrave. ACS Chem Neurosci. Bansal AB, Al Khalili Y. Updated December 11, 2022. A prescription for achieving equitable access to antiobesity medications. JAMA Health Forum.

Overdose

Overdose ACS Plasma ALS

Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mass delusion (and Opiate pain relief).

Dr. Smith's ECG Blog

MAY 31, 2023

And now this finding is even formally endorsed as a "STEMI equivalent" in the 2022 ACC guidelines!!! See this study showing an association between morphine and mortality in ACS: Use of Morphine in ACS is independently associated with mortality, at odds ratio of 1.4. de Winter et al in N Engl J Med 359:2071-2073, 2008.

STEMI

STEMI Coronary ACS OR

A woman in her 50s with acute chest pain

Dr. Smith's ECG Blog

JANUARY 6, 2023

Lupu L, et al. Clin Cardiol 2022; [link] Labs included: hsTnI 156 ng/L, Hb 12 g/dL, WBC 12x10^9/L, Cr. Smith comment: We have shown that use of opiates is associated with worse outcomes in ACS: Bracey, A. Opioids in ACS may reduce the pain score, but do not provide reperfusion for ongoing ACS. mg/dL, K 3.5

ACS

ACS Coronary ICU STEMI

On its way from occlusion to reperfusion (or vice versa), the ECG can be normal or near normal

Dr. Smith's ECG Blog

DECEMBER 12, 2022

You must understand this and the dynamic nature of ACS to provide excellent care for such patients. Comment by K EN G RAUER, MD ( 12/12 /2022 ): = I will summarize in 4 words the important message conveyed by Dr. Meyers in today's post = "Be Aware of Pseudo-Normalization!"

OR

OR ACS STEMI Coronary

External Validation of Pittsburgh Cardiac Arrest Category (PCAC) Illness Severity Score

REBEL EM

JULY 14, 2022

Paper: Nassal MMJ, et al. 2022 Mar; 17. REFERENCES: Nassal MMJ, et al. 2022 Mar; 17. PMID: 34968531 Rittenberger JC, et al. PMID: 21756969 Coppler PJ, et al. PMID: 25636896 Schober A, et al. PMID: 27368428 Elmer J, et al. PMID: 30060961 Koller AC, et al. Resuscitation.

ICU

ICU ALS OR CPR

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

Dr. Smith's ECG Blog

APRIL 8, 2022

The ECG is diagnostic for acute transmural infarction of the anterior and lateral walls, with LAD OMI being the most likely cause (which has various potential etiologies for the actual cause of the acute coronary artery occlusion, the most common of which is of course type 1 ACS, plaque rupture with thrombotic occlusion).

STEMI

STEMI Coronary ACS ED

Penetrating chest trauma

Don't Forget the Bubbles

JUNE 30, 2023

2022 Dec;57(12):986-993. 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). Trials 23, 384 (2022). Laan DV, Vu TD, Thiels CA et al.

E-9-1-1

E-9-1-1 FFP Plasma Emergency Department

A man in his 70s with acute chest pain and paced rhythm.

Dr. Smith's ECG Blog

MAY 8, 2023

This was several months after the 2022 ACC Guidelines adding modified Sgarbossa criteria as a STEMI equivalent in ventricular paced rhythm). 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.

STEMI

STEMI Coronary ED ACS

65 year old with syncope and a 'normal' ECG: discharge home?

Dr. Smith's ECG Blog

DECEMBER 6, 2022

S yncope is an uncommon presentation of ACS, but anginal equivalents are more likely in older patients with diabetes 2. The highest risk group are patients with a cardiac cause of their syncope, in whom 1-year mortality can reach 33% ( Koene et al: J Arrhythm 33(6):533-544, 2017 ). Take home 1.

STEMI

STEMI ACS Coronary OR

Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

OCTOBER 30, 2024

Multimodal medication options for fentanyl-xylazine withdrawal management in London et al. Drug Checking Quarterly Report (Q3 2022). 2022; 06/26/2023. DOI: Papudesi BN, Malayala SV, Regina AC. 2022 May;14(5). PMID 35774687 D’Onofrio G, Chawarski MC, O’Connor PG, et al. D’Onofrio G, Hawk KF, Perrone J, et al.

E-9-1-1

E-9-1-1 Naloxone Emergency Department ALS

High sensitivity cardiac troponins for ED chest pain evaluation (2022 ACC pathway)

Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Trending Sources

SGEM#370: Listen to your Heart (Score)…MACE Incidence in Non-Low Risk Patients with known Coronary Artery Disease

Clinical Conundrum: Should a Troponin Routinely be Ordered in Patients with SVT?

emDOCs Podcast – Episode 100: Acute Chest Syndrome Part 1

emDOCs Podcast – Episode 101: Acute Chest Syndrome Part 2

SGEM#367: GRACE2 – Low-Risk, Recurrent Abdominal Pain

Episode 152 Hemochromatosis: Ironing out the details

Bubble Wrap PLUS – June 2023

Steroids in preschool wheeze

Bubble Wrap PLUS – May 2023

OMI in a pediatric patient? Teenagers do get acute coronary occlusion, so don't automatically dismiss the idea.

Choosing Wisely – Investigations for seizures that have returned to baseline

emDOCs Revamp – Acute Chest Syndrome

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Pediatric Submersion Injury Tips

See this "NSTEMI" go unrecognized for what it really is, how it progresses, and what happens

90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Elbow Dislocations

75 year old dialysis patient with nausea, vomiting and lightheadedness

Is OMI an ECG Diagnosis?

Case Report: a High-Voltage Victim

Case Report: The Not So Normal, Normal EKG

Acute OMI or "Benign" Early Repolarization?

emDOCs Podcast: Episode 108 – Unexplained Sinus Tachycardia Mental Model

A 30-something with Chest pain and SOB

Fluoroquinolone Use In Children

Amiodarone Versus Digoxin for Acute Rate Control of Atrial Fibrillation in the Emergency Department

EM@3AM: Basilar Artery Occlusion

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

emDOCs Podcast – Episode 107: Eclampsia

Diagnostic Errors, Revisited: Where Do We Go Wrong, and How Can We Change?

Compare these two ECGs. Do either, neither, or both show anything important?

A 60 year old with chest pain

Popular Antiobesity Medications Bring New Challenges to Emergency Physicians

Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mass delusion (and Opiate pain relief).

A woman in her 50s with acute chest pain

On its way from occlusion to reperfusion (or vice versa), the ECG can be normal or near normal

External Validation of Pittsburgh Cardiac Arrest Category (PCAC) Illness Severity Score

A woman in her 30s with sudden chest pain, nausea, and diaphoresis. Was her cardiology management appropriate?

Penetrating chest trauma

A man in his 70s with acute chest pain and paced rhythm.

65 year old with syncope and a 'normal' ECG: discharge home?

Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

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