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. link] Lupu, L., Shmueli, H.,

E-9-1-1 131

E-9-1-1 OR Coronary ACS 131

REBEL EM

SEPTEMBER 11, 2023

1 It is a quickly deployable and easily interpreted study that can be done in real time to guide decisions in the Emergency Department. Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions. Published 2022 Sep 2. and specificity of 88.0%

ED 69

ED ACS Emergency Department OR 69

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. Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting." References: 1.

Emergency Department 52

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

EMDocs

OCTOBER 8, 2024

Lactate Troponin Could this be ACS or myocarditis? Treasure Island (FL): StatPearls Publishing; April 30, 2022. Unanticipated death after discharge home from the emergency department. Ann Emerg Med. Qualitative factors in patients who die shortly after emergency department discharge. Acad Emerg Med.

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E-9-1-1 Emergency Department ED ALS 105

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. Clin Cardiol 2022 4. 1] European guidelines add "regardless of biomarkers". But only 6.4% Int J Cardiol 2024 3.

STEMI 121

STEMI Coronary ALS CAD 121

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? She had a single chamber ICD/Pacemaker implanted several years prior due to ventricular tachycardia. The ECG below was recorded.

Coronary 119

Coronary ACS ED OR 119

ACEP Now

AUGUST 12, 2024

A 35-year-old male presented to the emergency department complaining of chest pain that started 1.5 5 Studies looking at this phenomenon in the emergency department setting for patients presenting with chest pain are lacking. Dr. Young is an emergency physician at Saint Francis Hospital and Medical Center, Hartford, Conn.

Emergency Department 52

Emergency Department STEMI ACS ED 52

Don't Forget the Bubbles

MAY 17, 2023

2023 Apr 20:fetalneonatal-2022-324835. Invasive bacterial infection in children with fever and petechial rash in the emergency department: a national prospective observational study. 2023 Apr 4:archdischild-2022-325281. De Alwis AC, et al. Kuypers KLAM, et al. Arch Dis Child Fetal Neonatal Ed. Hegeman EM, et al.

ALS 72

ALS ACS Emergency Department EMS 72

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.

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

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

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Updated 2022 Dec 22]. Updated 2022 Oct 15]. Application of the ABCD2 score to identify cerebrovascular causes of dizziness in the emergency department. PMID: 27422968; PMCID: PMC5583675. Reinemeyer NE, Tadi P, Lui F.

EMS 98

EMS ALS OR ACS 98

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

MARCH 20, 2023

I finished my residency of Emergency Medicine and I’m working at a great Emergency Department here in Brazil. Remember: these findings above are included as STEMI equivalent findings in the 2022 ACC Expert Consensus Decision Pathway on ACS Patients in the ED.

STEMI 52

STEMI ACS CAD ED 52

ACEP Now

OCTOBER 11, 2024

Optimally, bystander CPR, including the administration of rescue breaths, should be initiated prior to arrival of emergency medical services. 3 Once the patient arrives in your emergency department, a rapid review of the patient’s status and results of resuscitative efforts should be performed. Am J Emerg Med.

ALS 52

ALS Emergency Department Emergency Medical Services ED 52

ACEP Now

MAY 9, 2024

It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergency department (ED). Diagnostic errors in the emergency department: a systematic review [internet]. Ann Emerg Med. Comparative Effectiveness Review, No.

Emergency Department 52

Emergency Department ICU ALS ACS 52

Dr. Smith's ECG Blog

APRIL 17, 2023

He had no symptoms of ACS. The remainder of his Emergency Department stay was uneventful. Here is the clinical informaton on ECG 2: A man in his 50s presented to the Emergency Department with acute chest pain that started within the past few hours. QOH: "OMI High confidence". Physician interpretation: "No STEMI."

OR 52

OR STEMI ACS Emergency Department 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. The screening physician ordered an EKG and noted his ashen appearance and moderate distress. Triage EKG: What do you think?

ACS 52

ACS Coronary Defibrillator STEMI 52

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 98

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

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 91

EMS E-9-1-1 ACS Coronary 91

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.

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E-9-1-1 EMS Coronary ACS 102

Don't Forget the Bubbles

JULY 22, 2024

A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department. Annals of Emergency Medicine. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. 2022 Sep 4 [cited 2024 Jan 30];60(suppl 66).

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

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] J Am Coll Cardiol 2022 Nov 15;80(20):1925-1960 2. Kontos et al. Welsh et al.

STEMI 86

STEMI Coronary Paramedic ALS 86

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. 2022 Dec;41(12):947–52. 2022 Jun;58(6):1007–12. Karageorgos, S.;

Emergency Department 143

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

EMDocs

JUNE 27, 2024

2022 Jul 5;328(1):57-68. Am J Emerg Med. 2022 Aug;58:235244. Epub 2022 Jun 11. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. Am J Emerg Med. 2022 Aug;58:235-244. Epub 2022 Jun 11. 2022 Aug 29;13:796837. C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

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E-9-1-1 ICU ACS EMS 98

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.

E-9-1-1 105

E-9-1-1 ED Emergency Department ALS 105

ALiEM

DECEMBER 9, 2024

A 25-year-old female with no pertinent past medical history presented to an emergency department in Massachusetts with four days of generalized malaise, myalgias, congestion, low-grade fever, and a rash behind her left knee. 2022, Jan 19. link] www.cdc.gov/lyme/ Steere AC. Clin Infect Dis. 2010 Feb 15;50(4):512-20.

Emergency Department 152

Emergency Department ACS EMS OR 152

REBEL EM

DECEMBER 23, 2024

Paper: Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. Target trial emulation is a methodologic framework to improve observational studies that begins by creating a hypothetical protocol for the ideal RCT, and then designing your observational protocol to emulate it as closely as possible ( Hernn 2022 ). JAMA Intern Med.

ALS 128

ALS ED ACS EMR 128

ACEP Now

FEBRUARY 11, 2025

A 33-year-old male with a history of drug use presented to the emergency department (ED) for extreme agitation after receiving two doses of 2 mg naloxone by EMS for respiratory depression. 2022 Annual Report of the National Poison Data System (NPDS) from Americas Poison Centers: 40th Annual Report. Gold MS, Pottash AC.

NARCAN 89

NARCAN Naloxone Overdose Mental Health Services 89

Dr. Smith's ECG Blog

MARCH 3, 2025

A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chest pain and shortness of breath. A month later, she presented again to the emergency department with a few hours of chest pain that resolved before ED presentation. This was written by Hans Helseth.

E-9-1-1 74

E-9-1-1 Coronary STEMI Emergency Department 74

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

He presented to the emergency department for evaluation. Patients with suspected ACS should be evaluated with echocardiography. Written by Magnus Nossen, edits by Smith The patient in today's case is an 85-year-old male with a history of COPD and dementia. Lets us consider two different clinical presentations. Cardiology , 114.

STEMI 89

STEMI ALS OR Coronary 89

EMDocs

NOVEMBER 25, 2024

Vision loss carries a high degree of morbidity and is associated with higher all-cause mortality, 4 and it is our role as emergency providers to recognize potentially reversible causes of such adverse outcomes. 5 Epidemiology Onchocerciasis is endemic in 31 African countries but is also problematic in Brazil, Venezuela, and Yemen.

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E-9-1-1 ALS Emergency Department OR 74

EMDocs

JANUARY 6, 2025

Background: Refugees on the Rise As of 2022, it was estimated that there were 35.3 Global Trends Report 2022. link] Hummell AC, Cummings M. Published online November 14, 2022. Published online November 14, 2022. HIV Prevention and Treatment: The Evolving Role of the Emergency Department. link] UNHCR.

ED 75

ED E-9-1-1 ALS Emergency Department 75