2022, ALS and Coronary - 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]. Intermediate-risk patients may be further stratified based on recent stress testing or coronary angiogram findings plus a modified HEART or Emergency Department Assessment of Chest Pain (EDACS) score. Time to know your hs-cTn better.

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. Unfortunately, vascular remodeling is variable and inconsistent.

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. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? AEM June 2022. Date: June 30th, 2022 Reference: McGinnis et al. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter?

Coronary

Coronary Heart Attack ACS CAD

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. CORONARY ARTERIES: Exam was not directly tailored for coronary artery evaluation, noting recent diagnostic coronary angiogram.

Coronary

Coronary E-9-1-1 STEMI ACS

Contrast Media Shortage of 2022 – Lessons Learned

EMDocs

OCTOBER 30, 2023

” – Musings of an American ED resident in July 2022 when US healthcare was affected simultaneously by supply chain issues from GE Healthcare (contrast media) and Abbott Laboratories (Similac baby formula). A baby formula milk shortage for adults.” 11 Table 1.

E-9-1-1

E-9-1-1 Emergency Department ALS CCT

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

Acute coronary syndrome in a pediatric patient? Ultimately, cardiac cath was done — revealing patent coronary arteries. I've listed potential causes of acute pericarditis in My Comment at the bottom of the page in the June 11, 2022 post in Dr. Smith's ECG Blog. Smith : this was the prudent thing to do!!

Coronary

Coronary CAD ACS ALS

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 ). Type 2: MI secondary to ischaemia, but not related to coronary atherosclerosis.

Coronary

Coronary ACS ED OR

Chest pain: Are these really "Nonspecific ST-T wave abnormalities", as the cardiologist interpretation states?

Dr. Smith's ECG Blog

MAY 27, 2024

1] But there are multiple other abnormalities that make this ECG diagnostic of Occlusion MI, localized likely to the right coronary artery: 1. Inferior hyperacute T waves, which have been added to the 2022 ACC consensus on chest pain as a “STEMI equivalent”[3] 3. Nikus et al. Kontos et al. Kontos et al.

STEMI

STEMI Coronary ALS Emergency Department

Is OMI an ECG Diagnosis?

Dr. Smith's ECG Blog

APRIL 18, 2024

The ECG is just a test: a Bayesian approach to acute coronary occlusion If a patient with a recent femur fracture has sudden onset of pleuritic chest pain, shortness of breath, and hemoptysis, the D-dimer doesn’t matter: the patient’s pre-test likelihood for PE is so high that they need a CT. Amsterdam et al. Alencar et al.

STEMI

STEMI Coronary ALS CAD

60 year old with chest pain, STEMI negative. What should the discharge diagnosis be?

Dr. Smith's ECG Blog

JULY 7, 2024

First trop was 7,000ng/L (normal 25% of ‘Non-STEMI’ patients with delayed angiography have the exact same pathology of acute coronary occlusion. The new ACC expert consensus explains that: “STEMI ECG criteria on a standard 12-lead ECG alone will miss a significant minority of patients who have acute coronary occlusion. Take home 1.

STEMI

STEMI Coronary 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. Dr. Joshua Broder is the Residency Program Director and Vice Chief for Education In the Divisi.

Emergency Department

Emergency Department ACS ALS Coronary

Updates in the Management of Refractory Ventricular Tachycardia or Ventricular Fibrillation Arrest

ACEP Now

JULY 7, 2023

Extracorporeal membrane oxygenation Of patients with out-of-hospital cardiac arrest presenting to the ED in refractory VF, a majority have significant coronary artery disease, much of which is amenable to percutaneous coronary intervention. References Tsao CW, et al. Benjamin EJ, et al. Kimblad H, et al.

Defibrillator

Defibrillator OR ALS Epinephrine

Prehospital activation: De-activated on ED arrival by Cardiologist because "It's not a STEMI"

Dr. Smith's ECG Blog

OCTOBER 27, 2024

Initial 4th generation troponin I was 10 ng/mL is consistent with large MI due to acute coronary occlusion (OMI). There are moderate coronary artery calcifications. Lupu et al. Reference : Lupu L, Taha L, Banai A, Shmueli H, Borohovitz A, Matetzky S, Gabarin M, Shuvy M, Beigel R, Orvin K, et al.

STEMI

STEMI ED Coronary EMS

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Dr. Smith's ECG Blog

APRIL 22, 2024

A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Lemkes JS, et al. Total coronary occlusion, if very brief, may have minimal infarction and yet be very dangerous. Am Heart J. 2000;139:430–436. Eur Heart J [Internet].

Coronary

Coronary STEMI ED OR

Acute artery occlusion -- which one?

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Thanks in part to rapid bedside diagnosis, the patient was able to avoid emergent coronary angiography. Consider the following: We become attuned to looking for acute coronary occlusion in patients who present with acute symptoms to the ED ( E mergency D epartment ).

E-9-1-1

E-9-1-1 Coronary STEMI ALS

EM@3AM: Kawasaki Disease

EMDocs

JULY 1, 2023

Upon further research in the 1970’s, retrospective data from autopsies of those patients showed coronary aneurysms 5 Pathophysiology: Kawasaki Disease is a vasculitis of medium sized arteries. Tomisaku Kawasaki, who noticed 50+ similar pediatric presentations between the years 1961 and 1967. Lakhani, N. BMC Pediatrics. 2018;18(334).

EMS

EMS Coronary ED OR

A 30-something with acute chest pain

Dr. Smith's ECG Blog

OCTOBER 3, 2024

Coronaries were clean. Not OMI with High Confidence Click here to sign up for Queen of Hearts Access We showed that the Queen of Hearts decreases false positive cath lab activations: 1) Published recently in Prehospital Emergency Care Baker PO et al. 2) To be presented at AHA conference in Chicago in 2 weeks: Sharkey SW et al.

E-9-1-1

E-9-1-1 Coronary ALS ED

What Lies Beneath

EMS 12-Lead

AUGUST 22, 2022

The coronary angiogram revealed no critical stenosis, or acute plaque ulceration. Takotsubo should be a diagnosis of exclusion after angiography reveals no obstructive coronary disease, and repeat Echo displays left ventricular recovery. Furthermore, pertinent electrolyte values (e.g. potassium) were within normal parameter.

E-9-1-1

E-9-1-1 Coronary ALS ICU

Medical Malpractice Insights: Radiology over-reads – Who’s responsible?

EMDocs

SEPTEMBER 26, 2024

Autopsy shows coronary atherosclerosis and marked cardiomegaly with a thickened left ventricular wall. Baccei SJ et al. Tyler W et al. 3 : September 2022. An unknown EP reviews the report, determines that there is no reason to notify the patient, and documents nothing. J Am Coll Rad 15:4;639-647, April 1, 2018.

Emergency Department

Emergency Department ED ALS Coronary

Why you should use the Queen of Hearts and record serial ECGs more often. If you wait for troponin.

Dr. Smith's ECG Blog

OCTOBER 22, 2024

The coronary angiography showed a 100% ostial main (obtuse) marginal occlusion!" Dominant right coronary, atherosclerotic and calcified. Presence of a single coronary lesion: occlusion of the ostial main marginal.

Coronary

Coronary STEMI OR ALS

emDOCs Podcast – Episode 94: GLP-1 Agonist Complications

EMDocs

FEBRUARY 7, 2024

American Gastroenterological Association issued a practice guideline in November 2022 recommending that semaglutide 2.4 GLP-1 agonists are also associated with improved ejection fraction, coronary blood flow, and cardiac output while reducing the risk of cardiovascular events, infarction size, and all-cause mortality. How do they work?

Allergic Reaction

Allergic Reaction ALS CAD OR

Texted from a former EM resident: 70 yo with syncope and hypotension, but no chest pain. Make their eyes roll!

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Acute MI per se usually does not depress cardiac function and blood pressure enough to cause syncope ( Mostafa et al — J Com Hosp Intern Med Perspect 13(4):9-12, 2023 - ). Other cardiac-related causes for syncope associated with acute MI may include malignant ventricular arrhythmias and bradyarrhythmias including AV block.

EMS

EMS CPR ED Coronary

The REVIVED Trial: PCI in Patients with Severe Ischemic Left Ventricular Systolic Dysfunction?

REBEL EM

SEPTEMBER 12, 2022

Background: Coronary artery disease can result in hibernating myocardium (chronic myocardial contractile dysfunction) due to ischemia. The theory is that there is reduced coronary blood flow and increased myocardial demand resulting in impaired contractility. Paper: Perera D et al. OMT: 38.0% HR 0.99; 95% CI 0.78 to 1.27; p = 0.96

Coronary

Coronary ALS OR EMS

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

Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy. Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. It can only be seen by IVUS. MINOCA has many etiologies.

Emergency Department

Emergency Department E-9-1-1 Coronary STEMI

Acute OMI or "Benign" Early Repolarization?

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Note that as many as 7% of patients with acute coronary syndrome have chest pain reproducible on palpation [Lee, Solomon]. which reduces the pre-test probability of acute coronary syndrome by less than 30% [McGee]. The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al.

E-9-1-1

E-9-1-1 OR Coronary ACS

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

Hgb 11g/dL (110g/L) and leukocytosis, and a mildly elevated troponin (36 ng/L, with normal 1mm STE in aVR due to ACS will require coronary artery bypass surgery for revascularization, the infarct artery is often not the LM, but rather the LAD or severe 3-vessel disease. Harhash AA, Huang JJ, Reddy S, et al. Knotts et al.

ACS

ACS Coronary STEMI ALS

A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?

Dr. Smith's ECG Blog

MAY 23, 2023

2022 Jan;51:384-387. 2022 May;55:180-182. 2022 May;55:180-182. Epub 2022 Mar 17. I have here 38 cases of "Computer Normal" ECGs which were critically abnormal and the vast majority are missed acute coronary occlusions (Missed Acute OMI) and most were recognized by the physician. Am J Emerg Med. doi: 10.1016/j.ajem.2021.11.023.

STEMI

STEMI Coronary Paramedic OR

What are treatment options for this rhythm, when all else fails?

Dr. Smith's ECG Blog

JULY 21, 2024

It shows a proximal LAD occlusion, in conjunction with a subtotally occluded LMCA ( Left Main Coronary Artery ). Upon contrast injection of the LMCA, the patient deteriorated, as the LMCA was severely diseased and flow to all coronary arteries ( LAD, LCx and RCA ) was compromised. He was taken immediately to the cath lab.

Defibrillator

Defibrillator Coronary ALS STEMI

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

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The De Winter ECG pattern: morphology and accuracy for diagnosing acute coronary occlusion: systematic review. Hayakawa A, Tsukahara K, Miyagawa S, et al. Published 2022 Feb 20. Immediate and early percutaneous coronary intervention in very high-risk and high-risk non-ST segment elevation myocardial infarction patients.

ACS

ACS Coronary ALS CAD

Palpitations while awaiting CABG

Dr. Smith's ECG Blog

JUNE 14, 2024

He underwent coronary angiography which showed severe multivessel disease, and he agreed to proceed with workup for CABG. The October 21, 2022 post — for " artifactual VT". 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.

Defibrillator

Defibrillator ALS Coronary OR

Two patients with chest pain and RBBB: do either have occlusion MI?

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Coronaries were normal, as was serial troponin. I sent the initial ECG of both cases without any context to my colleague Mazen El-Baba, a senior EM resident with an interest in ECG interpretation, and he responded: “RBBB with first degree AV block” for the first (ie no acute coronary occlusion), and “RBBB and superimposed OMI” for the second.

STEMI

STEMI Paramedic Coronary ED

Case Report: The Not So Normal, Normal EKG

ACEP Now

AUGUST 12, 2024

Sequence of events in angina at rest: Primary reduction in coronary flow. 2022 ACC Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee. 2022 Nov, 80 (20) 1925–1960. Arch Intern Med.

Emergency Department

Emergency Department STEMI ACS ED

The EMERGE Trial: Emergency vs Delayed Catheterization in Survivors of Out-of-Hospital Cardiac Arrest

REBEL EM

MARCH 30, 2023

Clinical Question : In patients who suffer an OHCA without ST-segment elevation on the post-resuscitation ECG, will early coronary angiogram (CAG) vs. delayed CAG improve outcomes? Article: How-Berlemont C, Lamhaut L, Diehl J, et al. Published online June 08, 2022. JAMA Cardiol. P., & Cariou, A. PMID: 26453685 Vyas, A.,

Coronary

Coronary CPR OR ICU

Four patients with chest pain and ‘normal’ ECG: can you trust the computer interpretation?

Dr. Smith's ECG Blog

OCTOBER 18, 2023

Dr. Smith’s ECG Blog has published a growing list of over 40 cases of ECGs falsely labeled ‘normal’ by the computer which are diagnostic of Occlusion MI, and Smith et al. Smith’s ECG Blog has published a growing list of over 40 cases of ECGs falsely labeled ‘normal’ by the computer which are diagnostic of Occlusion MI, and Smith et al.

STEMI

STEMI Emergency Department Coronary OR

EM@3AM: Basilar Artery Occlusion

EMDocs

OCTOBER 21, 2023

A 68-year-old male with a past medical history of hypertension, diabetes mellitus, and coronary artery disease with a drug eluting stent placed 2 months ago presents with dizziness and vomiting that began 3 hours ago. References: Gaillard F, Glick Y, Tatco V, et al. Updated 2022 Dec 22]. Updated 2022 Oct 15]. Arch Neurol.

EMS

EMS ALS OR ACS

A 20-something with intermittent then acute chest pain

Dr. Smith's ECG Blog

APRIL 25, 2023

But the stuttering pain and sudden onset suggest acute coronary occlusion (Occlusion MI, or OMI). Cath lab activation by the ED and I agree with coronary angiography emergently." Result: no angiographically significant obstructive coronary artery disease. Smith and Meyers to diagnose both obvious (STEMI) and subtle OMI.

Coronary

Coronary STEMI ALS OR

Can you spot the problem with the recording of this 12-lead ECG?

Dr. Smith's ECG Blog

JANUARY 6, 2024

Therefore the impulse must have originated somewhere lower in the atria, perhaps near the coronary sinus. The April 17, 2022 post ( Leads V1,V2 misplacement ). The May 5, 2022 post ( LA-RA reversal ). The May 24, 2022 post ( LA-LL reversal ). The May 26, 2022 post ( LA-LL reversal ).

ALS

ALS STEMI Coronary OR

50-year old with chest pain, “no ischemic changes”

Dr. Smith's ECG Blog

DECEMBER 29, 2023

STEMI criteria is bad at differentiating between normal variant and acute coronary occlusion or reperfusion, and initial troponin levels don't differentiate between occlusive and non-occlusive MI 3. the presence of J waves from early repolarization doesn’t rule out an acute coronary occlusion 4. McLaren et al, including Meyers/Smith.

STEMI

STEMI Coronary OR 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!!! Association of intravenous morphine use and outcomes in acute coronary syndromes: Results from the CRUSADE Quality Improvement Initiative. de Winter et al in N Engl J Med 359:2071-2073, 2008. Am Heart J. 2005;149:1043–1049.

STEMI

STEMI Coronary ACS OR

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

75 year old dialysis patient with nausea, vomiting and lightheadedness

Dr. Smith's ECG Blog

AUGUST 19, 2023

Herzog et al. Khan et al. Problem #1: As I emphasized in My Comment in the December 6, 2022 post — Not all patients with acute MI report chest pain. As we've often emphasized in Dr. Smith's ECG Blog — Posterior leads often provide false reassurance ( See My Comment at the bottom of the page in the September 21, 2022 post ).

STEMI

STEMI ACS OR ALS

The BOX Trial: BP & O2 Targets in Comatose Survivors of Cardiac Arrest

REBEL EM

SEPTEMBER 5, 2022

Paper 1: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Paper 2: Kjaergaard J et al. References: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Kjaergaard J et al. A higher MAP may offer advantages due to improved cerebral perfusion pressure, however data is lacking. Liberal O2: 33.9%

ICU

ICU ALS OR CPR

Case Report: a High-Voltage Victim

ACEP Now

MARCH 14, 2024

Tintinalli JE, Stapczynski J, Ma O, et al. Acute myocardial infarction with normal and near normal coronary arteries. Documentation with coronary arteriography within 12 1/2 hours of the onset of symptoms in two cases (three episodes). Arnoldo BD, Purdue GF, Kowalske K, et al. 2023 Jul 17. In: StatPearls [Internet].

Operating Room

Operating Room ACS Critical Care Coronary

Why the sudden shock after a few days of malaise?

Dr. Smith's ECG Blog

SEPTEMBER 5, 2024

A Short Comment on PIRP and T Waves: Oliva et al found a strong association of myocardial rupture with postinfarction regional pericarditis. Another possible cause of pseudonormalization of T waves mentioned many times on this blog is the pseudonormalization caused by re-occlusion of an infarct related reperfused coronary artery.

STEMI

STEMI Coronary OR 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

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

Contrast Media Shortage of 2022 – Lessons Learned

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

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

Chest pain: Are these really "Nonspecific ST-T wave abnormalities", as the cardiologist interpretation states?

Is OMI an ECG Diagnosis?

60 year old with chest pain, STEMI negative. What should the discharge diagnosis be?

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

Updates in the Management of Refractory Ventricular Tachycardia or Ventricular Fibrillation Arrest

Prehospital activation: De-activated on ED arrival by Cardiologist because "It's not a STEMI"

Chest pain, resolved. Does it need emergent cath lab activation (some controversy here)? And much much more.

Acute artery occlusion -- which one?

EM@3AM: Kawasaki Disease

A 30-something with acute chest pain

What Lies Beneath

Medical Malpractice Insights: Radiology over-reads – Who’s responsible?

Why you should use the Queen of Hearts and record serial ECGs more often. If you wait for troponin.

emDOCs Podcast – Episode 94: GLP-1 Agonist Complications

Texted from a former EM resident: 70 yo with syncope and hypotension, but no chest pain. Make their eyes roll!

The REVIVED Trial: PCI in Patients with Severe Ischemic Left Ventricular Systolic Dysfunction?

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

Acute OMI or "Benign" Early Repolarization?

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

A man in his early 40s with chest pain a "normal ECG" by computer algorithm. Should we avoid interrupting a physician to interpret his ECG?

What are treatment options for this rhythm, when all else fails?

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

Palpitations while awaiting CABG

Two patients with chest pain and RBBB: do either have occlusion MI?

Case Report: The Not So Normal, Normal EKG

The EMERGE Trial: Emergency vs Delayed Catheterization in Survivors of Out-of-Hospital Cardiac Arrest

Four patients with chest pain and ‘normal’ ECG: can you trust the computer interpretation?

EM@3AM: Basilar Artery Occlusion

A 20-something with intermittent then acute chest pain

Can you spot the problem with the recording of this 12-lead ECG?

50-year old with chest pain, “no ischemic changes”

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

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

75 year old dialysis patient with nausea, vomiting and lightheadedness

The BOX Trial: BP & O2 Targets in Comatose Survivors of Cardiac Arrest

Case Report: a High-Voltage Victim

Why the sudden shock after a few days of malaise?

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