ACEP Now

MAY 3, 2023

Acute chest syndrome (ACS) is a potentially life-threatening complication of sickle cell disease characterized by lung infiltrates, fever, and respiratory symptoms, including cough, tachypnea, wheeze, increased work of breathing or shortness of breath, and reduced oxygen saturation. Sickle cell disease is the primary risk factor for ACS.

ACS 52

ACS OR 52

FOAMcast

OCTOBER 17, 2023

Published online October 12, 2023. Published online October 12, 2023. Published online October 12, 2023. Despite initial enthusiasm for widespread use, there are minimal data suggesting significant mortality benefit. ” As a result, Jansen et al. undertook a pragmatic RCT to investigate the use of REBOA in trauma.

ACS 52

ACS ALS OR 52

Dr. Smith's ECG Blog

JUNE 5, 2024

As per my review of this subject ( Check out My Comment at the bottom of the page in the November 16, 2023 post in Dr. Smith's ECG Blog ) — the 3 most common Causes of ACS ( A cute C oronary S yndrome ) with a "negative" cath are: i ) Myocarditis; ii ) Takotsubo cardiomyopathy; and , iii ) MINOCA.

Coronary 101

Coronary ACS ALS OR 101

Don't Forget the Bubbles

OCTOBER 7, 2024

This is supplied via alternating current (AC), increasing the risk of titanic contraction of skeletal muscle, leading to kids holding on to the electrical power source. AC and DC shocks may result in different injury patterns. Philadelphia, PA: Elsevier; 2023:chap 130. How does electricity cause harm? Chen P, Bukhman AK.

ACS 80

ACS Life Support OR CPR 80

Dr. Smith's ECG Blog

JUNE 17, 2024

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. In this study, (quote) "negative T waves in leads III and V 1 were observed in only 1% of patients with ACS compared with 88% of patients with Acute PE (p less than 0.001).

E-9-1-1 134

E-9-1-1 ACS Emergency Department ALS 134

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 107

Coronary CAD ACS ALS 107

Dr. Smith's ECG Blog

DECEMBER 22, 2023

Comment : ACS with persistent symptoms is a guideline recommended indication for ＜2 hour angio (both ACC/AHA and ESC). The ESC states that patients with suspected ACS should go to the cath lab in ＜2 hours "regardless of ECG or biomarker evidence of MI!!" Unfortunately, given occurrence in the past — some details are not available.

ACS 97

ACS STEMI OR 97

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 52

Operating Room ACS Critical Care Coronary 52

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

References: 1) See this study showing an association between morphine and mortality in Non-STE-ACS: Meine TJ, Roe M, Chen A, Patel M, Washam J, Ohman E, Peacock W, Pollack C, Gibler W, Peterson E. Link to abstract Link to full text 2) Use of Morphine in Non-STE-ACS is independently associated with mortality, at odds ratio of 1.4

E-9-1-1 80

E-9-1-1 ACS STEMI Coronary 80

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.

ACS 85

ACS Coronary ALS CAD 85

EMDocs

JUNE 27, 2024

Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. Epub 2023 Nov 27. 2023 Apr;98(4):620-627. Epub 2023 Feb 6. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

E-9-1-1 76

E-9-1-1 ICU ACS EMS 76

ACEP Now

DECEMBER 11, 2023

Many conditions outside of acute coronary syndrome (ACS) mimic ST-elevation myocardial infarction (STEMI), but only a handful of cases have reported ST-elevations (STE) in the setting of pancreatic inflammation where underlying ACS was excluded. Accessed November 29, 2023. Click to enlarge.) Yu ES, Lange JJ, Broor A, et al.

STEMI 52

STEMI Coronary ACS Critical Care 52

Dr. Smith's ECG Blog

MARCH 1, 2023

This pattern occurs regardless of whether the cause is ACS (decreased supply) or any other cause of decreased supply or increased demand. You must understand that this pattern does not differentiate ACS from other causes of supply/demand mismatch.

Allergic Reaction 52

Allergic Reaction E-9-1-1 Epinephrine Coronary 52

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. Most studies examine undifferentiated ACS cohorts, with only a handful providing separate data. References: 1.

Coronary 95

Coronary E-9-1-1 STEMI ACS 95

Dr. Smith's ECG Blog

AUGUST 10, 2023

So now there was ACS + electrical instability, another indication for emergent angiogram. Emergency Medicine Journal , 34 (2), 119-123. == MY Comment, by K EN G RAUER, MD ( 8/10 /2023 ): == Today's case by Drs. ACS with refractory ischemia and electrical instability are indications for emergent cath regardless of the ECG!

STEMI 82

STEMI ACS Emergency Department ED 82

This Podcast Will Kill You

SEPTEMBER 24, 2024

ACS omega , 7 (24), pp.20441-20456. Tune in to catch us ironing out the details of this incredibly common genetic disorder. History Biology Adams, Paul C. “Hemochromatosis: ancient to the future.” ” Clinical Liver Disease 16 (2020): 83-90. Adams, P.C., Jeffrey, G. and Ryan, J., Haemochromatosis. The Lancet , 401 (10390), pp.1811-1821.

ALS 52

ALS ACS 52

ACEP Now

FEBRUARY 11, 2024

Published December 18, 2023. ACS chemical neuroscience molecule spotlight on Contrave. ACS Chem Neurosci. Published January 2023.Updated Updated May 16, 2023. Published January 2023. Poison centers see nearly 1,500% increase in calls related to injected weight-loss drugs as people accidentally overdose.

Overdose 52

Overdose ACS Plasma ALS 52

Dr. Smith's ECG Blog

APRIL 14, 2023

It is easy to say this in retrospect, especially not being the one in charge of this overcrowded waiting room full of unseen patients, but an elderly patient with known CAD and ongoing ACS-sounding chest pain despite medical management with positive troponin is already an indication for emergent cath, regardless of the ECG!

CAD 52

CAD ACS STEMI Coronary 52

Don't Forget the Bubbles

OCTOBER 2, 2024

2024 Sep 19:archdischild-2023-326507. 2024 Sep 17:archdischild-2023-326556. De Alwis AC, Kumar TS. Language ability and virtual mental healthcare utilisation among immigrant and refugee youth: a population-based cohort study. Mohamud H, et al. Arch Dis Child. Leyenaar JK, et al. Pediatrics. 2024 Oct 1;154(4):e2024065776.

ALS 52

ALS Emergency Department ED ACS 52

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.

E-9-1-1 113

E-9-1-1 Coronary ACS BLS 113

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. Reference article,   Radiopaedia.org (Accessed on 15 Apr 2023) [link] Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G: Basilar artery occlusion. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Lancet Neurol.

EMS 74

EMS ALS OR ACS 74

Dr. Smith's ECG Blog

MARCH 13, 2023

This is acute ACS, but it almost always seen in a pain free state. My Comment by K EN G RAUER, MD ( 3/13 /2023 ): = Today's case illustrates optimal clinical use of a pre-hospital Wellens' pattern for understanding the evolution of acute OMI. An ED ECG, if recorded with pain, should show LAD OMI.

ED 52

ED ACS Coronary Paramedic 52

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

For more on MINOCA — See My Comment in the November 16, 2023 post in Dr. Smith's ECG Blog ). Strictly speaking — this case does not at this time qualify as MINOCA — because the negative cath and 2 normal hs-troponins done 6 hours apart failed to document infarction. (

Coronary 110

Coronary ACS OR EMR 110

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 78

STEMI ACS OR ALS 78

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] 1] European guidelines add "regardless of biomarkers". But only 6.4% Eur Heart J Digital Health 2024 5. McLaren and Smith.

STEMI 114

STEMI Coronary ALS CAD 114

ACEP Now

OCTOBER 11, 2024

References Webb AC, Wheeler A, Ricci A, et al. 2023 Jun 14;49(1):74. Making affordable, culturally appropriate, and accessible interventions available to this population is key. 15 Other efforts should be aimed at education regarding bathtub and bucket drownings, as these are often overlooked. South Med J. 2021;114(5):266-270.

ALS 52

ALS Emergency Department Emergency Medical Services ED 52

Dr. Smith's ECG Blog

JANUARY 5, 2024

Thus, these troponins are very concerning for ACS, and subsequent ones will probably be diagnostic of acute MI. For this test it is VERY low (very good) at 4% at the 99th percentile -- 26 ng/L, but it will not be so good at a level of 9 ng/L. Thus, one considers a test result that varies by 2 or less to be the same result. of the time.

ACS 101

ACS ALS OR STEMI 101

Dr. Smith's ECG Blog

APRIL 9, 2024

ACS then becomes less likely. Smith's ECG Blog — it may sometimes not be possible to distinguish between acute myocarditis vs acute OMI on the basis of ECG findings and clinical history ( See My Comments in the April 25, 2023 — July 21, 2019 — December 10, 2019 — and January 10, 2020 posts). On arrival patient was slightly tachycardic.

Coronary 85

Coronary CAD ACS OR 85

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 52

OR STEMI ACS Emergency Department 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This is diagnostic of ACS; it appears to be a reperfused acute inferior OMI. That is what Emergency Medicine is all about. == MY Comment , by K EN G RAUER, MD ( 9/3 /2023 ): == I’ve seen a “common theme” with many of the ECGs that Drs. In aVF it is "coved" (upwardly convex). There is ischemic ST depression in V4-V6.

Defibrillator 126

Defibrillator Coronary STEMI CPR 126

Dr. Smith's ECG Blog

MARCH 20, 2023

Remember: these findings above are included as STEMI equivalent findings in the 2022 ACC Expert Consensus Decision Pathway on ACS Patients in the ED. Learning Points: To take optimal care of ACS patients, the initial providers who see the patient (hopefully assisted by AI soon) must be able to recognize subtle OMI findings.

STEMI 52

STEMI ACS CAD ED 52

Pediatric EM Morsels

AUGUST 18, 2023

References: Ross RK, Kinlaw AC, Herzog MM, Funk MJ, Gerber JS. However, Fluroquinolone resistance is increasing, so they should only be used if absolutely necessary! Nobody wants a pseudomonas superbug becoming prevalent! Fluoroquinolone Antibiotics and Tendon Injury in Adolescents. Pediatrics. 147(6):e202003316.

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

Dr. Smith's ECG Blog

JULY 27, 2023

I did not think it was due to ACS, but we ordered an ED ECG immediately: What do you think? But in this case the clinical scenario is not right for acute ACS with OMI, and there is very high voltage, and the patient is very young, (though beware of young patients , even 29 year olds!! There is profound "inferior" ST Depression.

Coronary 52

Coronary ACS Naloxone Plasma 52

Dr. Smith's ECG Blog

JANUARY 27, 2024

There were zero patients in this study with a "normal" ECG who had any kind of ACS! This defies all previous data on acute MI which would show that even undetectable troponins do not have a 100% negative predictive value. So this study is actually worthless. Patterns of occlusion and reperfusion can be learned and taught, including to AI 4.

STEMI 96

STEMI Coronary ACS ED 96

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

link] = My Comment by K EN G RAUER, MD ( 11/14 /2023 ): = One of the most helpful clinical clues in support that an acute cardiac event is ongoing — is the finding of " dynamic " ECG changes. For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ).

E-9-1-1 101

E-9-1-1 Coronary EMS ED 101

The Curious Clinicians

NOVEMBER 7, 2023

Listen to the episode [link] Credits & Citatio n Episode written by Tony Breu Show notes written by Giancarlo Buonomo and Tony Breu Audio edited by Clair Morgan of nodderly.com Breu AC, Cooper AZ, Abrams HR. November 8, 2023. Scleroderma Renal Crisis. The Curious Clinicians Podcast.

ACS 52

ACS OR 52

Dr. Smith's ECG Blog

MAY 31, 2023

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. See this case: A man his 50s with chest pain. What happens when you treat with morphine rather than with reperfusion?

STEMI 73

STEMI Coronary ACS OR 73