Pediatric EM Morsels

APRIL 19, 2024

J Bone Joint Surg Br. 2001;83:1173-5. Oakley EA, Ooi KS, Barnett PLJ. A randomized controlled trial of 2 methods of immobilizing torus fractures of the distal forearm. Pediatr Emerg Care. 2008;24:65–70. A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children. Pediatrics. 2006;117:691–697.

ALS 290

ALS ACS Emergency Department ED 290

Dr. Smith's ECG Blog

JULY 25, 2024

Then assume there is ACS. or is he an ACCESS Trial Candidate? == MY Comment , by K EN G RAUER, MD ( 7/5 /2024 ): == Clinical ECG interpretation is a 2-Step process. The ST depression usually resolves, or is clearly resolving (getting much better). This may or may not be true, but it should give you pause.

Defibrillator 123

Defibrillator Coronary Epinephrine ACS 123

The Curious Clinicians

OCTOBER 2, 2024

2024 Jun;72(6):1728-1740. As of January 1, 2024, VCU Health Continuing Education will charge a CME credit claim fee of $10.00 Episodes prior to January 1, 2024, will remain free. October 2nd, 2024. Growdon ME, Jing B, Morris EJ, Deardorff WJ, Boscardin WJ, Byers AL, Boockvar KS, Steinman MA. J Am Geriatr Soc.

ACS 105

ACS ALS OR 105

ESO

OCTOBER 18, 2024

Injury Prevention Summary ACS PRQ- Hospice ACS PRQ – Solid organ injuries PtReg: 2.5 We value your input and hope you will engage with us through the in-app capabilities we’re continuing to expand and refine. The post (Q3/2024) ESO Updates: Quarterly Product Enhancements appeared first on ESO.

Mobile Integrated Health 52

Mobile Integrated Health Community Paramedicine Critical Care MIH 52

Dr. Smith's ECG Blog

OCTOBER 12, 2024

Click here to sign up for Queen of Hearts Access Given the lack of intracranial hemorrhage, the patient was administered aspirin for suspected ACS and cardiology was consulted. For a list of lead reversal cases we've discussed in Dr. Smith's ECG Blog — GO TO the bottom of the page in My Comment from the January 6, 2024 post).

STEMI 114

STEMI Coronary Emergency Department OR 114

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] Int J Cardiol 2024 3. Eur Heart J Digital Health 2024 5. 1] European guidelines add "regardless of biomarkers". Lupu et al.

STEMI 120

STEMI Coronary ALS CAD 120

FOAMfrat

APRIL 22, 2024

While one may argue that nitro really has no mortality benefit in ACS, I have seen patients with CHF present with hyper tension and inferior S-T elevation, in which the providers were scared to even look at the bottle of nitro. References Kimbrell J, Kreinbrook J, Poke D, Kalosza B, Geldner J, Shekhar AC, Miele A, Bouthillet T, Vega J.

E-9-1-1 78

E-9-1-1 ACS Paramedic Critical Care 78

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. Sometimes it can take 12 or 24 hours to see ECG evidence of reperfusion. == MY Comment , by K EN G RAUER, MD ( 1/4/ 2024 ): == Superb and thorough discussion by Dr. Frick of today's case! of the time.

ACS 119

ACS ALS OR STEMI 119

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 81

ACS Coronary ALS CAD 81

Dr. Smith's ECG Blog

JULY 11, 2024

A 2-day history of a "crushing and discomforting feeling" that is worse with exertion and not relieved by any home measures that are tried — even if primarily "epigastric" in location — is a potential presentation for ACS ( A cute C oronary S yndrome ) that needs to be recognized.

Coronary 112

Coronary ED ACS OR 112

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! West J Emerg Med 2024). 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. Deutch et al.

STEMI 116

STEMI Coronary ACS ED 116

Dr. Smith's ECG Blog

APRIL 9, 2024

ACS then becomes less likely. link] == MY Comment , by K EN G RAUER, MD ( 4/9 /2024 ): == One can never get too much practice in recognizing acute tracings that must be distinguished from OMI mimics. On arrival patient was slightly tachycardic. HR about 90-100/min. Other vital signs normal. Final diagnosis was myocarditis.

Coronary 107

Coronary CAD ACS OR 107

The Curious Clinicians

JANUARY 31, 2024

Listen to the episode [link] Credits & Citatio n Episode written by Avi Cooper Show notes written by Giancarlo Buonomo and Avi Cooper Audio edited by Clair Morgan of nodderly.com Cooper AZ, Breu AC, Abrams HR. January 31st, 2024. Thalidomide Embryopathy. The Curious Clinicians Podcast.

ACS 110

ACS OR 110

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

No wall motion abnormality This shows that significant ACS can have ZERO WMA!! PubMed PMID: 7778540. == MY Comment , by K EN G RAUER, MD ( 9/7 /2024 ): == The KEY to comparing to ECGs — is to put both ECGs next -to-each-other! The estimated pulmonary artery systolic pressure is 27 mmHg + RA pressure. Am J Cardiol.

STEMI 115

STEMI ACS Critical Care Coronary 115

The Curious Clinicians

FEBRUARY 21, 2024

There are likely additional ways that HFE modulates the immune system that we’re still learning about Listen to the episode [link] Credits & Citatio n Episode written by Hannah Abrams Audio edited by Clair Morgan of nodderly.com Cooper AZ, Breu AC, Abrams HR. February 21st, 2024. The Curious Clinicians Podcast.

ACS 40

ACS OR 40

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

The app also states that there is "suspected" ACS without ST elevation (NSTEMI), posterior fascicular block, sinus bradycardia, and LVH) Note on version 1 of the Queen: she will diagnose "OMI" whether it is an active or reperfused OMI. (THE Translation from French: Acute Occlusion Myocardial Infarction with High Confidence.

STEMI 84

STEMI ACS OR 84

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

Whereas SCAD is found in ~1-4% of all angiograms performed for ACS — this percentage increases to over 30% in middle-aged women. The risk of SCAD is even higher in pregnancy — accounting for over 40% of angiograms performed for ACS during the peripartum period.

OR 65

OR STEMI ACS Coronary 65

Dr. Smith's ECG Blog

AUGUST 11, 2024

Most importantly, while waiting for the paradigm to evolve, maintain focus on our true goal for our patients with ACS: to identify and reperfuse patients with acute occlusion MI.” Follow up your patient's cath results to learn which were false-positives or missed occlusions. This paradigm shift can be accelerated by by expert-trained AI.

STEMI 99

STEMI Paramedic Coronary EMS 99

Dr. Smith's ECG Blog

JANUARY 9, 2024

Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? Cardioversion will address the rhythm problem immediately, also if the chest discomfort subsides when SR is restored, ischemia from ACS becomes much less likely. In either case, prompt cardioversion is indicated.

Coronary 118

Coronary ACS ED OR 118

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

The Queen of Hearts AI app will hopefully be FDA approved in Q1 of 2024. The emergency physician was skeptical and believed the ECG to be a mimic, a false positive. So they looked into the patient's chart. The Queen of Hearts has not yet been trained to compare with previous or with serial ECGs. It is already approved in Europe.

E-9-1-1 115

E-9-1-1 Coronary EMS ED 115

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

The patient was thought to have low likelihood of ACS, and cardiology recommended repeat troponin, urine drug testing, and echocardiogram. At that point, cardiology elected to treat for ACS. Initial hscTnI was 10 ng/L (ref. <14). There was no recommendation for repeat ECG. Angiography is shown below.

OR 65

OR Coronary ACS EMS 65

ACEP Now

FEBRUARY 11, 2024

Accessed January 11, 2024. ACS chemical neuroscience molecule spotlight on Contrave. ACS Chem Neurosci. Poison centers see nearly 1,500% increase in calls related to injected weight-loss drugs as people accidentally overdose. CNN website. Published December 18, 2023. Deerfield, Illinois: Takeda Pharmaceuticals America Inc; 2014.

Overdose 52

Overdose ACS Plasma ALS 52

The Skeptics' Guide to EM

SEPTEMBER 28, 2024

Date: September 23, 2024 Reference: Essat et al. Annals of Emergency Medicine, May 2024 Guest Skeptic: Dr. Casey Parker is a Rural Generalist from Australia who is also an ultrasounder. The patient has no specific risk factors for acute coronary syndrome (ACS) or dissection. Reference: Essat et al.

Emergency Department 234

Emergency Department ACS Coronary ALS 234

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). sepsis, anemia, hypoxemia, severe hypotension etc.,

Coronary 127

Coronary ACS Emergency Department Defibrillator 127

Don't Forget the Bubbles

JULY 22, 2024

2024 Mar 22 [cited 2024 Mar 25];0(0) Methods – What is an IPD meta-analysis? Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Fernandes RM, Wingert A, Vandermeer B, Featherstone R, Ali S, Plint AC, et al. 2024 Mar 22 [cited 2024 Mar 25];0(0). Cochrane; 2023 [cited 2024 Apr 15].

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

ESO

FEBRUARY 11, 2025

For the first time, the 2024 ESO Trauma Index took a deep dive into Time to Transfer data a critical, patient-centered metric that directly impacts survival rates and care outcomes. Download the full 2024 ESO Trauma Index to learn how your trauma center could improve patient outcomes and community health.

Emergency Department 105

Emergency Department ACS OR 105

Pediatric EM Morsels

SEPTEMBER 20, 2024

CID 2020:70 (15 April) Lin CY, Xie J, Freedman SB, McKee RS, Schnadower D, Tarr PI, Finkelstein Y, Desai NM, Lane RD, Bergmann KR, Kaplan RL, Hariharan S, Cruz AT, Cohen DM, Dixon A, Ramgopal S, Powell EC, Kilgar J, Michelson KA, Bitzan M, Yen K, Meckler GD, Plint AC, Balamuth F, Bradin S, Gouin S, Kam AJ, Meltzer JA, Hunley TE, Avva U, Porter R, Fein (..)

Emergency Department 164

Emergency Department ACS ALS EMS 164

Dr. Smith's ECG Blog

MAY 3, 2024

RBBB + LAFB in the setting of ACS is very bad. Some patients have baseline RBBB with LAFB, but in patients with likely ACS, these are associated with severe infarction with cardiac arrest, cardiogenic shock or impending shock. Patients with ACS and RBBB/LAFB usually have a left main vs. proximal LAD. Learning Points: 1.

ACS 126

ACS ED Coronary EMS 126

Dr. Smith's ECG Blog

JUNE 17, 2024

Accessed May 28, 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. looked at consecutive patients with PE, ACS, or neither. It is nearly pathognomonic for PE. Kosuge et al. Witting et al. of controls.

E-9-1-1 138

E-9-1-1 ACS Emergency Department Coronary 138

Dr. Smith's ECG Blog

AUGUST 9, 2024

Similarly, the OMI paradigm respects ACS as a dynamic process in which ECG changes reflect the phase of myocardial injury and risk stratify which patients may benefit from emergent PCI. Ventricular arrhythmias in ischemic heart disease: mechanism, prevalence, significance, and management.

STEMI 106

STEMI Coronary Heart Attack ACS 106

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Because the most severe LAD OMIs can cause ischemic failure of the RBB and LAF, any patient with ACS symptoms and new RBBB and LAFB with any concordant STE has LAD OMI until proven otherwise. In EMS2 ECG, the T waves in V5 is possibly hyperacute.

STEMI 120

STEMI EMS ACS ED 120

ACEP Now

MAY 9, 2024

Available from: [link] Newman-Toker DE, Nassery N, Schaffer AC, et al. Published 2024 Jan 19. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Dec. Comparative Effectiveness Review, No. Burden of serious harms from diagnostic error in the USA. BMJ Qual Saf. 2024;33(2):109-120.

Emergency Department 52

Emergency Department ICU ALS ACS 52

EMDocs

NOVEMBER 4, 2024

54 It is vital to consider dangerous epigastric pain mimickers like acute coronary syndrome (ACS), hepatobiliary disease, or pancreatitis. 2024 Feb 6;16(2):e53712. Pain can be gnawing, aching, burning, and located in the upper abdomen. Pain can be improved or exacerbated with meals. Sep 1989;14(9):962-4. doi: 10.7759/cureus.53712.

ED 106

ED E-9-1-1 Emergency Department ALS 106

EMDocs

NOVEMBER 9, 2024

2024 Oct 1;97(4):631-638. Epub 2024 Aug 30. 2024 Sep 16:e2415815. Source Antithrombotic Strategies in Atrial Fibrillation After ACS and/or PCI: A 4-Way Comparison From AUGUSTUS. 2024 Sep 3;84(10):875-885. Source Small versus large-bore thoracostomy for traumatic hemothorax: A systematic review and meta-analysis.

ACS 98

ACS Coronary OR 98

This Podcast Will Kill You

SEPTEMBER 24, 2024

2024): nwad237. ACS omega , 7 (24), pp.20441-20456. Haemochromatosis. The Lancet , 401 (10390), pp.1811-1821. Algeo, Thomas J., and Jun Shen. “Theory and classification of mass extinction causation.” ” National Science Review 11.1 Olynyk, J.K. and Ramm, G.A., Hemochromatosis. Barton, James C. 2013): 403-412. .”

ALS 52

ALS ACS 52

REBEL EM

DECEMBER 23, 2024

Both these physiologic principles and recent preclinical evidence have called into question whether NS is the best resuscitation fluid for patients experiencing VOE due to concerns its tonicity and tendency to induce acidosis may promote sickling ( Carden 2017a , Carden 2017b , Alwang 2024 ). Microcirculation. 2017;24(5):10.1111/micc.12353.

ALS 128

ALS ED ACS EMR 128

Dr. Smith's ECG Blog

DECEMBER 3, 2024

This dynamic change is diagnostic of ACS. Cardiology was consulted and agreed that his history was high risk for ACS and a next-day angiogram was merited. This was also non-diagnostic for OMI, although the dynamic changes are diagnostic of ACS. ECG at time 82 minutes: What do you think?

ED 110

ED Coronary ACS STEMI 110