2024, ACS and Emergency Department

SGEM#454: I Just Died in Your Arms Tonight – Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes

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

Emergency Department ACS Coronary ALS

Bubble Wrap PLUS – October 2024

Don't Forget the Bubbles

OCTOBER 2, 2024

Children often spend many hours in the emergency department (ED) before being sent home or admitted. In this issue of Pediatrics , Leyenaar and colleagues reported on a trial to compare the effectiveness of direct admission to bypass their emergency departments. 2024 Sep 1;154(3):e2024066681. 2024 Sep 30.

ALS

ALS Emergency Department ED ACS

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

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). The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization. As per Dr.

Coronary

Coronary ACS Emergency Department Defibrillator

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Accessed May 28, 2024. looked at consecutive patients with PE, ACS, or neither. What do you think?

E-9-1-1

E-9-1-1 ACS Emergency Department Coronary

Rebaked Morsel: Pediatric Buckle and Greenstick Forearm Fractures

Pediatric EM Morsels

APRIL 19, 2024

Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. Pediatr Emerg Care. We see all different flavors of upper extremity injuries. J Bone Joint Surg Br. 2001;83:1173-5. Oakley EA, Ooi KS, Barnett PLJ.

ALS

ALS ACS Emergency Department ED

Elbow Dislocations

REBEL EM

NOVEMBER 6, 2024

Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 32644703 Robinson PM, Griffiths E, Watts AC. PMID: 27227986 Glover NM, Black AC, Murphy PB. J Emerg Med. J Am Acad Orthop Surg.

E-9-1-1

E-9-1-1 ACS OR Emergency Department

An elderly male with acute altered mental status and huge ST Elevation

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Am J Emerg Med. Written by Bobby Nicholson What do you think of this “STEMI”? or basilar ischemia.

STEMI

STEMI Coronary Emergency Department OR

Steroids in preschool wheeze

Don't Forget the Bubbles

JULY 22, 2024

2024 Mar 22 [cited 2024 Mar 25];0(0) Methods – What is an IPD meta-analysis? 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. 2024 Mar 22 [cited 2024 Mar 25];0(0).

E-9-1-1

E-9-1-1 ALS ACS ED

emDOCs Revamp – Acute Chest Syndrome

EMDocs

JUNE 27, 2024

2024 Mar 12;14(1):5978. Am J Emerg Med. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. 2024 Jul;71(7):e31002. Epub 2024 Apr 21. 2024 Apr 5. 2024 Feb;71(2):e30781. C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1

E-9-1-1

E-9-1-1 ICU ACS EMS

What does a final diagnosis of STEMI vs. NSTEMI depend upon?

Dr. Smith's ECG Blog

NOVEMBER 10, 2024

The ECG was transmitted to the Emergency Medicine physician who recognized inferior and posterior OMI findings, and confirmed that the patient has potential ACS symptoms. EMS gave aspirin and nitroglycerin, and the patient noted significant improvement on arrival to the Emergency Department.

STEMI

STEMI OR ED EMS

Is OMI an ECG Diagnosis?

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. Int J Cardiol 2024 3. Eur Heart J Digital Health 2024 5. But only 6.4% Amsterdam et al. Alencar et al.

STEMI

STEMI Coronary ALS CAD

46 year old with chest pain develops a wide complex rhythm -- see many examples

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. Usefulness of automated serial 12-lead ECG monitoring during the initial emergency department evaluation of patients with chest pain.

STEMI

STEMI Coronary Heart Attack ACS

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

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]. Published 2024 Jan 19. BMJ Qual Saf. JAMA Intern Med.

Emergency Department

Emergency Department ICU ALS ACS

Chest pain and a computer ‘normal’ ECG. Therefore, there is no need for a physician to look at this ECG.

Dr. Smith's ECG Blog

JANUARY 27, 2024

, tells us that we physicians do not need to even look at this ECG until the patient is placed in a room because the computer says it is normal: Validity of Computer-interpreted “Normal” and “Otherwise Normal” ECG in Emergency Department Triage Patients I reviewed this article for a different journal and recommended rejection and it was rejected.

STEMI

STEMI Coronary ACS ED

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

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

Coronary ACS ED OR

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

ALiEM

OCTOBER 30, 2024

Bupe Allergy Buprenorphine induction has been the mainstay of emergency department treatment of opioid use disorder for more than a decade [11, 12]. 2024 study [16]. DOI: Papudesi BN, Malayala SV, Regina AC. Emergency department–initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial.

E-9-1-1

E-9-1-1 Naloxone Emergency Department ALS

Hemolytic Uremic Syndrome (HUS): Rebaked Morsel

Pediatric EM Morsels

SEPTEMBER 20, 2024

Diarrhea is one of the most common complaints in the pediatric emergency department, especially in the summer and early fall. Predicting Adverse Outcomes for Shiga Toxin-Producing Escherichia coli Infections in Emergency Departments. 2021 May;232:200-206.e4. doi: 10.1016/j.jpeds.2020.12.077. 2020.12.077. Epub 2021 Jan 5.

Emergency Department

Emergency Department ACS ALS EMS

Pain Management of Common Chief Complaints in the ED

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.

ED

ED E-9-1-1 Emergency Department ALS

Paramedicine Now

SGEM#454: I Just Died in Your Arms Tonight – Diagnostic Accuracy of D-Dimer for Acute Aortic Syndromes

Bubble Wrap PLUS – October 2024

Trending Sources

See what happens when a left main thrombus evolves from subtotal occlusion to total occlusion.

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Rebaked Morsel: Pediatric Buckle and Greenstick Forearm Fractures

Elbow Dislocations

An elderly male with acute altered mental status and huge ST Elevation

Steroids in preschool wheeze

emDOCs Revamp – Acute Chest Syndrome

What does a final diagnosis of STEMI vs. NSTEMI depend upon?

Is OMI an ECG Diagnosis?

46 year old with chest pain develops a wide complex rhythm -- see many examples

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

Chest pain and a computer ‘normal’ ECG. Therefore, there is no need for a physician to look at this ECG.

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

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

Hemolytic Uremic Syndrome (HUS): Rebaked Morsel

Pain Management of Common Chief Complaints in the ED

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