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 115

Defibrillator Coronary Epinephrine ACS 115

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., Unless some LMCA flow is restored he will not survive.

Coronary 127

Coronary ACS Emergency Department Defibrillator 127

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. Some of these cascades, even if cumbersome to the patient, make a certain amount of physiological sense. J Am Geriatr Soc.

ACS 105

ACS ALS OR 105

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 66

OR Coronary ACS EMS 66

Pediatric EM Morsels

APRIL 19, 2024

Pediatric Buckle and Greenstick Forearm Fractures: Basics The junction of the metaphysis and diaphysis in pediatric long bones is an area of biomechanical transition (Light, 1984) Thin metaphyseal cortex meets the thick cortex of the diaphysis Or in Emergency Medicine terms, “ Thick bone meet thin bone.” J Bone Joint Surg Br. 2001;83:1173-5.

ALS 286

ALS ACS Emergency Department ED 286

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 59

E-9-1-1 ACS OR Emergency Department 59

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. In fact, Kosuge et al. It is nearly pathognomonic for PE. Stein et al. Kosuge et al.

E-9-1-1 138

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

The Curious Clinicians

NOVEMBER 13, 2024

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. November 13th, 2024. Episode 18 addresses a classic Curious Clinicians question: Why is thirst quenched so quickly? CME/MOC Click here to obtain AMA PRA Category 1 Credits (0.5

ACS 52

ACS OR 52

Don't Forget the Bubbles

JULY 22, 2024

2024 Mar 22 [cited 2024 Mar 25];0(0) Methods – What is an IPD meta-analysis? Since the PREVIEW trial, there have been more negative trials. One such trial was the WASP trial , which involved 477 children in New Zealand. This trial showed no difference in PRAM score or LOS in the prednisolone group compared to placebo.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

The Curious Clinicians

NOVEMBER 1, 2024

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 30th, 2024. CME/MOC Click here to obtain AMA PRA Category 1 Credits (0.5 hours), Non-Physician Attendance (0.5 hours), or ABIM MOC Part 2 (0.5 for new episodes.

ACS 105

ACS OR 105

EMDocs

JUNE 27, 2024

Left lower lung field end demonstrates expiratory wheezing on auscultation. Other lung fields unremarkable. 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 mg/kg, max 0.4 C or 100.4

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

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. My Comment , by K EN G RAUER, MD ( 11/10 /2024 ): = Think of today's case as a check of your skill in recognizing when to activate the cath lab. Just not yet.

STEMI 81

STEMI OR ED EMS 81

Dr. Smith's ECG Blog

NOVEMBER 8, 2024

However, due to the nature of the symptoms, the patient was treated for ACS and admitted to the hospital. Sometimes a poor quality tracing is all you have to make your decision. == MY Comment , by K EN G RAUER, MD ( 11/6 /2024 ): == Today’s case by Dr. Nossen brings out a series of important points: As per comments by Drs.

ACS 82

ACS Coronary STEMI OR 82

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. There is STE in aVR.

ACS 119

ACS ED Coronary EMS 119

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. or basilar ischemia. EKG on arrival to the ED is shown below: What do you think? However, T waves do not appear to be hyperacute or hyperkalemic. Version 2 = 0.0272.

STEMI 103

STEMI Coronary Emergency Department OR 103

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

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

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

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. He was diagnosed as NSTEMI.

ACS 83

ACS Coronary ALS CAD 83

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. Post cath EF was estimated at 15% with severe global hypokinesis, and akinesis of the apex.

STEMI 119

STEMI EMS ACS ED 119

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

No wall motion abnormality This shows that significant ACS can have ZERO WMA!! There are also subtly hyperacute T-wave in I, aVL, and V2-V6. There is also a very negative (reciprocally inverted) T-wave in lead III, and a down-up T-wave in aVF, both of which are highly suggestive of occlusion of the LAD or D1. The S-wave is reconstituted.

STEMI 114

STEMI ACS Critical Care OR 114

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! His angiogram is shown below.

ACS 111

ACS ALS OR STEMI 111

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. Rabbits treated with PNB in-utero had almost no instances of phocomelia or other defects.

ACS 111

ACS OR 111

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 96

Coronary CAD ACS OR 96

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 107

STEMI Coronary ACS ED 107

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.” In isolation this ECG does not show OMI, but following the paramedic ECGs this indicates spontaneous LAD reperfusion. McLaren ) that no "set" rhythm is present.

STEMI 78

STEMI Paramedic Coronary EMS 78

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. This can occur due to scar ( e.g. post infarct VT) or anatomical variants ( e.g. AVNRT or AVRT). In fact, use of antidyrhythimcs (e.g., Leave it alone.

STEMI 88

STEMI Coronary Heart Attack ACS 88

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. There are many reasons that this ECG is diagnostic of LAD OMI.

Coronary 93

Coronary ED ACS OR 93

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 103

Coronary ACS ED OR 103

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. Translation from French: Acute Occlusion Myocardial Infarction with High Confidence.

STEMI 106

STEMI ACS OR 106

ACEP Now

FEBRUARY 11, 2024

Given the fact that he has not had these headaches before and has diffuse symptoms including weakness, lab work and head imaging are obtained. There were no acute findings on head CT. His lab values demonstrate no anemia, leukocytosis, or electrolyte abnormalities except for an elevated creatinine.

Overdose 52

Overdose ACS Plasma ALS 52

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. If you have old ECGs available, seek them out and compare today's ECGs to those old one. It is already approved in Europe.

E-9-1-1 111

E-9-1-1 Coronary EMS ED 111

ACEP Now

MAY 9, 2024

Available from: [link] Newman-Toker DE, Nassery N, Schaffer AC, et al. Published 2024 Jan 19. Taking a different approach than the authors of the AHRQ report, Auerbach et al used a “look back” approach to perform both qualitative and quantitative evaluations of the types and frequencies of errors occurring in hospital settings.

Emergency Department 52

Emergency Department ICU ALS ACS 52

ESO

OCTOBER 18, 2024

Injury Prevention Summary ACS PRQ- Hospice ACS PRQ – Solid organ injuries PtReg: 2.5 Injury Prevention Summary ACS PRQ- Hospice ACS PRQ – Solid organ injuries PtReg: 2.5 Thanks to your feedback, we’ve also enhanced our process for introducing new dashboards, making it more efficient and responsive.

Mobile Integrated Health 52

Mobile Integrated Health Community Paramedicine Critical Care MIH 52

ALiEM

OCTOBER 30, 2024

The biggest change has been the gradual replacement of diacetylmorphine (heroin) by fentanyl and other synthetic opioids. Along the same time, a veterinary sedative, xylazine , became popular in Puerto Rico in individuals who used injection drugs [3]. We treat with wound care and reserve surgical management only for limbs that are no longer viable.

E-9-1-1 161

E-9-1-1 Naloxone Emergency Department ALS 161

Pediatric EM Morsels

SEPTEMBER 20, 2024

HUS is often associated with bloody diarrhea … but… There is a variant of HUS (D-) that is not associated with diarrhea; HUS (D-) does not have seasonal variation and is relatively uncommon. Hemolytic Uremic Syndrome: Presentation The diarrhea associated with typical HUS may be bloody or watery.

Emergency Department 161

Emergency Department ACS ALS EMS 161

EMDocs

NOVEMBER 4, 2024

The pain is worse with deep breaths, coughing, or certain movements, and improves with rest and nonsteroidal anti-inflammatory drugs (NSAIDs). A 45-year-old male presents to the ED after a motor vehicle collision where he was the restrained driver. He reports severe, localized chest pain, worsened by breathing, coughing, and movement.

ED 98

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