Dr. Smith's ECG Blog

JANUARY 28, 2025

Hyperacute T-waves frequently NEVER progress to diagnostic ST Elevation Patients with ACS and pain refractory to anti-ischemic therapy should be sent emergently for catheterization, regardless of the ECG. It is also possible for hyperacute T waves to remain somewhat stable during either a sustained period of occlusion or partial reperfusion.

STEMI 104

STEMI ED ACS Emergency Department 104

Dr. Smith's ECG Blog

JANUARY 21, 2025

Negative trops and negative angiogram does not rule out coronary ischemia or ACS. It is a judgment call retrospectively, but to assume there is no ACS at presentation is very risky, especially in a patient with previously diagnosed severe CAD and poor LV function. It must be diagnosed with IVUS or Optical Coherence Tomography.

OR 61

OR Coronary STEMI ACS 61

The Curious Clinicians

APRIL 23, 2025

2025 Feb 20;188(4):1119-1136.e23. 2025 Feb 20;188(4):1119-1136.e23. Credits & Suggested Citation Episode written by Avi Cooper Show notes written by Avi Cooper and Giancarlo Buonomo Audio edited by Clair Morgan of nodderly.com Cooper AZ, Abrams HR, Breu AC, Buonomo G. April 23rd, 2025. Zhong L et Al. Zhong L et Al.

Allergic Reaction 52

Allergic Reaction ACS ALS OR 52

Dr. Smith's ECG Blog

FEBRUARY 2, 2025

He had several older ECGs on file, here are two examples: 6 days prior: 2 months prior: In the context of ACS symptoms, and when able to compare the new vs. old ECG, the top ECG is DIAGNOSTIC of OMI until proven otherwise. In the absence of old ECGs, one must record serial ECGs every 15 minutes.

STEMI 85

STEMI Defibrillator ACS OR 85

Dr. Smith's ECG Blog

FEBRUARY 12, 2025

When the Queen has some suspicion of OMI, she asks if the patient has ACS Symptoms. The emergency physician does cautiously (correctly) note that the ECG meets STEMI criteria in V3 and V4, but goes on to document absence of ACS symptoms. When I reviewed the chart, I learned that the patient had presented with syncope.

STEMI 81

STEMI E-9-1-1 ACS Coronary 81

Dr. Smith's ECG Blog

DECEMBER 27, 2024

After ruling out for ACS, the patient underwent angiography where he was found to have severe stable disease, which was already known. NOTE: Although this case study is from 1995 the misdiagnosis of wide tachycardias "because the patient is stable" remains all-too-common in 2025.

Coronary 120

Coronary Defibrillator ACS ED 120

Dr. Smith's ECG Blog

MARCH 25, 2025

In ACS, chest pain is the warning sign of ongoing ischemia. Other trials have found a benefit to revascularizing non-culprit lesions when a patient presents with ACS, the largest of which was COMPLETE , and more recently MULTISTARS AMI. Smith : it is highly suspicious for inferior OMI, but not 100% diagnostic. in absolute terms!

Defibrillator 62

Defibrillator ACS Coronary ALS 62

The Curious Clinicians

MARCH 27, 2025

The word argillaceous means “clay-like” and they felt this didnt reflect the broad range of materials which can be associated with this earthy smell, including rocks containing silica or iron oxide. They preferred “petrichor,” which literally means “essence of stone.” But, there may be reason to. for new episodes.

ACS 59

ACS OR 59

Dr. Smith's ECG Blog

MARCH 3, 2025

Summary : it is hard to say whether this ST Elevation was initiated by 1) something which led to pulmonary edema, then hypoxia, then supply-demand mismatch, or 2) whether ACS with OMI combined with some other pre-existing condition led to a decrease in LV function and pulmonary edema. We certainly know that there is hypoxia.

E-9-1-1 73

E-9-1-1 Coronary STEMI Emergency Department 73

The Curious Clinicians

JANUARY 9, 2025

Why don’t we administer insulin orally? In inpatient medicine, a phrase one often hears is “transition to PO.” ” Medications that start out as injections or infusions antibiotics, steroids, anticoagulants are switched to an oral equivalent as soon as possible. What is it about insulin that makes an oral route untenable ?

ACS 52

ACS OR ALS 52

The Curious Clinicians

FEBRUARY 19, 2025

Credits & Suggested Citation Episode written by Avi Cooper Show notes written by Avi Cooper and Giancarlo Buonomo Audio edited by Clair Morgan of nodderly.com Cooper AZ, Abrams HR, Breu AC, Buonomo G, The Grapes of Pseudomonas’ Wrath. February 12th, 2025. In this episode, we’ll be exploring a more benign side of PA.

ACS 52

ACS ICU OR 52

The Curious Clinicians

JANUARY 31, 2025

Credits & Suggested Citation Episode written by Giancarlo Buonomo Show notes written by Giancarlo Buonomo Audio edited by Clair Morgan of nodderly.com Buonomo G, Abrams HR, Breu AC, Abrams HR, Cooper AZ. January 22nd, 2025. Diabetes is not, in and of itself, a risk factor for all types of Pseudomonas infections. for new episodes.

ACS 52

ACS OR ALS 52

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Patients with suspected ACS should be evaluated with echocardiography. It will probably show an occlusion of the LAD, and it might be difficult to know how long the occlusion has been there and how viable the myocardium is, but it needs to be opened. Let us have a look at the limb lead ST-T changes. Is this ST elevation ischemic in nature?

STEMI 88

STEMI ALS OR Coronary 88

Pediatric EM Morsels

FEBRUARY 28, 2025

Sea AC, Lensing S, Rompalo A, et al. Sexual Transmitted Infections in Children ? Dr. Jackson, are you gonna have us talk to teens about sex again? Stigma has played a significant role in care for marginalized groups, leading to many health disparities. Therefore, CDC does not recommend risk-factor-based screening.

ACS 130

ACS Emergency Department ED ALS 130

Dr. Smith's ECG Blog

APRIL 2, 2025

Serial ECGs demonstrated dynamic changes diagnostic of ACS (transient STEMI) 4. Wehrens XH, Doevendans PA, Ophuis TJ, Wellens HJ. A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. Am Heart J 2000;139(3):4306. Learning Points 1.

STEMI 75

STEMI Coronary ED ACS 75

Dr. Smith's ECG Blog

FEBRUARY 6, 2025

Whenever I see PVCs with the morphology and axis seen in todays case I always look for signs of AC ( Arrhythmogenic Cardiomyopathy ). See this case for an in-depth discussion of AC and an example of VT and ECG changes associated with this disorder. Arrhythmogenic cardiomyopathy often manifests with PVCs from the RV.

Plasma 71

Plasma ACS OR Coronary 71

Dr. Smith's ECG Blog

APRIL 18, 2025

Does this patient have ACS Symptoms? He had no symptoms when seated, but felt lightheaded when standing and walking. He played a round of golf a week prior and felt an episode of chest pain during the round, which spontaneously resolved. On presentation, he reported no chest pain or shortness of breath. See Example case at bottom.

ED 80

ED ACS ICU OR 80

Dr. Smith's ECG Blog

MARCH 8, 2025

After completing the ACS algorithm with amiodarone and lidocaine, there are diminishing returns on further treatments. In lab, patients are monitored on continuous abbreviated ECG with 5 electrodes. During ballooning, we often see immediate hyperacute T waves. The patient's ECG at the beginning of the case is shown below. SanzRuiz, R.,

E-9-1-1 74

E-9-1-1 OR Defibrillator Coronary 74

The Curious Clinicians

MARCH 23, 2025

Credits & Suggested Citation Episode written by Tony Breu Show notes written by Tony Breu and Giancarlo Buonomo Audio edited by Clair Morgan of nodderly.com Breu AC, Abrams HR, Cooper AZ, Buonomo G, Pulse Check: Methemoglobin. March 12th, 2025. Listen to the episode ! hours), Non-Physician Attendance (0.5 for new episodes.

ACS 59

ACS ALS OR 59

Don't Forget the Bubbles

JANUARY 2, 2025

Hesseling AC, et al. The post Bubble Wrap PLUS – January 2025 appeared first on Don't Forget the Bubbles. This comprehensive list is developed from 34 journals, including major and subspecialty paediatric journals. During the first days of the new year, many people make solemn resolutions. Mohammed Abdul Wajid L, et al.

E-9-1-1 59

E-9-1-1 ALS ACS OR 59

EMDocs

MARCH 24, 2025

The patient denies any current symptoms but states that he just wants to get checked out. He has no chronic medical conditions, does not take any medications, and does not use any drugs or alcohol. Vital signs are within normal limits, with BP 110/70 mmHg, HR 60 bpm, RR 18 breaths/min, O2 saturation 98% on RA, T 37 C.

E-9-1-1 93

E-9-1-1 ALS ED OR 93