EMS 12-Lead

JUNE 20, 2022

Although the attending crews did not consider the ECG pathognomonic for occlusive thrombosis, they nonetheless considered the patient high-risk for ACS and implored him to reconsider. The attending crews were concerned for an ACS-equivalent of LAD occlusion and initiated a prehospital STEMI activation to the closest PCI center.

ACS 130

ACS Coronary STEMI CAD 130

EMOttawa

DECEMBER 18, 2023

Methodology: 3/5 Usefulness: 1/5 Georgiopoulos G, et al. 2023 Oct 1;8(10):946-956 Question: Does the modified GRACE score incorporating continuous troponin improve ACS risk prediction? JAMA Cardiol. Methods: Retrospective.

Coronary 52

Coronary ACS ALS 52

The Skeptics' Guide to EM

JANUARY 18, 2020

You turn to the attending and ask, “do you really think this could be acute coronary syndrome (ACS)?” ACS is usually amongst this differential, as cardiovascular disease is a leading cause of morbidity and mortality in this population. Reference: Wang et al. The utility of troponin testing to diagnose or exclude ACS. *

ACS 130

ACS Coronary Emergency Department OR 130

ACEP Now

JUNE 6, 2023

Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. The patient is admitted for ACS to a cardiologist who says he will see the patient in the morning.

ACS 85

ACS ALS ED OR 85

The Skeptics' Guide to EM

MAY 25, 2019

Date: May 23rd, 2019 Reference: Joseph et al. Date: May 23rd, 2019 Reference: Joseph et al. The American College of Emergency Physicians (ACEP) and American College of Surgeons Committee on Trauma (ACS COT) in 2018 put out a joint statement for the use of REBOA [4]. Reference: Joseph et al. JAMA Surgery March 2019.

ACS 130

ACS Emergency Department ALS OR 130

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Date: September 8th, 2021 Reference: Desch et al. Defibrillation is the treatment of choice in these cases but does not often result in sustained ROSC ( Kudenchuk et al 2006). Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients.

EMR 130

EMR Coronary Defibrillator Life Support 130

EMS 12-Lead

APRIL 14, 2022

It should be emphasized here that this is a presentation of high-pretest probability for Acute Coronary Syndrome (ACS). ACS and hyperkalemia both have lethal downstream consequences, so it is imperative for the clinician to acclimate to the presentation, or developing, features of each. link] [1] Zachary et al. 2] Costanzo, L.

ACS 130

ACS Paramedic Coronary ALS 130

REBEL EM

MAY 29, 2024

VS abnormalities can drive this as well Strongly consider reversal of AC (this will typically come after control) Stopping the Bleeding PPE: these things bleed like stink. EMRAP HD: Epistaxis Posterior Pack References Cassisi NJ et al. PMID: 5569677 Zeyyan E et al. PMID: 20938948 Loftus BC et al.

ICU 85

ICU ALS ACS EMS 85

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. 2 Proposed hypothesis as described by Hsu et al., Yu ES, Lange JJ, Broor A, et al.

STEMI 52

STEMI Coronary ACS Critical Care 52

Don't Forget the Bubbles

JUNE 14, 2023

Lava SAG, et al. Hsiao W, et al. Mullaly R, et al. Puoti MG, et al. Stenson EK, et al. Bruinsma RA, et al. Rivetti G, et al. van Gameren-Oosterom HBM, et al. Lester TR, et al. Mansell H, et al. Fernandes AER, et al. Wolstencroft J, et al. Roodbol J, et al.

ALS 118

ALS ACS ED OR 118

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. Lindahl et al. From Gue at al. Most studies examine undifferentiated ACS cohorts, with only a handful providing separate data.

Coronary 100

Coronary E-9-1-1 STEMI ACS 100

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 112

Coronary CAD ACS ALS 112

REBEL EM

OCTOBER 23, 2023

Follow up with the dentist in the morning Reinsert the tooth and avoid solid food Reinsert the tooth and stabilize it with a bridge Remove the tooth and repair the gingival laceration Remove the tooth and wrap it in saline-soaked gauze FOR THE RIGHT ANSWER CLICK ON THE ROSH REVIEW LOGO BELOW References Day PF, Flores MT, O’Connell AC, et al.

EMS 55

EMS ACS ALS ED 55

FOAMcast

OCTOBER 17, 2023

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

ACS 52

ACS ALS OR 52

The Skeptics' Guide to EM

FEBRUARY 27, 2021

Reference: Brichko et al. Reference: Brichko et al. Reference: Brichko et al. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. AEM Feb 2021. AEM Feb 2021.

Emergency Department 130

Emergency Department ALS ACS ED 130

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. Am J Emerg Med.

ACS 86

ACS Coronary ALS CAD 86

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Smith: If this is ACS (a big if), t his is just the time when one should NOT use "upstream" dual anti-platelet therapy ("upstream" means in the ED before angiography). History sounds concerning for ACS (could be critical stenosis, triple vessel), but differential also includes dissection, GI bleed, etc. Knotts et al.

Coronary 52

Coronary ACS STEMI ALS 52

The Skeptics' Guide to EM

MAY 29, 2021

Reference: Jhunjhunwala et al. Reference: Jhunjhunwala et al. According to a recent study in the Journal of Surgical Research [3] , 44% of all penetrating thoracic trauma patients presented to a non-trauma center (not a level 1 or level 2 ACS defined trauma center). Journal of Trauma and Acute Care Surgery.

Emergency Medical Services 130

Emergency Medical Services ACS ALS Emergency Department 130

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

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. Bigger et al. Sadowski ZP, Alexander JH, Skrabucha B, et al. Bigger JR Jr, Dresdale RJ, Heissenbuttel RH, et al. Leave it alone.

STEMI 85

STEMI Coronary Heart Attack ACS 85

REBEL EM

FEBRUARY 12, 2024

Read More First10EM: Imaging for Renal Colic SGEM : SGEM XTRA: COME TOGETHER, RIGHT NOW – OVER RENAL COLIC References Chang, Helena, et al. Moore CL, Carpenter CR, Heilbrun ME, et al. Smith-Bindman R, Aubin C, Bailitz J, et al. PMID: 25229916 DOI: 10.1056/NEJMoa1404446 Westphalen AC, Hsia RY, Maselli JH, Wang R, Gonzales R.

Emergency Department 58

Emergency Department ALS ACS EMS 58

FOAMcast

MARCH 27, 2023

References: Metlay JP, Waterer GW, Long AC, et al. ESCAPe found no benefit in their trial of a continuous infusion of methylprednisolone in severely ill patients with CAP). In this podcast episode, we review a new multicenter randomized trial of hydrocortisone in severe CAP.

Critical Care 52

Critical Care ACS ALS 52

EMS 12-Lead

APRIL 8, 2022

Smith and Meyers found that patients presenting with high-risk ACS and any ST-depression, even less than 1 mm, maximal in leads V1-V4 to be 97% specific for OMI and 96% specific for OMI requiring emergent PCI. [5] 1] Driver, B. Posterior wall reperfusion T-waves: Wellens’ syndrome of the posterior wall. Emergency Medicine Journal, 1-5. [2]

STEMI 130

STEMI ALS Coronary CAD 130

EMDocs

JUNE 27, 2024

Alkindi S, Al-Busaidi I, Al-Salami B, Raniga S, Pathare A, Ballas SK. Alghamdi FA, Al-Kasim F, Alshhada F, Ghareeb E, Azmet FR, Almudaibigh A, Baitalmal L, Alnawfal B, Alluqmani R. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

E-9-1-1 75

E-9-1-1 ICU ACS EMS 75

EMDocs

SEPTEMBER 6, 2023

2016 study published in American Journal of Emergency Medicine , “ Urinary obstruction is an important complicating factor in patients with septic shock due to urinary infection ” by Reyner et al. Reference: Reyner K, Heffner AC, Karvetski CH. Learning points: Anatomic urinary obstruction with septic shock is deadly. Am J Emerg Med.

ACS 70

ACS ICU EMS ALS 70

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. Heitner et al. 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. The troponin is trapped in the myocardium that is not being perfused.

ACS 106

ACS ALS OR STEMI 106

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] Amsterdam et al. Alencar et al. Lupu et al. Herman, Meyers, Smith et al. But only 6.4% link] References 1.

STEMI 118

STEMI Coronary ALS CAD 118

Dr. Smith's ECG Blog

JUNE 19, 2023

Armstrong et al. ST depression maximal in V1-V4, without a QRS abnormality clearly causing it, in the setting of ACS symptoms, is very concerning for posterior MI until proven otherwise. The Queen of Hearts seems really really good at finding subtle OMI. Stay tuned for upcoming studies showing this.

STEMI 52

STEMI ACS Coronary Defibrillator 52

EMS 12-Lead

APRIL 21, 2022

Such aggressive investigation was particularly warranted in this case because of symptoms compatible with ACS, as well as an equally frightening revelation of family history. Readers interested in a more robust discussion of STD vectors, and their implications in OMI, are encouraged to read this phenomenal post at the Smith ECG Blog.

Coronary 130

Coronary ALS OR ACS 130

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 83

STEMI ACS OR ALS 83

Dr. Smith's ECG Blog

MARCH 19, 2024

The cath report showed: Significant stenosis with subtotal occlusion (99%) in the prox to mid Lcx, culprit of ACS, TIMI flow 1. Available from: [link] If you are wondering about the Barcelona rule, then you should read the above paper by Khawaja et al. Cardiac catheterization occurred around 1pm (18 hours after arrival). 2021;23:187.

CAD 89

CAD STEMI ACS ALS 89

EMS 12-Lead

JUNE 1, 2022

In isolation, however, syncope does not hold significant weight for OMI – as opposed to something like crushing chest discomfort, for example – although stereotypical ACS might become blurry in both the elderly and diabetic populations. This is important because we must rely on the ECG to further elucidate the story when the patient cannot.

Coronary 130

Coronary ALS Firefighter OR 130

ACEP Now

MAY 9, 2024

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. References Newman-Toker DE, Peterson SM, Badihian S, et al. Auerbach AD, Lee TM, Hubbard CC, et al.

Emergency Department 52

Emergency Department ICU ALS ACS 52

ECG & Echo Learning

OCTOBER 2, 2022

References Overgaard, Dzavik et al. Jentzer et al. Müllner M, Urbanek B, Havel C, et al. Lherm T, Troché G, Rossignol M, et al. Gattinoni L, Brazzi L, Pelosi P, et al. Gregory JS, Bonfiglio MF, Dasta JF, et al. MacGregor DA, Smith TE, Prielipp RC, et al. Hannemann L, Reinhart K, Grenzer O, et al.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

Dr. Smith's ECG Blog

JUNE 8, 2023

As recurrent ischaemia is the principle event reduced by early intervention in NSTE-ACS, these are important endpoint events occurring with delayed angiography and there is a consistent signal for harm now from two data sources.”[5] Kontos et al. Welsh et al. Busk et al. Eur Heart J 2009 4 Lemkes et al.

STEMI 61

STEMI Coronary Paramedic ALS 61

ACEP Now

FEBRUARY 11, 2024

Sodhi M, Rezaeianzadeh R, Kezouh A, et al. Ahmann AJ, Capehorn M, Charpentier G, et al. ACS chemical neuroscience molecule spotlight on Contrave. ACS Chem Neurosci. Bansal AB, Al Khalili Y. A prescription for achieving equitable access to antiobesity medications. JAMA Health Forum. 2023;4(4):e230493. Steatorrhea.

Overdose 52

Overdose ACS Plasma ALS 52

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. References: Gaillard F, Glick Y, Tatco V, et al. 61.4.496 Navi BB, Kamel H, Shah MP, et al. Goldmakher GV, Camargo EC, Furie KL, Singhal AB, Roccatagliata L, Halpern EF, et al. link] Burns JD, Rindler RS, Carr C, et al.

EMS 73

EMS ALS OR ACS 73