Don't Forget the Bubbles

SEPTEMBER 13, 2023

This series of DFTB articles aims to increase awareness of the Choosing Wisely ® recommendations. Each article will take a deeper dive into each recommendation’s supporting evidence and practical implications. doi:10.1093/tropej/fmz071 Expert Panel on Pediatric Imaging, Trofimova A, Milla SS, et al. J Trop Pediatr.

E-9-1-1 131

E-9-1-1 Emergency Department ALS OR 131

FOAMfrat

OCTOBER 20, 2023

And according to a paper from Russotto et al. Of note, in the paper by Russotto et al., However, a previous blog I wrote covers this in relative detail, and the purpose of this article is to cover optimization as it applies to hemodynamics. Sackles et al. Brown, C.A. and Walls, R.M. Edited by J.C.

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

REBEL EM

NOVEMBER 6, 2024

PMID: 32644703 Robinson PM, Griffiths E, Watts AC. PMID: 27227986 Glover NM, Black AC, Murphy PB. Commentary on an article by Marc Schnetzke, MD, et al.: “Determination of Elbow Laxity in a Sequential Soft-Tissue Injury Model. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Simple elbow dislocation.

E-9-1-1 59

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

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. In a recent article (J Electrocardiol this year, see reference below), peak trop onin I levels in takotsubo presenting with ST Elevation were median 1.02 Lindahl et al.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

Dr. Smith's ECG Blog

MARCH 4, 2023

MOREVER, the morphology of the TWI is just not right for ACS. S1Q3T3 This is a paper worth reading : Marchik et al. In the Marchik article, (assuming they defined it the same way, and the methods do not specify this), among patients with suspicion for PE, S1Q3T3 was found in 8.5% Kosuge et al. incomplete RBBB 1.7

ACS 52

ACS ALS OR 52

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

STEMI 107

STEMI Coronary ACS ED 107

Don't Forget the Bubbles

JULY 5, 2023

See this helpful summary article for more info. Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. The treatment for ACS is mainly supportive: Oxygen : supplemental oxygen should be given only when the patient is hypoxic (saturation of oxygen < 94%).

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

Dr. Smith's ECG Blog

MAY 13, 2020

Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS. The ECG only tells you there is ischemia, not the etiology of it. Nevertheless, the clinical situation made other etiologies unlikely.

Coronary 52

Coronary ACS EMS STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

Some providers were worried about ACS because of this ECG. My answer alleviated their concern for ACS and no further workup was done for ACS. In the Marchik article, (assuming they defined it the same way, and the methods do not specify this), among patients with suspicion for PE, S1Q3T3 was found in 8.5% Kosuge et al.

E-9-1-1 52

E-9-1-1 ACS ALS OR 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

But if they do present: The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion , though it might be due to sub total LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. Widimsky P et al. Knotts et al. TIMI 0/1 flow).(61,62)

Coronary 52

Coronary STEMI ACS 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. Reference article,   Radiopaedia.org (Accessed on 15 Apr 2023) [link] Mattle HP, Arnold M, Lindsberg PJ, Schonewille WJ, Schroth G: Basilar artery occlusion. Top of the basilar syndrome.

EMS 72

EMS ALS OR ACS 72

Dr. Smith's ECG Blog

MARCH 12, 2018

It is also true that anterior and inferior T-wave inversion could be consistent with reperfusion of a type III wraparound LAD occlusion, despite the fact that Kosuge et al showed that T-wave inversion in lead III is much more likely to be PE than ACS if your differential contains nothing else. Stein et al. Kosuge et al.

ACS 52

ACS Coronary ALS ICU 52

Dr. Smith's ECG Blog

JANUARY 17, 2023

The September 27, 2019 post — for the Rowlands & Moore article with the above-noted formulas for recognizing the “culprit” extremity. Additional review of ECG artifacts by Pérez-Riera et al ( Ann Noninvasic Electrocardiol 23:e12494, 2018 ) VT Artifact — by Knight et al: NEJM 341:1270-1274, 1999.

ALS 52

ALS ACS OR ED 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Although this is considered a "STEMI equivalent" and the ACC/AHA guidelines even approve of thrombolytics for ACS with this ECG, the usual criteria used to alert the cath lab team of an inbound Code STEMI are not met by this ECG. For instance: sepsis, bleeding, dehydration, hypoxia, and mild ACS. NEJM 362(9):779; March 4, 2009.

Coronary 52

Coronary ACS ALS STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

3–8 Shi et al. 4 Unfortunately, this article provides no electrocardiographic, echo, or angiographic data, so it is not certain that these high levels were in the absence of acute MI. Sandoval Y, Smith SW, Sexter A, et al. Shi S, Qin M, Shen B, et al. Guo T, Fan Y, Chen M, et al. He XW, Lai JS, Cheng J, et al.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

JULY 11, 2019

CLICK HERE — for a brief article by Rowlands et al that explains these concepts in more detail. Meyers : This ECG was texted to me with no clinical information, and my response was: "That looks like a very subtle LAD OMI.

STEMI 52

STEMI ACS CAD ED 52

ACEP Now

NOVEMBER 7, 2023

8-12 A recent scoping review published in The American Journal of Emergency Medicine reviewed articles between 2016 and 2019, and found 18 observational studies, which failed to demonstrate sufficient evidence for widespread implementation of DSED. References Go AS, Mozaffarian D, Roger VL, et al. Margey R, Browne L, Murphy E, et al.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

Don't Forget the Bubbles

MAY 3, 2023

With millions of journal articles published yearly, it is impossible to keep up. This time the PEM MSc team from QML , in association with DFTB, are taking over… Article 1: Insulin infusion in paediatric DKA – high or low? Forestell B, Battaglia F, Sharif S, et al. Prekker ME, Bjorklund AR, Myers C, et al.

CPR 52

CPR Emergency Department ALS ICU 52

AAEM RSA

DECEMBER 3, 2020

This brief article discusses use of the monocyte-lymphocyte ratio, neutrophil-lymphocyte ratio, and platelet-lymphocyte ratio; recently innovated, simple, and effective biomarkers for prognosticating NSTIs. Fournier gangrene: an histori9]al reappraisal. Sugihara T, Yasunaga H, Horiguchi H, et al. References Short B. 2016;4:1-3.

Emergency Department 52

Emergency Department E-9-1-1 ALS EMT 52

EMDocs

NOVEMBER 4, 2024

Medication dosages detailed in this article are suggestions; local institutional pharmacy dosage policies should be followed. 54 It is vital to consider dangerous epigastric pain mimickers like acute coronary syndrome (ACS), hepatobiliary disease, or pancreatitis. 2014.01.015 Motov S, Strayer R, Hayes BD, et al. J Emerg Med.

ED 97

ED E-9-1-1 Emergency Department ALS 97

Dr. Smith's ECG Blog

APRIL 8, 2015

Also consider non-hemorrhagic volume depletion, dehydration : orthostatic vitals may uncover this [see Mendu et al. (3)]. Annotated Bibliography For an excellent overview of ED Syncope management , see this article by Kessler C et al. Del Rosso A, et al. starts at end of article on p. Heart 2008;94(12):1620–6.

Emergency Department 52

Emergency Department E-9-1-1 ED ALS 52