Dr. Smith's ECG Blog

JANUARY 5, 2024

The documentation does not describe any additional details of the history. They also documented "Reproducible chest tenderness." Thus, these troponins are very concerning for ACS, and subsequent ones will probably be diagnostic of acute MI. Heitner et al. The following ECG was obtained. ECG 1 What do you think?

ACS 121

ACS ALS OR STEMI 121

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 Coronary 85

Dr. Smith's ECG Blog

MARCH 19, 2024

Cardiology documents their interpretation of ECG in their consult note - “atrial paced with old LBBB” The patient stayed at outside hospital (which does not have cardiac cath capabilities). The cath report showed: Significant stenosis with subtotal occlusion (99%) in the prox to mid Lcx, culprit of ACS, TIMI flow 1. 2021;23:187.

CAD 111

CAD STEMI ACS ALS 111

Dr. Smith's ECG Blog

AUGUST 9, 2024

He had no previously documented medical problems except polysubstance use. 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.

STEMI 107

STEMI Coronary Heart Attack ACS 107

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al. We therefore need to assume and rule "out" ACS — more than having to rule it "in".

E-9-1-1 131

E-9-1-1 OR Coronary ACS 131

Pediatric EM Morsels

AUGUST 18, 2023

None of the patients were documented to have joint disease at follow up. References: Ross RK, Kinlaw AC, Herzog MM, Funk MJ, Gerber JS. PMID: 27940800 Hersch AL, Gerber JS, Hicks LA, Pavia AT. There were 2523 children included. 451 pediatric patients were included. Nobody wants a pseudomonas superbug becoming prevalent!

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. This segues relatively nicely into a section of the document on palliative care. Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. To start with there are apparently 5 types of cardiorenal syndrome.

Critical Care 96

Critical Care ACS OR ALS 96

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. Kosuge et al. 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.

E-9-1-1 52

E-9-1-1 ACS ALS OR 52

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

APRIL 17, 2023

He had no symptoms of ACS. His HEAR score (before troponin resulted) was documented at 3, with documentation stating "low suspicion for ACS." A troponin this high in a patient with no known chronic troponin elevation, and active acute ACS symptoms, has a very high likelihood of type 1 ACS regardless of the ECG.

OR 52

OR STEMI ACS Emergency Department 52

Dr. Smith's ECG Blog

JULY 27, 2023

I did not think it was due to ACS, but we ordered an ED ECG immediately: What do you think? But in this case the clinical scenario is not right for acute ACS with OMI, and there is very high voltage, and the patient is very young, (though beware of young patients , even 29 year olds!! There is profound "inferior" ST Depression.

Coronary 52

Coronary ACS Naloxone Plasma 52

ACEP Now

FEBRUARY 11, 2024

There have been documented cases of overdose, and of note, there is no known antidote. 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. JAMA Health Forum. Steatorrhea.

Overdose 52

Overdose ACS Plasma ALS 52

EMDocs

JANUARY 11, 2024

Hematologic Management Takeaway : They recommend a transfusion threshold < 9 g/dL in those with ACS, but several studies (MINT trial) and guidelines suggest 8 g/dL can be used. Reference: Hirsch KG, Abella BS, Amorim E, et al; American Heart Association, Neurocritical Care Society.

Critical Care 98

Critical Care E-9-1-1 OR ICU 98

Dr. Smith's ECG Blog

OCTOBER 6, 2018

See the proof for yourself in the literature below: Schmitt et al. Diagnosis of acute myocardial infarction in angiographically documented occluded infarct vessel: limitations of ST-segment elevation in standard and extended ECG leads. From AM et al. Pride et al. From: Giannitsis et al. mm for women, 2.0

STEMI 40

STEMI Coronary ALS OR 40

ECG & Echo Learning

JANUARY 18, 2023

I C Glucose-lowering therapy should be considered in ACS patients with glucose levels >10 mmol/L (>180 mg/dL), while episodes of hypoglycaemia (defined as glucose levels <_3.9 I C In patients on metformin and/or SGLT2 inhibitors, renal function should be monitored for at least 3 days after angiography.

STEMI 40

STEMI Coronary OR Defibrillator 40

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 86

STEMI Coronary Paramedic ALS 86

EMDocs

FEBRUARY 12, 2024

ABG and VBG Correlation The correlation between venous and arterial blood gases is well-documented for standard differences (Table 1), and the data obtained from the VBG can be acted on as if it were an ABG (1, 3-6). References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. PMID: 11685301. (10)

Emergency Department 98

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

AAEM RSA

DECEMBER 3, 2020

Introduction: While cases of genital gangrene were documented as early as 980 CE, the condition we know today as FG was coined in the 1880’s by French venerologist, Jean Alfred Fournier. Fournier gangrene: an histori9]al reappraisal. Sugihara T, Yasunaga H, Horiguchi H, et al. Bjurlin MA, O'Grady T, Kim DY, et al.

Emergency Department 52

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

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)]. Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful. Del Rosso A, et al. Other studies 1) EGSYS score (full text link).

Emergency Department 52

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

Don't Forget the Bubbles

JULY 5, 2023

Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. Older children and adults usually present with ACS 2-3 days after hospitalisation due to pulmonary infarction (in situ sickling), hypoventilation due to rib infarction (which may be exacerbated by recent narcotic administration) or fat embolism.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

Dr. Smith's ECG Blog

MARCH 17, 2025

There is very scarce documentation, but the next ECG was obtained around 1 PM. Discussion: This case highlights many important points worthy of discussion, mainly because it represents very routine care for ACS but there are so many ways we could improve outcomes with tools we already have! A recent meta-analysis by Stone et al.

ACS 81

ACS STEMI Coronary ALS 81

Dr. Smith's ECG Blog

MARCH 25, 2025

In ACS, chest pain is the warning sign of ongoing ischemia. Documentation indicates that the patient was shocked 4 times (with no comment on energy level) and received amiodarone 300 mg IV and magnesium 2 g IV. In fact, in this elegant study by Heitner et al. It has some morphologic features of LVH, but not the voltage.

Defibrillator 63

Defibrillator ACS Coronary ALS 63

ACEP Now

FEBRUARY 19, 2025

As mentioned, AI has tremendous potential for automating non-teaming tasks such as documentation and data retrieval, and for managing ED workflow processes. References Edmondson AC. Tsai CH, Eghdam A, Davoody N, et al. Edmondson AC. Kirubarajan A, Taher A, Khan S, et al. Hinson JS, Taylor RA, Venkatesh A, et al.

E-9-1-1 51

E-9-1-1 ALS ED Emergency Department 51

The Curious Clinicians

JANUARY 9, 2025

Arrick et Al, Cephalopod-inspired jetting devices for gastrointestinal drug delivery. Sponsor Freed is an AI scribe that listens, transcribes, and writes medical documentation for you. It turns clinicians patient conversations into accurate documentation instantly. 2024 Dec;636(8042):481-487. Oral Argument. January 8th, 2025.

ACS 52

ACS OR ALS 52

The Curious Clinicians

JANUARY 31, 2025

Winski R, Xu J, Townsend J, Chan A, Wattengel BA, Davis M, Puckett A, Huntsman K, O’Leary AL, Mergenhagen KA. Sponsor Freed is an AI scribe that listens, transcribes, and writes medical documentation for you. It turns clinicians patient conversations into accurate documentation instantly. Open Forum Infect Dis.

ACS 52

ACS OR ALS 52

EMDocs

JANUARY 6, 2025

4,5 Of particular concern is the Sudanese conflict, which began in April 2023, and which has caused the largest internal displacement of a population in documented history. 57 Adapted from: Long B, MacDonald A, Liang SY, et al. link] Rother B, Pierre G, Lombardo D, et al. link] Hummell AC, Cummings M. 57 Table 2.

ED 75

ED E-9-1-1 ALS Emergency Department 75