REBEL EM

MARCH 2, 2023

REBEL Cast Ep114 – High Flow O2, Suspected ACS, and Mortality? Click here for Direct Download of the Podcast Paper: Stewart, RAH et al. PMID: 33653685 Clinical Question: Is there an association between high flow supplementary oxygen and 30-day mortality in patients presenting with a suspected acute coronary syndrome (ACS)?

ACS 52

ACS Coronary STEMI Ambulance 52

Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. In fact, Kosuge et al. Stein et al. This is a paper worth reading : Marchik et al. Kosuge et al. Witting et al. looked at consecutive patients with PE, ACS, or neither. What do you think?

E-9-1-1 138

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

Pediatric EM Morsels

SEPTEMBER 20, 2024

The post Hemolytic Uremic Syndrome (HUS): Rebaked Morsel appeared first on Pediatric EM Morsels. Schnadower, D., Finkelstein, Y.,Desai, Bergmann, K., Hariharan, S., HUS and RRT in STEC-infected Children. 2021 May;232:200-206.e4. doi: 10.1016/j.jpeds.2020.12.077. 2020.12.077. Epub 2021 Jan 5. PMID: 33417918; PMCID: PMC8084908.

Emergency Department 164

Emergency Department ACS ALS EMS 164

EMS 12-Lead

APRIL 14, 2022

He presented to EMS with extreme pallor, Levine sign, diaphoresis, bilateral arm pain, and an apprehensive sense of doom. It should be emphasized here that this is a presentation of high-pretest probability for Acute Coronary Syndrome (ACS). In the case of ACS, the ECG can rapidly change from this. link] [1] Zachary et al.

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. REBEL EM: Do Patients with Posterior Epistaxis Managed by Posterior Packs Require ICU Admission? EMRAP HD: Epistaxis Posterior Pack References Cassisi NJ et al.

ICU 104

ICU ALS ACS EMS 104

EMS 12-Lead

APRIL 8, 2022

He reported to EMS a medical history of GERD only. V2 – in the final EMS ECG the ST segment was baseline. V3 – in the final EMS ECG the ST segment was still slightly depressed. The EMS crews were correct moving forward with STEMI activation. However, in this context (i.e. 1] Driver, B. Emergency Medicine Journal, 1-5. [2]

STEMI 130

STEMI ALS Coronary CAD 130

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 58

EMS ACS ALS ED 58

The Skeptics' Guide to EM

MAY 29, 2021

Reference: Jhunjhunwala et al. Reference: Jhunjhunwala et al. The patient is an adult male with a gunshot wound to the chest, and they’re combative with emergency medical services (EMS). Reassessing the cardiac box: A comprehensive evaluation of the relationship between thoracic gunshot wounds and cardiac injury.

Emergency Medical Services 130

Emergency Medical Services ACS ALS Emergency Department 130

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. References: Jaff MR et al. PMID: 21422387 Wan S et al. PMID: 15262836 Sharifi M et al. PMID: 27422214 Wang C et al. PMID: 19741062 Kucher N et al. PMID: 24226805 Piazza G et al. PMID: 26315743 Tapson VF et al.

ALS 136

ALS ACS OR CPR 136

The Skeptics' Guide to EM

MAY 28, 2022

Date: May 24th, 2022 Reference: Broder et al. Date: May 24th, 2022 Reference: Broder et al. Reference: Broder et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) 2: Low-Risk, Recurrent Abdominal Pain in the Emergency Department. There can be many presentations for low-risk abdominal pain.

Emergency Department 100

Emergency Department ACS ALS Coronary 100

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Kuttab et al’s findings, constituting 45% of the review’s weight, suggest that administering <30cc/kg IVF is associated with increased odds of mortality, delayed hypotension, and increased ICU utilization. times more intubations and 2.15

E-9-1-1 121

E-9-1-1 ALS ACS ICU 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 OR 85

EMDocs

SEPTEMBER 6, 2023

Reference: EM@3AM – Heat Stroke Case 2: 40-year-0ld female feels unwell but no other specific complaints. 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. ROS unremarkable.

ACS 97

ACS ICU EMS ALS 97

EMS 12-Lead

JUNE 1, 2022

EMS finds him supine, alert and oriented, and without any gross distress. 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. 3] Meyers, H. 4] Dodd, K.

Coronary 130

Coronary ALS ED ACS 130

Dr. Smith's ECG Blog

AUGUST 9, 2024

About 2 hours later the patient arrived at a PCI-capable center and repeat ECG was obtained: The transferring EMS crew noted “runs of VT” during transport. 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.

STEMI 107

STEMI Coronary Heart Attack ACS 107

Broome Docs

DECEMBER 22, 2024

PARAMEDIC 3 randomized 6,000 (but they were supposed to get to 15,000) patients with out of hospital arrest from multiple EMS agencies in the UK to either an IO or IV to start. PMID: 39480221 We have 2 studies looking at the same question published in the same edition of the NEJM, so I will tackle them together. ( of the IO group and 5.1%

E-9-1-1 52

E-9-1-1 ACS Paramedic Emergency Department 52

Don't Forget the Bubbles

MAY 17, 2023

Antonaci L, et al. Tritos NA, et al. Levi M, et al. Fishbein MH, et al. Cetinkaya PG, et al. Niu T, et al. Verkuijl SJ, et al. Varni JW, et al. Dias FC, et al. Peter C, et al. Ahlberg R, et al. Shir A, et al. Kuypers KLAM, et al. Hegeman EM, et al.

ALS 72

ALS ACS Emergency Department EMS 72

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 121

STEMI Coronary ALS CAD 121

Dr. Smith's ECG Blog

DECEMBER 19, 2023

EMS obtained the following vital signs: pulse 50, respiratory rate 16, blood pressure 96/49. It appears EMS obtained two EKGs, but unfortunately these were not saved in the medical record. The EMS crew was only BLS certified, so EKG interpretation is not within their scope of practice.

E-9-1-1 127

E-9-1-1 Coronary ACS BLS 127

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

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 77

Emergency Department ALS ACS EMS 77

EMDocs

AUGUST 31, 2023

link] Li Z, Krippendorff BF, Sharma S, Walz AC, Lavé T, Shah DK. Bush SP, Ruha AM, Seifert SA, et al. link] Kanaan NC, Ray J, Stewart M, et al. link] Full prescribing information. Crotalidae polyvalent immune fab (ovine). Published online January 2018. Accessed August 17, 2023. 2016;8(1):113-119. Published online November 2020.

Allergic Reaction 97

Allergic Reaction Plasma ALS EMS 97

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

Queen of Hearts now thinks that this one looks like posterior OMI, since the STD does appear worst in V3-4: None of this seems to have been understood by the EM doctor or the cardiologist who was consulted. In our opinion it should not be given in ACS unless you are committed to the cath lab. Hayakawa A, Tsukahara K, Miyagawa S, et al.

ACS 82

ACS Coronary ALS CAD 82

EMDocs

SEPTEMBER 25, 2023

Personal take: While discussing this approach with many EM physicians whom we respect, one recurring critique was “We fought so hard to get the right to use paralytics in the ED, why would you want to go backwards.” References: Heffner AC et al. PMID: 23911630 Kim WY et al. PMID: 23911630 Kim WY et al. 2007): 748.

ED 93

ED Emergency Department ALS Paramedic 93

EMS 12-Lead

APRIL 2, 2022

Anecdotally, had there been symptoms unequivocally consistent with ACS then one could justifiably make the case for a potential D1 occlusion. 4] Baranchuk, A, et al. Given such findings, serial ECG’s are prudent to consider, and carry significant impact moving forward, which has been demonstrated in previous posts. 2] Surawicz, B.

ALS 130

ALS STEMI Coronary OR 130

Pediatric EM Morsels

AUGUST 18, 2023

References: Ross RK, Kinlaw AC, Herzog MM, Funk MJ, Gerber JS. PMID: 27940800 Hersch AL, Gerber JS, Hicks LA, Pavia AT. PMID: 29356761 The post Fluoroquinolone Use In Children appeared first on Pediatric EM Morsels. However, Fluroquinolone resistance is increasing, so they should only be used if absolutely necessary!

E-9-1-1 130

E-9-1-1 ACS OR ALS 130

Dr. Smith's ECG Blog

MAY 13, 2020

A 60-something man presented by EMS with 5 hours of fairly typical sounding substernal chest pain. 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. Today’s Post by Dr.

Coronary 52

Coronary ACS EMS STEMI 52

ACEP Now

NOVEMBER 7, 2023

EMS physicians report he was found in ventricular fibrillation. References Go AS, Mozaffarian D, Roger VL, et al. Larribau R, Deham H, Niquille M, et al. Margey R, Browne L, Murphy E, et al. Kudenchuk PJ, Brown SP, Daya M, et al. Spies DM, Kiekenap J, Rupp D, et al. Holmén J, Hollenberg J, Claesson A, et al.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. 2023 Jul 17.

Operating Room 52

Operating Room ACS Critical Care Coronary 52

Don't Forget the Bubbles

JUNE 30, 2023

Baraniuk S, Tilley BC, del Junco DJ, Fox EE, van Belle G, Wade CE, Podbielski JM, Beeler AM, Hess JR, Bulger EM, Schreiber MA, Inaba K, Fabian TC, Kerby JD, Cohen MJ, Miller CN, Rizoli S, Scalea TM, O’Keeffe T, Brasel KJ, Cotton BA, Muskat P, Holcomb JB; PROPPR Study Group. Laan DV, Vu TD, Thiels CA et al. 2014 Sep;45(9):1287-95.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

REBEL EM

FEBRUARY 2, 2023

Paper: Mason JM, et al. This could have biased the results in favor of amiodarone as we’ve covered this before on REBEL EM before The IV amiodarone group required less additional HR control agents to control increased heart rate. These results were corroborated with other another study by Gritensko et al. Am J Emerg Med.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. En route, EMS administered aspirin 325mg by mouth, but withheld nitroglycerin due to initial hypotension. Answer below in the still shot. NEJM 362(9):779; March 4, 2009.

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al.

Emergency Department 52

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

Dr. Smith's ECG Blog

MARCH 6, 2019

She did not receive any opioids (which would mask her pain without affecting any underlying ACS). Patel et al., Krucoff et al.) Patel et al. Krucoff et al. Schomig et al. Krucoff et al.) ) to disastrous consequences that may deteriorate before the patient can be rushed to the cath lab. Heart 1996.

STEMI 52

STEMI ALS ACS ICU 52

ACEP Now

NOVEMBER 14, 2023

Bourke Tillmann and Scott Weingart for their expertise on the EM Cases podcast that inspired this column. References Deshwal H, Sinha A, Mehta AC. Atchinson PRA, Hatton CJ, Roginski MA, et al. Ittrich H, Bockhorn M, Klose H, et al. Li H, Ding X, Zhai S, et al. Kathuria H, Hollingsworth HM, Vilvendhan R, et al.

E-9-1-1 52

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

Don't Forget the Bubbles

MAY 3, 2023

Forestell B, Battaglia F, Sharif S, et al. Prekker ME, Bjorklund AR, Myers C, et al. O’Connell KJ, Sandler A, Dutta A, et al. O’Connell et al. O’Connell et al. Garabon JJW, Gunz AC, Ali A, Lim R. Garabon et al. Which way should we go? Crit Care Explor. 2023;5(2):e0857. Published 2023 Feb 17.

CPR 52

CPR Emergency Department ALS ICU 52

FOAMfrat

OCTOBER 20, 2023

And according to a paper from Russotto et al. Of note, in the paper by Russotto et al., Dr. Jarvis of The EMS Lighthouse Project podcast also covers this paper in detail here: [link] ^^^ I highly recommend listening! Sackles et al. Heffner AC, Swords DS, Neale MN, Jones AE. De Jong A, Molinari N, Terzi, et al.

E-9-1-1 52

E-9-1-1 ALS ACS OR 52