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Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device. Here is an article I wrote: Updates on the ECG in ACS. Was this: 1) ACS with ischemia and spontaneous reperfusion? She arrived in the ED 37 minutes after 911 was called, with continuing CPR.
Armstrong et al. The patient is started on epinephrine infusion for cardiogenic shock and cardiology took the patient to the cath lab. 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.
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. Fekri MS, Hashemi-Bajgani SM, Shafahi A, et al. Wand O, Guber E, Guber A, et al. Am J Emerg Med.
With ventilations and epinephrine, she regained a pulse. Kurkciyan et al. Kurkciyan et al., A middle-age woman with h/o hypertension was found down by her husband. Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. She was hypotensive in the ED and her bedside echo showed a normal RV and LV.
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.
And according to a paper from Russotto et al. Of note, in the paper by Russotto et al., Epinephrine should be considered as the vasopressor of choice in patients with decreased myocardial function. Sackles et al. Heffner AC, Swords DS, Neale MN, Jones AE. De Jong A, Molinari N, Terzi, et al. Brown, C.A.
He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. 3–8 Shi et al. Sandoval Y, Smith SW, Sexter A, et al. Shi S, Qin M, Shen B, et al. Guo T, Fan Y, Chen M, et al. Lala A, Johnson KW, Russak AJ, et al.
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.
Multiple attempts at defibrillation, epinephrine, and amiodarone have been unsuccessful. 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. Circulation.
Rosh Review Website Link Further Reading Further FOAMed: [link] [link] References: Ahmad SA, Brito D, Khalid N, et al. Additional fluids will not improve her condition and may worsen it. Takotsubo Cardiomyopathy. Updated 2023 Jan 9]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
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