ACEP Now

NOVEMBER 14, 2023

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.

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Emergency Medicine Ireland

JULY 3, 2023

Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS. It is important to realise that a referral to ICU for refractory cardiorenal syndrome may simply be a sign that the patient is reaching end of life. Type 1 is the acute deterioration in kidney function seen in cardiogenic shock from ACS.

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REBEL EM

FEBRUARY 2, 2023

2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Paper: Mason JM, et al. These results were corroborated with other another study by Gritensko et al. Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). References Mason JM, et al.

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EMDocs

JUNE 7, 2023

Disposition is often admission to an intensive care unit (ICU) setting. Further management and resuscitation were required, and she had a lengthy ICU stay of 21 days until she was extubated. References: Boostani R, Mellat A, Afshari R, et al: Delayed polyneuropathy in farm sprayers due to chronic low dose pesticide exposure.

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EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay. Arch Neurol.

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ECG & Echo Learning

OCTOBER 2, 2022

Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). 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. Circulation 2011.

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Dr. Smith's ECG Blog

JANUARY 6, 2023

Lupu L, et al. Smith comment: We have shown that use of opiates is associated with worse outcomes in ACS: Bracey, A. The facility was not pressed to activate emergent transfer for PCI since the pain was improving and suggested we optimize pain control and admit to the Cardiac ICU. mg/dL, K 3.5 OMI is not just an ECG diagnosis.

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REBEL EM

JULY 14, 2022

Paper: Nassal MMJ, et al. An example using a real case I had while on call in the ICU: A 61-year-old female had a post-induction arrest on the wards/hospital telemetry floor after being intubated for airway protection. REFERENCES: Nassal MMJ, et al. PMID: 34968531 Rittenberger JC, et al. PMID: 21756969 Coppler PJ, et al.

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AAEM RSA

APRIL 1, 2021

1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 Holcomb JB, Tilley BC, Baraniuk S, et al.

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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.

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Dr. Smith's ECG Blog

MARCH 6, 2019

She did not receive any opioids (which would mask her pain without affecting any underlying ACS). If for some reason the angiogram is delayed, they should receive maximal medical therapy in an ICU setting with continuous 12-lead ST segment monitoring under the close attention of a practitioner with advanced ECG interpretation training.

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EMDocs

SEPTEMBER 25, 2023

Despite the risk of hypotension and bradycardia, propofol has been shown in the ICU setting to be a safe and effective monotherapy intubation agent for hemodynamically unstable patients (19). References: Heffner AC et al. PMID: 23911630 Kim WY et al. PMID: 23911630 Kim WY et al. PMID: 25402500 Forsythe SM et al.

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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. Digestive Management Takeaway: Start enteral feeds when the patient gets to the ICU. Administer VTE prophylaxis in the first 48 hours, preferably LMWH.

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Don't Forget the Bubbles

JUNE 30, 2023

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. Kulvatunyou N, Bauman ZM, Zein Edine SB, de Moya M, Krause C, Mukherjee K, Gries L, Tang AL, Joseph B, Rhee P. Laan DV, Vu TD, Thiels CA et al. Trauma Surg Acute Care Open.

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ALiEM

OCTOBER 30, 2024

We have certainly seen patients who have pain which is controlled and still have psychomotor agitation and sympathetic activation, leading some to require ICU admission for dexmedetomidine and/or ketamine infusion. Multimodal medication options for fentanyl-xylazine withdrawal management in London et al. mg IVP Tizanidine 4 mg PO 0.15

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Dr. Smith's ECG Blog

APRIL 20, 2018

I took part in her ICU care and she was extubated and stable to transfer to a stepdown unit after a few days. Patients like her are the reason we are advocating for a change in the ACS paradigm from STEMI to OMI. Her repeat ECHO showed an improving EF of 37%. Note that this is completely different from 'terminal QRS distortion'.

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EMDocs

JANUARY 6, 2024

10 Although this is not the same pathophysiology seen in ACS from an acute plaque rupture leading to coronary artery occlusion, patients can have relatively abrupt coronary ischemia causing ACS due to acute, concentric vessel narrowing. 3 Many will experience vague, nonspecific symptoms such as weakness or fatigue.

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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.

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EMDocs

OCTOBER 7, 2023

Oda J, Tanaka H, Yoshioka T, et al. Tanaka H, Oda J, Iwai A, et al. Goodman AD, Got CJ, Weiss AC. Chen CY, Lin YR, Zhao LL, et al. Wald R, Quinn RR, Luo J, et al. Somagutta MR, Pagad S, Sridharan S, et al. Crush Injuries with Impairment of Renal Function. 1941;1(4185):427-432. Am J Emerg Med. Critical Care.

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EMDocs

FEBRUARY 12, 2024

In this situation, an ABG should be obtained periodically for correlation, though this is more relevant for the intensive care unit (ICU) setting than in routine ED care (5, 9). References/Further Reading (1) Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. 11) Webb RK, Ralston AC, Runciman WB. PMID: 11685301. (10)

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