ACS, Article and E-9-1-1 - Paramedicine Now

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

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. C Examination notable for diaphoresis, 1+ bilateral lower extremity edema, regular heart rate and rhythm, and no signs of respiratory distress with normal breath sounds. What do you think? In fact, Kosuge et al. Stein et al.

E-9-1-1

E-9-1-1 ACS Emergency Department Coronary

Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Guideline-based and restricted fluid resuscitation strategy in sepsis patients with heart failure: A systematic review and meta-analysis [published online ahead of print, 2023 Aug 9]. References: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM.

E-9-1-1

E-9-1-1 ALS ACS ICU

Elbow Dislocations

REBEL EM

NOVEMBER 6, 2024

1998 Jan-Feb;6(1):15-23. PMID: 32644703 Robinson PM, Griffiths E, Watts AC. 2017 Jul;9(3):195-204. PMID: 27227986 Glover NM, Black AC, Murphy PB. PMID: 29681420 Gottschalk HP, Eisner E, Hosalkar HS. 1999 Jan;13(1):58-9. J Am Acad Orthop Surg. doi: 10.5435/00124635-199801000-00002. 2022 Aug 2.

E-9-1-1

E-9-1-1 ACS OR Emergency Department

Optimizing Hemodynamics Prior to RSI

FOAMfrat

OCTOBER 20, 2023

As reported within the 6th edition Manual of Emergency Airway Management, there are cardiac arrest rates between 1% and 4%, with other complications (mostly hypoxemia and hypotension) as high as 30% in patients with first-pass success [1, pg 29; 4-10]. Why is Physiologic Optimization Important? Up to 44% per other sources [12].

E-9-1-1

E-9-1-1 ALS ACS OR

Sickle Cell Disease Module

Don't Forget the Bubbles

JULY 5, 2023

See this helpful summary article for more info. Figure 1: Clinical manifestations and long-term consequences of sickle cell disease Training and education on sickle cell disease: Training and education are crucial to improve morbidity and mortality. In patients with sickle cell anaemia, functional asplenia develops at 1 year of age.

E-9-1-1

E-9-1-1 ACS OR ICU

Choosing Wisely – Investigations for seizures that have returned to baseline

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. When considering tumours, 37 observation studies involving 2661 children found that 3% (95% CI 1-7%) had tumours.

E-9-1-1

E-9-1-1 Emergency Department ALS OR

Are these Wellens' waves?

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. 4 important features that indicate acute right hear strain: 1. looked at consecutive patients with PE, ACS, or neither. Tachycardia (or nearly) 2. Poor R-wave progression 4.

E-9-1-1

E-9-1-1 ACS ALS OR

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

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. mm of ST segment elevation, V2 and V3 have 1 mm of elevation, v4 has 2 mm of elevation and v5 around 1.5 Learning Points: 1. What do you think? V1 has 0.5

Emergency Department

Emergency Department E-9-1-1 Coronary STEMI

"Pericarditis" strikes again

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. On review of systems the patient reported back pain for approximately 1 week which he was treating with NSAIDs with minimal relief. 15-9/6/2017 ). His first troponin T then resulted elevated at 0.19

E-9-1-1

E-9-1-1 ACS Coronary CAD

Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Here they are: Learning Points: 1. 7 These 3 studies, as well as 1 smaller meta-analysis, 6 and another small study, 8 make it clear that troponin is associated with increased severity and mortality in COVID when adjusted for multiple other variables. Am J Med [Internet] 2017;130(12):1431–9.e4. Available from: [link] 9.

E-9-1-1

E-9-1-1 STEMI Coronary ALS

What Is the Best Defibrillation Strategy for Refractory Ventricular Fibrillation?

ACEP Now

NOVEMBER 7, 2023

1 Overall, survival is poor following cardiac arrest, and is affected by factors including age, comorbidities, witnessed arrest, early CPR, early defibrillation, and return of spontaneous circulation (ROSC). 2018;13(9):e0204169. Margey R, Browne L, Murphy E, et al. Emmerson AC, Whitbread M, Fothergill RT. 20(S1):S67.

Defibrillator

Defibrillator E-9-1-1 ALS Epinephrine

Platelet-Lymphocyte Ratio and Neutrophil-Lymphocyte Ratio: Updates in Prognosticating Fournier Gangrene in the Emergency Department

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. 2018;48(9):1157-1160. 2020;26(1):8-17. 2018;8(1):88. Internal medicine journal. Filippone LM. Clin Microbiol Infect.

Emergency Department

Emergency Department E-9-1-1 ALS EMT

Pain Management of Common Chief Complaints in the ED

EMDocs

NOVEMBER 4, 2024

1 The ED is a fast-paced environment where patient stability and life-and-limb-threatening conditions are prioritized. Medication dosages detailed in this article are suggestions; local institutional pharmacy dosage policies should be followed. Opioid analgesia is appropriate for moderate to severe acute abdominal pain (Table 1).

ED

ED E-9-1-1 Emergency Department ALS

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

APRIL 8, 2015

Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. Palpitations preceding syncope (highest value on EGSYS score) 9. Annotated Bibliography For an excellent overview of ED Syncope management , see this article by Kessler C et al. Hemoglobin less than 10 (SF rule) 6.

Emergency Department

Emergency Department E-9-1-1 ED OR

Paramedicine Now

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Congestive Heart Failure and Sepsis: A Closer Look at Fluid Management

Trending Sources

Elbow Dislocations

Optimizing Hemodynamics Prior to RSI

Sickle Cell Disease Module

Choosing Wisely – Investigations for seizures that have returned to baseline

Are these Wellens' waves?

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

"Pericarditis" strikes again

Extreme shock and cardiac arrest in COVID patient

What Is the Best Defibrillation Strategy for Refractory Ventricular Fibrillation?

Platelet-Lymphocyte Ratio and Neutrophil-Lymphocyte Ratio: Updates in Prognosticating Fournier Gangrene in the Emergency Department

Pain Management of Common Chief Complaints in the ED

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

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