Dr. Smith's ECG Blog

MARCH 1, 2023

This pattern occurs regardless of whether the cause is ACS (decreased supply) or any other cause of decreased supply or increased demand. You must understand that this pattern does not differentiate ACS from other causes of supply/demand mismatch. ST depression will not always be present in 9/12 leads — as is seen in Figure-1.

Allergic Reaction 52

Allergic Reaction E-9-1-1 Epinephrine Coronary 52

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

References: 1) See this study showing an association between morphine and mortality in Non-STE-ACS: Meine TJ, Roe M, Chen A, Patel M, Washam J, Ohman E, Peacock W, Pollack C, Gibler W, Peterson E. Despite not being considered in this category, opioid medications are sometimes given for ACS. Am Heart J.

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E-9-1-1 ACS STEMI Coronary 78

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

We who know ischemic ECGs know that really when T-wave inversion is specific for coronary thrombosis that it indicates reperfusion of the artery, not active occlusion. Learning Point: 1. For examples of such exceptions — See My Comment in the January 9, 2019 — August 22, 2020 — and June 30, 2023 posts in Dr. Smith's ECG Blog ).

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E-9-1-1 Coronary EMS ED 107

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 What do you think? V1 has 0.5 mm of elevation.

Emergency Department 52

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

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.

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E-9-1-1 ACS ALS OR 52

ECG & Echo Learning

OCTOBER 2, 2022

Most agents exhibit both vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). μg/kg/min + + + ++ Low dose dopamine stimulates D1 receptors and induces vasodilation in coronary, renal, cerebral and mesenteric vessels.

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E-9-1-1 ALS Coronary Epinephrine 52

Dr. Smith's ECG Blog

DECEMBER 10, 2019

The pain is described as located in the midsternal area, radiating to the right arm, described as 8-9/10 and worse with deep inspirations. In the evening, he became diaphoretic and complained of 9/10 continuous chest pain. If there is NO WMA, then it is not coronary occlusion, but if there IS one, then you still don't have a diagnosis.

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E-9-1-1 Coronary OR ACS 52

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

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E-9-1-1 ACS Coronary CAD 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

A 40-something male presented with dyspnea and left arm numbness, and perhaps some chest tightness, for 1 1/2 hours. E CG # 1 = the initial Triage ECG ( TOP ) — As per Dr. . = Here is his triage ECG: There is massive STE in V3-V6, and also STE in II, III, aVF. Why is this important? Mokhtari et al. JACC 2016;67:1531.

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

And so it is wise to look at the coronary arteries. Here they are: Learning Points: 1. This ECG certainly looks like myocarditis, and was due to myocarditis, but missing acute coronary occlusion is not acceptable. In acute MI, the T-wave is large, and the T/ST ratio is high. This is much more typical of myocarditis.

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E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

There are two main etiologies of ischemic ST-depression: 1) subendocardial ischemia 2) reciprocal to ST-elevation in an opposite wall Here there are distinct R-waves with marked ST-depression throughout most of the precordium. Tips for recognizing Acute Posterior STEMI: 1. References: 1. This can help in confirmation.

STEMI 52

STEMI E-9-1-1 Coronary ALS 52

EMDocs

JANUARY 11, 2024

The neurologic section was divided into (1) brain oxygenation, perfusion, edema, and intracranial pressure (ICP); (2) seizures and the ictal-interictal continuum (IIC); and (3) sedation and analgesia. Reference: Hirsch KG, Abella BS, Amorim E, et al; American Heart Association, Neurocritical Care Society. 2023 Dec 1.

Critical Care 75

Critical Care E-9-1-1 OR ICU 75

EMDocs

JANUARY 20, 2024

She describes the pain as left-sided, non-radiating, and 9/10 in severity. The catheterization lab is activated, but catheterization shows no coronary artery occlusion. A 67-year-old female with past medical history of hypertension presents with acute onset of chest pain without associated symptoms. What is the diagnosis?

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E-9-1-1 EMS Coronary ACS 74

EMDocs

JANUARY 6, 2024

1 Indications for transplant include: Non-ischemic cardiomyopathy (49%) Ischemic cardiomyopathy (35%) Restrictive cardiomyopathy (4%) Retransplantation following failed prior transplant (3%) Hypertrophic cardiomyopathy (3%) Congenital heart disease (3%) Valvular cardiomyopathy (3%) The median survival after heart transplant is over 12 years.

EMS 63

EMS E-9-1-1 ACS Coronary 63

EMDocs

NOVEMBER 4, 2024

1 The ED is a fast-paced environment where patient stability and life-and-limb-threatening conditions are prioritized. The pain began abruptly 1 hour ago, described as a stabbing sensation, and has occurred daily at the same time for the past week, each episode lasting about 45 minutes. Pain can be improved or exacerbated with meals.

ED 98

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

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. It's complicated, but they derived a score based on these variables: 1. h/o heart disease (+1) 3. Troponin greater than 99th percentile (+1) 5.

Emergency Department 52

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