ACS, Definition and ICU - Paramedicine Now

Sickle Cell Disease Module

Don't Forget the Bubbles

JULY 5, 2023

Haemoglobin electrophoresis: To reach a definitive diagnosis, Hb electrophoresis is used. Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. The treatment for ACS is mainly supportive: Oxygen : supplemental oxygen should be given only when the patient is hypoxic (saturation of oxygen < 94%).

E-9-1-1

E-9-1-1 ACS OR ICU

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

JANUARY 9, 2024

However , this patient is having chest discomfort, and by definition then she should be considered not to be stable. Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? If the patient is hemodynamically stable, iv amiodarone could be considered in such a clinical situation. Is this: 1.

Coronary

Coronary ACS ED OR

Diagnostic Errors, Revisited: Where Do We Go Wrong, and How Can We Change?

ACEP Now

MAY 9, 2024

After developing encephalopathy and hypoxemic respiratory failure, the patient was transferred to the ICU. Further diagnostic testing in the ICU identified salicylate toxicity. The diagnostic error was therefore classified as relating to the delays associated with testing and its effect on subsequent definitive management.

Emergency Department

Emergency Department ICU ALS ACS

Penetrating chest trauma

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. REBOA increased deaths due to bleeding at three hours and 90 days and substantially delayed time to definitive haemorrhage control. c) Or, do both? Trauma Surg Acute Care Open.

E-9-1-1

E-9-1-1 FFP Plasma Emergency Department

A woman in her 50s with acute chest pain

Dr. Smith's ECG Blog

JANUARY 6, 2023

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. OMI is not just an ECG diagnosis.

ACS

ACS Coronary ICU STEMI

A Seven-Step Approach to Massive Hemoptysis

ACEP Now

NOVEMBER 14, 2023

The definition of massive hemoptysis is variable across publications with expectorated blood volumes ranging from 100 to 1,000 mL per 24 hours, as these volumes are difficult to estimate for any given patient. References Deshwal H, Sinha A, Mehta AC. Portable chest X-ray may help determine from which lung the bleeding originates.

E-9-1-1

E-9-1-1 ALS Emergency Department OR

Amiodarone Versus Digoxin for Acute Rate Control of Atrial Fibrillation in the Emergency Department

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). Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). Therefore, no definitive conclusions can be made about this trial.

Emergency Department

Emergency Department ALS Critical Care ED

Resident Journal Review: Massive Transfusion Protocols (MTPs) in Traumatic Hemorrhage

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 ACS TQIP Best Practice Guidelines. 248(3):447-58.

E-9-1-1

E-9-1-1 Plasma ACS ALS

What will you do for this patient transferred to you who is now asymptomatic?

Dr. Smith's ECG Blog

MARCH 6, 2019

She did not receive any opioids (which would mask her pain without affecting any underlying ACS). Lead I has a definitively hyperacute T-wave without STE. By the time the patient arrived at our facility, she had received aspirin and nitroglycerin, and her pain had apparently completely resolved. V2 still has STE and hyperacute T-waves.

STEMI

STEMI ALS ACS OR

A Patient with Respiratory Failure and a Computer "Normal" ECG

Dr. Smith's ECG Blog

MARCH 11, 2019

The patient was managed in the ICU and had serial troponins. An angiogram confirmed ACS as the etiology. Finally — there has been further evolution of the subtle ST-T wave abnormalities in leads V2, V5 and V6 — which now all show definite ST-T wave flattening in ECG #2. He had no more ECGs recorded. First was 2.9

OR

OR ACS ICU STEMI

Beyond Ketamine: When to use Facilitated Intubation in the ED

EMDocs

SEPTEMBER 25, 2023

Also known as Facilitated intubation (FI), the use of intubating with only a sedative was an accepted alternative intubation technique prior to those definitive studies in the late 1990s but quickly was abandoned for RSI in all emergent endotracheal intubations (ETI) (8,9). References: Heffner AC et al. PMID: 23911630 Kim WY et al.

ED

ED Emergency Department ALS Paramedic

EM@3AM: Cardiac Transplant Complications

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.

EMS

EMS E-9-1-1 ACS Coronary

EM@3AM: Crush Injury

EMDocs

OCTOBER 7, 2023

6 Prolonged down time from falls, usually in the elderly Incidence is difficult to ascertain due to broad definition and that events that cause crush injuries are rather rare. Goodman AD, Got CJ, Weiss AC. A systematic review on the definition of rhabdomyolysis. Crush syndrome: a case report and review of the literature.

EMS

EMS E-9-1-1 Emergency Department ALS

ABG Versus VBG in the Emergency Department

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). 11) Webb RK, Ralston AC, Runciman WB. proning patients, ECMO) (12). PMID: 11685301. (10) 10) Jubran A. Pulse oximetry. Intensive Care Med. Epub 2004 Jul 24.

Emergency Department

Emergency Department E-9-1-1 ED ICU

The 70th Bubble Wrap – DFTB x MSc in PEM

Don't Forget the Bubbles

MAY 3, 2023

Garabon JJW, Gunz AC, Ali A, Lim R. This explorative review described insertion success rates, time to first insertion, and duration of IO function (time from insertion to IO failure, IV access insertion, transfer to ICU, or death). Prehosp Emerg Care. 2023;27(2):221-226. doi:10.1080/10903127.2022.2072553 What’s it about?

CPR

CPR Emergency Department ALS ICU

Paramedicine Now

Sickle Cell Disease Module

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Trending Sources

Diagnostic Errors, Revisited: Where Do We Go Wrong, and How Can We Change?

Penetrating chest trauma

A woman in her 50s with acute chest pain

A Seven-Step Approach to Massive Hemoptysis

Amiodarone Versus Digoxin for Acute Rate Control of Atrial Fibrillation in the Emergency Department

Resident Journal Review: Massive Transfusion Protocols (MTPs) in Traumatic Hemorrhage

What will you do for this patient transferred to you who is now asymptomatic?

A Patient with Respiratory Failure and a Computer "Normal" ECG

Beyond Ketamine: When to use Facilitated Intubation in the ED

EM@3AM: Cardiac Transplant Complications

EM@3AM: Crush Injury

ABG Versus VBG in the Emergency Department

The 70th Bubble Wrap – DFTB x MSc in PEM

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