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

ACEP Now

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.

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ABG Versus VBG in the Emergency Department

EMDocs

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.

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

Dr. Smith's ECG Blog

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 52
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A Seven-Step Approach to Massive Hemoptysis

ACEP Now

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 52
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EM@3AM: Cardiac Transplant Complications

EMDocs

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 63
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A woman in her 50s with acute chest pain

Dr. Smith's ECG Blog

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 52
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A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

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 102