EMS 12-Lead

JULY 24, 2023

Category 1 : Sudden narrowing of a coronary artery due to ACS (plaque rupture with thrombosis and/or downstream showering of platelet-fibrin aggregates. Smith : This is ACS even if the troponin returns normal, and the first troponin especially might return normal. This results in Type I MI. This results in Type II MI. Severe HTN d.

Coronary 130

Coronary ACS CAD ED 130

EMS 12-Lead

APRIL 2, 2022

1, 2] The most clinically useful definition to account for this entire constellation is intraventricular conduction delay. Anecdotally, had there been symptoms unequivocally consistent with ACS then one could justifiably make the case for a potential D1 occlusion. He denied difficulty breathing, epigastric pain, or chest discomfort.

ALS 130

ALS STEMI Coronary OR 130

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 107

E-9-1-1 ACS OR Emergency Department 107

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This is diagnostic of ACS; it appears to be a reperfused acute inferior OMI. Suppose the OMI had been recognized, or suppose another ECG had been recorded and it showed definite OMI. He reports feeling nauseated with emesis. He denies taking aspirin or antihypertensive medications for the last year and a half.

Defibrillator 139

Defibrillator Coronary STEMI CPR 139

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. REBEL Cast Ep123: Reduced-Dose Systemic Peripheral Alteplase in Massive PE?

ALS 133

ALS ACS OR CPR 133

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Because the most severe LAD OMIs can cause ischemic failure of the RBB and LAF, any patient with ACS symptoms and new RBBB and LAFB with any concordant STE has LAD OMI until proven otherwise. Post cath EF was estimated at 15% with severe global hypokinesis, and akinesis of the apex. Long term outcome is unavailable.

STEMI 124

STEMI EMS ACS ED 124

Dr. Smith's ECG Blog

JUNE 15, 2023

Thus, this does NOT meet STEMI criteria (though, as of 2022, it is a formal "STEMI equivalent", assuming everyone agrees that this is de Winter morphology, for which there is currently no objective definition). Everywhere I'm aware of (only about 5 systems), the ECGs are not even recorded in the "STEMI database." What a farce.

STEMI 98

STEMI Coronary ACS OR 98

Dr. Smith's ECG Blog

OCTOBER 24, 2018

Therefore, this does not meet the definition of myocardial infarction ( 4th Universal Definition of MI ), which requires at least one troponin above the 99% reference range. You can see the deficiency of the definition of MI. Because there is reciprocal ST depression in aVL, this should not be called early repol. But maybe not.

E-9-1-1 40

E-9-1-1 STEMI ACS Coronary 40

Dr. Smith's ECG Blog

JANUARY 5, 2024

80%) and definitely too much for hour to hour. However, the Definition of MI requires at least one value above the 99th percentile, which for a male is 34 ng/L (16 ng/L for women). Thus, these troponins are very concerning for ACS, and subsequent ones will probably be diagnostic of acute MI. His angiogram is shown below.

ACS 124

ACS ALS OR STEMI 124

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. Link to abstract Link to full text 2) Use of Morphine in Non-STE-ACS is independently associated with mortality, at odds ratio of 1.4

E-9-1-1 82

E-9-1-1 ACS STEMI Coronary 82

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

When Pendell and I are coding ECGs for the Queen's training, this is one category: "Definite ischemia, difficult to differentiate between posterior OMI and subendocardial ischemia." In our opinion it should not be given in ACS unless you are committed to the cath lab. He was diagnosed as NSTEMI.

ACS 86

ACS Coronary ALS CAD 86

Dr. Smith's ECG Blog

APRIL 9, 2024

ACS then becomes less likely. BOTTOM Line: There clearly is enough on this initial ECG to support Dr. Nossen's concern that a definitive diagnosis needed to be made on this young man with new, persistent chest pain. On arrival patient was slightly tachycardic. HR about 90-100/min. Other vital signs normal. How did the Queen do?

Coronary 110

Coronary CAD ACS OR 110

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

There is definite reperfusion. There was definite evolution of the ECG. He had been smoking an opiate and suddenly collapsed. He was ventilated with BVM on arrival. He awoke with naloxone. This EKG was recorded as part of a standing order for critical care. He denied any CP or SOB. Maybe there is some spontaneous reperfusion?

Overdose 52

Overdose OR Coronary ACS 52

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

Despite the seemingly worrisome ST-T wave changes on serial tracings shown in Figure-1 — an acute event was definitively ruled out by 4 consecutive negative hs troponins — with further support provided by an Echo showing excellent LV function without wall motion abnormality. So they looked into the patient's chart. Learning Point: 1.

E-9-1-1 119

E-9-1-1 Coronary EMS ED 119

Don't Forget the Bubbles

JULY 22, 2024

Since the PREVIEW trial, there have been more negative trials. One such trial was the WASP trial , which involved 477 children in New Zealand. This trial showed no difference in PRAM score or LOS in the prednisolone group compared to placebo. An IPD approach is a collaborative exercise including the authors of included studies and stakeholders.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

Dr. Smith's ECG Blog

MARCH 13, 2024

The patient has ACS by history, active pain, and an elevated troponin. By definition , this is acute myocardial infarction, the only question now is the etiology. It is impossible to overstate the importance of putting the ECG and troponin into the context of the clinical history. Smith : at this point, the ECG becomes irrelevant.

Coronary 112

Coronary ACS Emergency Management Emergency Manager 112

Dr. Smith's ECG Blog

AUGUST 19, 2023

But because the patient had no chest pain or shortness of breath, it was not deemed to be from ACS. But because the patient had no chest pain or shortness of breath, it was not deemed to be from ACS. They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS. Potassium was normal.

STEMI 98

STEMI ACS OR ALS 98

Dr. Smith's ECG Blog

OCTOBER 15, 2023

Definition: Technically, for the tracing in ECG #1 to truly “qualify” as Wellens’ Syndrome — there should be no CP at the time the ECG is recorded. However, in the chest leads — there has definitely been evolution , in that ST segments are more coved and slightly more elevated in virtually all chest leads. No diaphoresis or vomiting.

ACS 120

ACS ED STEMI OR 120

EMDocs

SEPTEMBER 24, 2024

Episode 107: Eclampsia Definition: Severe hypertensive disease of pregnancy (HDP) with new onset tonic-clonic, focal, or multifocal seizures or unexplained altered mental status in a patient who is pregnant or postpartum and there’s no other causative etiologies. Today on the emDOCs cast with Brit Long ( @long_brit) , we cover eclampsia.

ED 98

ED OR ACS ALS 98

Emergency Medicine Ireland

JUNE 21, 2021

This week we’re looking at the other ACS, the surgical ACS, the old abdominal compartment syndrome. This week we’re looking at the other ACS, the surgical ACS, the old abdominal compartment syndrome. This week we’re looking at the other ACS, the surgical ACS, the old abdominal compartment syndrome.

Critical Care 52

Critical Care ACS OR 52

Dr. Smith's ECG Blog

MARCH 26, 2024

Moreover, what I call "domed" T-wave inversion in V1-V3 is typical for acute PE and NOT typical of ACS (i.e., Moreover, T-wave inversion in V1-V3 due to ACS is typically seen in reperfusion states when the patient is symptom free. Wellens'), presumably because the source of the T-wave inversion is RV strain, not LV ischemia.

ACS 72

ACS OR 72

Dr. Smith's ECG Blog

APRIL 17, 2023

He had no symptoms of ACS. His HEAR score (before troponin resulted) was documented at 3, with documentation stating "low suspicion for ACS." A troponin this high in a patient with no known chronic troponin elevation, and active acute ACS symptoms, has a very high likelihood of type 1 ACS regardless of the ECG.

OR 52

OR STEMI ACS Emergency Department 52

The Curious Clinicians

JANUARY 31, 2024

If you like the types of questions we answer on The Curious Clinicians, you’ll definitely want to check that out and subscribe. Listen to the episode [link] Credits & Citatio n Episode written by Avi Cooper Show notes written by Giancarlo Buonomo and Avi Cooper Audio edited by Clair Morgan of nodderly.com Cooper AZ, Breu AC, Abrams HR.

ACS 110

ACS OR 110

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

3) RV Failure leads to hypotension but NOT pulmonary edema (unlike LV failure) 4) Repeat ECGs, right sided ECG and bedside echo may be helpful in making a diagnosis of ACS. Lead aVL is definitely not normal. Any cause of pulmonary hypertension. At this point an old ECG on file was found for comparison.

STEMI 120

STEMI ACS OR ALS 120

Dr. Smith's ECG Blog

OCTOBER 28, 2013

Here is an article I wrote: Updates on the ECG in ACS. Was this: 1) ACS with ischemia and spontaneous reperfusion? The patient was taken for an angiogram and had an 80% LAD lesion, but it could not be definitely determined whether this was an acute thrombotic lesion or a chronic stable lesion. See image with lines below).

Defibrillator 52

Defibrillator ACS CPR STEMI 52

FOAMcast

OCTOBER 17, 2023

Apple Podcasts , Spotify , Listen Here Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive way of providing resuscitative aortic occlusion in severe hemorrhage to gain temporary hemorrhage control as a bridge to definitive procedures. ” As a result, Jansen et al. ” As a result, Jansen et al.

ACS 52

ACS ALS OR 52

Dr. Smith's ECG Blog

MAY 31, 2023

See this study showing an association between morphine and mortality in ACS: Use of Morphine in ACS is independently associated with mortality, at odds ratio of 1.4. Do NOT give it unless you are committed to the cath lab!! Cath attending is aware. I think it is OMI; am I right? See this case: A man his 50s with chest pain.

STEMI 96

STEMI Coronary ACS OR 96

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. A "STEMI alert" was called and soon cancelled.

Allergic Reaction 52

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

Dr. Smith's ECG Blog

FEBRUARY 1, 2023

But it still doesn’t meet STEMI criteria, so the patient was referred to cardiology as ACS. Are there any signs of occlusion or reperfusion? There’s normal sinus rhythm, normal conduction, normal axis, normal R wave progression and normal voltages.

OR 52

OR STEMI Coronary ACS 52

Dr. Smith's ECG Blog

OCTOBER 24, 2013

Therefore, even with a normal or non-diagnostic ECG, a 50 year old male patient should undergo serial ECGs and troponins and be admitted to a monitored bed until MI or ACS can be ruled out. There is no way to tell the difference between GI etiology of chest pain and MI. This is obviously a very big topic in itself.

CPR 52

CPR ACS Coronary OR 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

SCAD isn’t rare, especially in women Historically SCAD had been identified in 22% of ACS cases in women. Pregnancy is not a common cause of SCAD When ACS occurs in the peripartum period, SCAD is responsible in 43% of cases. This rate and height of troponin rise strongly suggested a type 1 MI. This case occurred 10+ years ago.

Coronary 52

Coronary CAD ACS STEMI 52

Dr. Smith's ECG Blog

MAY 13, 2020

Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS. Sensitivity of POCUS even for definite wall motion abnormalities is far from perfect. The ECG only tells you there is ischemia, not the etiology of it.

Coronary 52

Coronary ACS EMS STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 9, 2023

This case fits this definition of cardiac memory. == MY Comment , by K EN G RAUER, MD ( 11/9 /2023 ): == I found Dr. Smith's presentation of today's case highly insightful for the changes in ST-T wave appearance that may sometimes be seen, depending on whether or not LBBB ( L eft B undle B ranch B lock ) is present. Is it Wellens' syndrome?

E-9-1-1 82

E-9-1-1 ACS ALS OR 82

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. 2 Death from hemoptysis is akin to drowning, so airway considerations usually take precedence over hemodynamic considerations.

E-9-1-1 52

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

Dr. Smith's ECG Blog

MARCH 13, 2023

This is acute ACS, but it almost always seen in a pain free state. So this ECG was immediately recorded: Indeed, as predicted, a patient with previous Wellens' waves who now definitely has chest pain has acute Occlusion, with new ST elevation in I, aVL, V2-V5. An ED ECG, if recorded with pain, should show LAD OMI.

ED 52

ED ACS Coronary Paramedic 52

Dr. Smith's ECG Blog

APRIL 26, 2017

I remained unconvinced that this was due to ACS. With the added history, and the entirety of the presentation, it was determined by cardiology that the clinical presentation was not due to ACS. Note 2 other similar cases at the bottom that come from my book, The ECG in Acute MI. What do you think? mm in V3.

STEMI 52

STEMI ACS ED Coronary 52

Dr. Smith's ECG Blog

APRIL 9, 2023

Only if you are uncertain about the diagnosis of ACS. The interventional cardiologist was not initially convinced this was ACS and recommended CT pulmonary angiography to rule out pulmonary embolism. There was no associated diaphoresis, nausea, vomiting, arm pain, jaw pain, syncope, lightheadedness or other acute symptoms.

ACS 52

ACS ED OR EMS 52