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

Occlusion myocardial infarction is a clinical diagnosis

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Triage documented a complaint of left shoulder pain. Moreover , the patient has ongoing symptoms and has an unexplained elevated troponin, so she is having an MI and the only question is whether it is type 1 or type 2 due to hypertension. In this version 1, the Queen of Hearts does not compare serial ECGs. At midnight.

E-9-1-1

E-9-1-1 ACS Coronary STEMI

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. looked at consecutive patients with PE, ACS, or neither.

E-9-1-1

E-9-1-1 ACS Emergency Department Coronary

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. J Am Acad Orthop Surg. doi: 10.5435/00124635-199801000-00002. PMID: 9692937 Decker N, Norse A. 2022 Aug 2.

E-9-1-1

E-9-1-1 ACS OR Emergency Department

Acute OMI or "Benign" Early Repolarization?

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. ECG 1 What do you think? Grines, C.

E-9-1-1

E-9-1-1 OR Coronary ACS

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

Simulation Brain Wash

FOAMfrat

APRIL 22, 2024

This kid had sticks go through his cheek from running with a lollipop, hit by a car, almost kidnapped, attacked by a dog, and almost burnt his house down by throwing a 9-volt battery in the trash. References Kimbrell J, Kreinbrook J, Poke D, Kalosza B, Geldner J, Shekhar AC, Miele A, Bouthillet T, Vega J. 2024 Mar 15:1-9.

E-9-1-1

E-9-1-1 ACS Paramedic Critical Care

Judge for yourself the management of this patient with "NSTEMI, multivessel disease"

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Ongoing pain noted throughout all documentation, but after nitro drip and prn morphine, "pain improved to 2/10." 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.

E-9-1-1

E-9-1-1 ACS STEMI Coronary

Fluoroquinolone Use In Children

Pediatric EM Morsels

AUGUST 18, 2023

Myth #1: Musculoskeletal Adverse Events (MAE) This concern is likely the most common reason fluoroquinolones are rarely used in children. Which is a risk of 1 event for 62.5 None of the patients were documented to have joint disease at follow up. References: Ross RK, Kinlaw AC, Herzog MM, Funk MJ, Gerber JS. Pediatrics.

E-9-1-1

E-9-1-1 ACS OR ALS

Sickle Cell Disease Module

Don't Forget the Bubbles

JULY 5, 2023

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. Investigations : Bloods show Hb of 8 g/L, White cell count 13x 10 9 /L, Platelets 570 x10 9 /L, CRP 35mg/L.

E-9-1-1

E-9-1-1 ACS OR ICU

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

AHA/NCS Statement on Critical Care Management of Post ROSC Patients

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

Critical Care E-9-1-1 OR ICU

ABG Versus VBG in the Emergency Department

EMDocs

FEBRUARY 12, 2024

Introduction Arterial blood gas (ABG) or venous blood gas (VBG) testing is used to assess the pH and systemic carbon dioxide tension in patients, and, therefore, provide a more complete picture of their acid-base status than an isolated basic metabolic panel (BMP) (1). However, ABGs have many drawbacks compared to VBGs.

Emergency Department

Emergency Department E-9-1-1 ED ICU

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

AAEM RSA

DECEMBER 3, 2020

Introduction: While cases of genital gangrene were documented as early as 980 CE, the condition we know today as FG was coined in the 1880’s by French venerologist, Jean Alfred Fournier. 2018;48(9):1157-1160. 2020;26(1):8-17. 2018;8(1):88. 2016;4:1-3. Internal medicine journal. Filippone LM. Clin Microbiol Infect.

Emergency Department

Emergency Department E-9-1-1 ALS EMT

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. Thus, if there is documented sinus bradycardia, and no suspicion of high grade AV block, at the time of the syncope, this is very useful.

Emergency Department

Emergency Department E-9-1-1 ED ALS

Paramedicine Now

Occlusion myocardial infarction is a clinical diagnosis

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

Trending Sources

Elbow Dislocations

Acute OMI or "Benign" Early Repolarization?

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

Simulation Brain Wash

Judge for yourself the management of this patient with "NSTEMI, multivessel disease"

Fluoroquinolone Use In Children

Sickle Cell Disease Module

Are these Wellens' waves?

AHA/NCS Statement on Critical Care Management of Post ROSC Patients

ABG Versus VBG in the Emergency Department

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

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

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