Dr. Smith's ECG Blog

DECEMBER 27, 2023

Cardiology consult note written around that time documents that "Pain improved with NTG, morphine in ED but still present." As a result, even before looking at this patient's initial ECG — he falls into a high -prevalence likelihood group for ACS ( for an A cute C oronary S yndrome ). This patient was not one of the lucky 6.4%

E-9-1-1 131

E-9-1-1 OR Coronary ACS 131

Dr. Smith's ECG Blog

OCTOBER 12, 2024

EKG on arrival to the ED is shown below: What do you think? Click here to sign up for Queen of Hearts Access Given the lack of intracranial hemorrhage, the patient was administered aspirin for suspected ACS and cardiology was consulted. or basilar ischemia. However, T waves do not appear to be hyperacute or hyperkalemic.

STEMI 116

STEMI Coronary Emergency Department ACS 116

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. Repeat trop 150 ng/L.

E-9-1-1 78

E-9-1-1 ACS STEMI Coronary 78

Dr. Smith's ECG Blog

JANUARY 31, 2020

A middle-aged man complained of 15 minutes of classic angina that resolved upon arrival to the ED. But it does prove that the patient has coronary disease and makes the probability that his chest pain is due to ACS very very high. Figure-1: The initial ECG that was done in the ED ( See text ).

ED 52

ED Coronary ACS CAD 52

EM Didactic

OCTOBER 15, 2018

Abdominal pain is a common ED presentation and one of the top differential for RLQ pain is Acute Appendicitis. It is worth doing and documenting serial abdomen exams in non-specific abdo pains. References Meltzer AC, Baumann BM, Chen EH, Shofer FS, Mills AM. The original Alvarado score was on a 10 point scale.

ACS 52

ACS ED OR 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? Cardioversion will address the rhythm problem immediately, also if the chest discomfort subsides when SR is restored, ischemia from ACS becomes much less likely. This patient presented to the ED “after a couple of days of chest discomfort”.

Coronary 119

Coronary ACS ED OR 119

Dr. Smith's ECG Blog

JULY 3, 2018

Submitted and written by Alex Bracey with edits by Pendell Meyers and Steve Smith Case A 50ish year old man with a history of CAD w/ prior LAD MI s/p LAD stenting presented to the ED with chest pain similar to his prior MI, but worse. Around 19 hours later, he experienced the same pain, which prompted his presentation to the ED.

ACS 52

ACS STEMI Coronary CAD 52

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. 2,3,5 Except for laundry or electrical car outlets (240 V AC), all U.S. household outlets are rated at 120 V AC. 2023 Jul 17.

Operating Room 52

Operating Room ACS Critical Care Coronary 52

Dr. Smith's ECG Blog

APRIL 14, 2023

Sent by Anonymous, written by Pendell Meyers A man in his 60s with history of CAD and 2 prior stents presented to the ED complaining of acute heavy substernal chest pain that began while eating breakfast about an hour ago, and had been persistent since then, despite EMS administering aspirin and nitroglycerin.

CAD 52

CAD ACS STEMI Coronary 52

Dr. Smith's ECG Blog

OCTOBER 2, 2021

Submitted by Benjamin Garbus, MD with edits by Bracey, Meyers, and Smith A man in his early 30s presented to the ED with chest pain described as an “explosion" of left chest pressure. At the time of arrival to the ED, the patient reported 1/10 chest pain with normal vital signs. There is no age cut-off for ACS. 1] Wereski, R.,

OR 52

OR ACS STEMI Coronary 52

Dr. Smith's ECG Blog

JUNE 27, 2021

They gave him 2 nitroglycerine and transported to the ED. In the ED, the patient was "moaning, writhing in bed, and clutching his chest." Here is the first ED ECG (there was no previous ECG on file for comparison): Sinus rhythm and LVH There is some (less than 1 mm) of STD in V3 and V4. There is no significant ST Elevation.

STEMI 40

STEMI ACS Coronary ED 40

Dr. Smith's ECG Blog

JULY 27, 2023

On arrival to the ED, the patient was diaphoretic, tachycardic. I did not think it was due to ACS, but we ordered an ED ECG immediately: What do you think? He had a prehospital ECG that was worrisome to the medics, so they called me to see him at the door. and had dilated pupils. He was alert and oriented. both here and here ).

Coronary 52

Coronary ACS Naloxone Plasma 52

Dr. Smith's ECG Blog

APRIL 17, 2023

One case sent by Dr. Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve Smith Take a look at these two ECGs below from two patients in the ED, first without any clinical context. He had no symptoms of ACS. Chest pain is documented as ongoing. Full case details and outcomes are below. Physician: "No STEMI."

OR 52

OR STEMI ACS Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2015

Most, but not all, ECG “aneurysm morphology” is associated with an actual aneurysm on Echo ( see this case with ED bedside echo ). Beware of ACS presenting with atypical symptoms, including absence of chest pain. So a bedside Echo showing a dyskinetic inferior wall may be helpful in this scenario as well, but this wasn't the case here.

STEMI 52

STEMI ACS Emergency Department OR 52

Dr. Smith's ECG Blog

JULY 19, 2019

He still had active pain on arrival to the ED. This is the most important exception to the classic teaching of "diffuse STE without reciprocal depression is less likely ACS, more likely pericarditis". His initial ECG in the ED ( = E CG # 1 ) is shown in Figure-1. Here is his triage ECG: What do you think? ng/mL (very elevated).

STEMI 52

STEMI ED ACS OR 52

Dr. Smith's ECG Blog

FEBRUARY 16, 2019

It is true that other documents occasionally describe "abnormal ST segment elevation" in the posterior leads (commonly accepted criteria is 0.5 mm in just one lead V7-9), but as far as I can tell all of these documents specifically avoid calling this condition STEMI and specifically avoid using any terminology similar to "STEMI equivalent."

STEMI 52

STEMI E-9-1-1 ACS OR 52

Dr. Smith's ECG Blog

JUNE 28, 2019

If a patient presents with symptoms of ACS, has an elevated troponin, and has persistent symptoms in spite of medical therapy [antiplatelet, antithrombotic, and anti-ischemic (nitro)], then cath lab activation is indicated regardless of ECG findings. In this case, one might say it is "obvious" MI because of a straight ST segment in aVF.

Coronary 52

Coronary ACS ED OR 52

Dr. Smith's ECG Blog

OCTOBER 6, 2018

We performed a beside US (shown below) which showed lateral wall hypokinesis as read by an US-boarded ED attending in real time. Diagnosis of acute myocardial infarction in angiographically documented occluded infarct vessel: limitations of ST-segment elevation in standard and extended ECG leads.

STEMI 40

STEMI Coronary ALS OR 40

Dr. Smith's ECG Blog

JUNE 8, 2023

According to the STEMI paradigm, the patient doesn’t have an acute coronary occlusion and doesn't need emergent reperfusion, so the paramedics can bring them to the ED for assessment, without involving cardiologists. paramedic transportation to the ED as “chest pain, STEMI negative” 2.

STEMI 86

STEMI Coronary Paramedic ALS 86

EMDocs

FEBRUARY 12, 2024

As the only respiratory therapist in the ED has been paged and is starting BiPAP for this patient, an overhead call for two incoming trauma alerts from a multivehicle collision sounds. Because the RT responsible for drawing arterial blood gases is busy caring for these patients, ABGs will be delayed.

Emergency Department 98

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

Dr. Smith's ECG Blog

APRIL 8, 2015

Summary of ED Approach to Syncope Please excuse the formatting problems, which I have not been able to fix! 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. Any ED systolic blood pressure less than 90 or greater than 180 mm Hg (+1) 4.

Emergency Department 52

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

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. Wysoki MG, Santora TA, Shah RM, Friedman AC. 22 Computed tomography (CT) with IV contrast has a better sensitivity and specificity for NSTI, 88.5%

Emergency Department 52

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

Don't Forget the Bubbles

JULY 5, 2023

Haematology specialist clinics are key to manage the chronic side of the disease, while ED doctors should be able to act rapidly on the common acute emergencies. with thanks A 15-month-old Kenyan boy presents to ED with right hand swelling. A 10-year-old boy with known SCA presents to ED due to severe pain in the legs.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

Dr. Smith's ECG Blog

DECEMBER 31, 2024

But thankfully, when the clinical context is clearly and highly concerning for ongoing ischemia from ACS, this distinction doesn't matter much. The note documents that the first view of the LCX showed 99%, TIMI 2 flow, but then (before intervention) was seen to fully occlude in real time (100%, TIMI 0). This idea is erroneous.

Coronary 119

Coronary ACS STEMI CAD 119

Dr. Smith's ECG Blog

DECEMBER 27, 2024

Documentation lists a diagnosis of "sinus tachycardia." After ruling out for ACS, the patient underwent angiography where he was found to have severe stable disease, which was already known. The patient was then sent to the ED for evaluation not by ambulance but driven to the ED by his wife.

Coronary 121

Coronary Defibrillator ACS ED 121

ACEP Now

FEBRUARY 19, 2025

In contrast to traditional teams that have the luxury of time for their members to build rapport, teams in the emergency department (ED) change every day. 1,2 As Edmondson described, ED teams disband almost as quickly as they are assembled. Harvard professor Amy C. 4 Can AI Help with Teaming? 4 Can AI Help with Teaming?

E-9-1-1 51

E-9-1-1 ALS ED Emergency Department 51

Dr. Smith's ECG Blog

JANUARY 15, 2025

He was worked up non-emergently in the ED with pain recurring and resolving multiple times during his stay. html ) Despite an undetectable troponin and three normal EKGs, the nature of the patients symptoms and his positive cardiac history warranted concern for ACS. ng/mL) was drawn at 1650 and resulted below the limit of detection.

Coronary 68

Coronary ED CAD Paramedic 68

EMDocs

JANUARY 6, 2025

ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. Labs Laboratory workup in the ED is notable for a leukocytosis of 41,000/L, hemoglobin of 6.5 She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI.

ED 75

ED E-9-1-1 ALS Emergency Department 75