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High sensitivity cardiac troponins for ED chest pain evaluation (2022 ACC pathway)

ALiEM

The 2022 American College of Cardiology (ACC) pathway provides timely guidance [1]. Intermediate-risk patients may be further stratified based on recent stress testing or coronary angiogram findings plus a modified HEART or Emergency Department Assessment of Chest Pain (EDACS) score. Time to know your hs-cTn better.

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

Dr. Smith's ECG Blog

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. Stein et al.

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Elbow Dislocations

REBEL EM

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. Elbow Dislocations in the Emergency Department: A Review of Reduction Techniques. J Emerg Med. J Emerg Med. 1999 Jan;13(1):58-9.

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Acute OMI or "Benign" Early Repolarization?

Dr. Smith's ECG Blog

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?

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emDOCs Podcast: Episode 108 – Unexplained Sinus Tachycardia Mental Model

EMDocs

Discharging a patient with abnormal vital signs has been linked to unanticipated death (1-4). Lactate Troponin Could this be ACS or myocarditis? 2005;2(1):44-52. doi:10.1038/ncpcardio0068 Sklar DP, Crandall CS, Loeliger E, Edmunds K, Paul I, Helitzer DL. Ann Emerg Med. Ann Emerg Med. Acad Emerg Med.

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Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. mm of ST segment elevation, V2 and V3 have 1 mm of elevation, v4 has 2 mm of elevation and v5 around 1.5 Learning Points: 1. What do you think? V1 has 0.5

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emDOCs Revamp – Acute Chest Syndrome

EMDocs

Abdomen : ND, NT, no guarding or rebound MSK : Tenderness to palpation over L ribs 7-9 Derm : No rashes Imaging: Image 1: Case courtesy of Miriam Leiderer, Radiopaedia.org, rID: 81468 Chest radiograph (CXR) shows new left lower lobe opacity What’s most likely diagnosis? 2022 Jul 5;328(1):57-68. C or 100.4 mg/kg, max 0.4

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