Dr. Smith's ECG Blog

DECEMBER 26, 2020

On arrival to the PCI center's Emergency Department, the receiving team recorded an ECG on arrival: Persistent atrial flutter, however this time the QRS occurs on a slightly different portion of the flutter wave. No obvious adverse events were attributed to the thrombolytics. There was again no intracranial hemorrhage.

STEMI 52

STEMI ACS Coronary Emergency Department 52

Dr. Smith's ECG Blog

JULY 3, 2018

While in the emergency department, he undergoes an additional ECG: 00:49 - Not much change Second ECG with measurements and calculations Magnified view of second ECGs measurements and calculation It is still "negative" for LAD occlusion (less than 23.4) Use caution when prescribing opioids to patients concerning for ACS.

ACS 52

ACS STEMI Coronary CAD 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. The most recent event had occurred just before being triaged. Triage EKG: What do you think?

ACS 52

ACS Coronary Defibrillator STEMI 52

Dr. Smith's ECG Blog

MARCH 20, 2023

I finished my residency of Emergency Medicine and I’m working at a great Emergency Department here in Brazil. Remember: these findings above are included as STEMI equivalent findings in the 2022 ACC Expert Consensus Decision Pathway on ACS Patients in the ED.

STEMI 52

STEMI ACS CAD ED 52

Dr. Smith's ECG Blog

APRIL 17, 2023

He had no symptoms of ACS. The remainder of his Emergency Department stay was uneventful. Here is the clinical informaton on ECG 2: A man in his 50s presented to the Emergency Department with acute chest pain that started within the past few hours. QOH: "OMI High confidence". Physician interpretation: "No STEMI."

OR 52

OR STEMI ACS ALS 52

Dr. Smith's ECG Blog

AUGUST 26, 2019

She was brought to the Emergency Department and this ECG was recorded while she was still feeling nauseous but denied chest pain, shortness of breath, or other symptoms: What do you think? I wouldn't activate the lab for this EKG alone, but if the patient is clinically compatible with ACS you could call a heart alert.

STEMI 52

STEMI Coronary OR ED 52

EM Didactic

JANUARY 27, 2019

Myth 1 Absence of Classic Chest Pain obviates the need for ACS work up The absence of chest pain in no way excludes the diagnosis of ACS. Around 33-50% of the patients with ACS present to the hospital without chest pain. Ann Emerg Med 2002; 40:180–6. Heart 2001; 86:494–8. Gupta M, Tabas JA, Kohn MA.

ACS 52

ACS ALS Coronary Emergency Department 52

Dr. Smith's ECG Blog

AUGUST 10, 2023

Case submitted and written by Dr. Mazen El-Baba and Dr. Emily Austin, with edits from Jesse McLaren A 50 year-old patient presented to the Emergency Department with sudden onset chest pain that began 14-hours ago. The pain improved (6/10) but is persisting, which prompted him to visit the Emergency Department. Shroff, G.

STEMI 98

STEMI ACS Emergency Department ED 98

EMDocs

SEPTEMBER 25, 2023

The trade off to using FI for these challenging airways is the consideration of an aspiration event, the initial indication for RSI. However, RSI has never been shown to reduce the risk of aspiration in the ED (13) or during emergent OR cases (14). Desaturation can lead to hypoxia and adverse events. Int J Emerg Med.

ED 95

ED Emergency Department ALS Paramedic 95

Don't Forget the Bubbles

JULY 22, 2024

Whilst the incidence of adverse events was low in this meta-analysis, this reflects adverse event reporting in RCTs rather than reality. A Randomized Trial of Single-Dose Oral Dexamethasone Versus Multidose Prednisolone for Acute Exacerbations of Asthma in Children Who Attend the Emergency Department. Arch Dis Child.

E-9-1-1 105

E-9-1-1 ALS ACS ED 105

ACEP Now

OCTOBER 11, 2024

Optimally, bystander CPR, including the administration of rescue breaths, should be initiated prior to arrival of emergency medical services. 3 Once the patient arrives in your emergency department, a rapid review of the patient’s status and results of resuscitative efforts should be performed. Pediatr Emerg Med Pract.

ALS 52

ALS Emergency Department Emergency Medical Services ED 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

Defibrillator 134

Defibrillator Coronary STEMI CPR 134

Don't Forget the Bubbles

MAY 3, 2023

Results of this study showed that the use of low-dose insulin infusion led to similar clinical outcomes and fewer adverse events compared to the standard-dose insulin infusion. units/kg/hr ) is as efficacious as standard-dose, with fewer adverse events. Garabon JJW, Gunz AC, Ali A, Lim R. Prehosp Emerg Care.

CPR 52

CPR Emergency Department ALS ICU 52

Dr. Smith's ECG Blog

JUNE 8, 2023

There were trends toward larger infarct size with delayed angiography, both by cMR and integral high-sensitivity troponin concentration, as well as toward higher rate of major adverse cardiovascular events (MACE) (8.5 vs. 2.9%; P  = 0.28) in the delayed group. paramedic transportation to the ED as “chest pain, STEMI negative” 2. Kontos et al.

STEMI 86

STEMI Coronary Paramedic ALS 86

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergency department after an episode of syncope while standing in line at a grocery store. Moreover, the Queen is only supposed to be used with a high pretest probability of ACS/OMI.

Overdose 123

Overdose OR ACS ICU 123

FOAMfrat

OCTOBER 20, 2023

titled “Intubation Practices and Adverse Peri-intubation Events in Critically Ill Patients from 29 Countries,” at least one major critical event occurred after intubation in 45.2% The higher the shock index, the more likely adverse events are to occur; such as hypotension or cardiac arrest. Up to 44% per other sources [12].

E-9-1-1 52

E-9-1-1 ALS ACS OR 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury. of Cardiology AC, Others. Cardiac Troponin Testing in Patients with COVID-19: A Strategy for Testing and Reporting Results.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

ECG & Echo Learning

JANUARY 18, 2023

IIa C Pre-hospital logistics Management Recommendation Level of evidence The pre-hospital care of STEMI patients should be organized regionally (including all components from the emergency medical dispatch to catheterization laboratory) in order to provide reperfusion therapy as early as possible. mmol/L or <_ 70 mg/dL) should be avoided.

STEMI 40

STEMI Coronary OR Defibrillator 40

Dr. Smith's ECG Blog

APRIL 8, 2015

(full text link) Presence of any one of these 8 criteria had 97% sensitivity and specificity of 62% for adverse outcomes: 1) Signs of Acute Coronary Syndrome (ACS), 2) conduction disease, 3) worrisome cardiac history, (eg. The ROSE (Risk Stratification of syncope in the emergency department) Study.

Emergency Department 52

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

EMDocs

JANUARY 20, 2024

Answer: Takotsubo Cardiomyopathy 1-18 Background: Also known as transient apical ballooning syndrome, apical ballooning cardiomyopathy, stress-induced cardiomyopathy, stress cardiomyopathy, Gebrochenes-Herz syndrome, and broken-heart syndrome.

E-9-1-1 103

E-9-1-1 EMS Coronary ACS 103

EMDocs

OCTOBER 7, 2023

6 Prolonged down time from falls, usually in the elderly Incidence is difficult to ascertain due to broad definition and that events that cause crush injuries are rather rare. J Emerg Med. Goodman AD, Got CJ, Weiss AC. Clinical spectrum of rhabdomyolysis presented to pediatric emergency department. Int J Emerg Med.

EMS 98

EMS E-9-1-1 Emergency Department ALS 98

Dr. Smith's ECG Blog

JANUARY 28, 2025

Another EKG, shown with a V1 rhythm strip, was recorded in the emergency department: EKG 3, 1930 There appears again to be some reperfusion since the last EKG, as the T waves in inferior leads have deflated slightly. When the patient finally arrived to the PCI-capable hospital, his pain had reportedly improved, but not resolved.

STEMI 104

STEMI ED ACS Emergency Department 104

Dr. Smith's ECG Blog

NOVEMBER 10, 2024

The ECG was transmitted to the Emergency Medicine physician who recognized inferior and posterior OMI findings, and confirmed that the patient has potential ACS symptoms. EMS gave aspirin and nitroglycerin, and the patient noted significant improvement on arrival to the Emergency Department.

STEMI 80

STEMI OR ED EMS 80

Dr. Smith's ECG Blog

MARCH 3, 2025

A 69 year old woman with a history of hypertension presented to the emergency department by EMS for evaluation of chest pain and shortness of breath. A month later, she presented again to the emergency department with a few hours of chest pain that resolved before ED presentation. This was written by Hans Helseth.

E-9-1-1 73

E-9-1-1 Coronary STEMI Emergency Department 73

Dr. Smith's ECG Blog

JANUARY 15, 2025

Case A 68 year old man with a medical history of hypertension, hyperlipidemia, and CAD with stent deployment in the RCA presented to the emergency department with chest pain. html ) Despite an undetectable troponin and three normal EKGs, the nature of the patients symptoms and his positive cardiac history warranted concern for ACS.

Coronary 67

Coronary ED CAD Paramedic 67

EMDocs

JUNE 27, 2024

Am J Emerg Med. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. C or 100.4 mg/kg, max 0.4 2022 Aug;58:235244. Am J Hematol.

E-9-1-1 98

E-9-1-1 ICU ACS EMS 98

Dr. Smith's ECG Blog

APRIL 18, 2025

. __ Thus , in a patient presenting with symptoms of ACS, this EKG is diagnostic of subacute LAD occlusion, possibly reperfused. The clinical presentation in this case is not typical for OMI, but it is typical enough to warrant emergent evaluation. Does this patient have ACS Symptoms? The patient died early the next morning.

ED 80

ED ACS ICU OR 80

Dr. Smith's ECG Blog

FEBRUARY 26, 2025

He presented to the emergency department for evaluation. Patients with suspected ACS should be evaluated with echocardiography. This could have been another clue for facilitating earlier recognition of tihs patient's post-event pericarditis. How extensive was this patient's heart disease prior to this recent event?

STEMI 88

STEMI ALS OR Coronary 88

Don't Forget the Bubbles

JULY 5, 2023

Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. A 6-year-old girl from Saudi Arabia was referred by her General Practitioner to the local emergency department. Mechanical or non-invasive ventilation : children with ACS may require ventilatory support.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126