ACS, Emergency Department and ICU

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

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. The patient was upgraded to the ICU for closer monitoring. looked at consecutive patients with PE, ACS, or neither.

E-9-1-1

E-9-1-1 ACS Emergency Department Coronary

Amiodarone Versus Digoxin for Acute Rate Control of Atrial Fibrillation in the Emergency Department

REBEL EM

FEBRUARY 2, 2023

Background Information: Atrial fibrillation with rapid ventricular rate (RVR) is one of the many tachydysrhythmias we encounter in the Emergency Department (ED). 2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Am J Emerg Med. Am J Emerg Med.

Emergency Department

Emergency Department ALS Critical Care ED

A man in his 60s with syncope and ST depression. What does the ECG mean?

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

Overdose ACS ICU OR

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. Ischemia from ACS causing the chest discomfort, with VT another consequence (or coincidence)? The pacing rate was increased without clinical improvement and the patient was transferred to the ICU for closer monitoring/treatment.

Coronary

Coronary ACS ED OR

Beyond Ketamine: When to use Facilitated Intubation in the ED

EMDocs

SEPTEMBER 25, 2023

Despite the risk of hypotension and bradycardia, propofol has been shown in the ICU setting to be a safe and effective monotherapy intubation agent for hemodynamically unstable patients (19). References: Heffner AC et al. Incidence and factors associated with cardiac arrest complicating emergency airway management. J Emerg Med.

ED

ED Emergency Department ALS Paramedic

Diagnostic Errors, Revisited: Where Do We Go Wrong, and How Can We Change?

ACEP Now

MAY 9, 2024

It has been well over a year since the controversial publication of the Agency for Healthcare Research and Quality (AHRQ) report on diagnostic errors in the emergency department (ED). After developing encephalopathy and hypoxemic respiratory failure, the patient was transferred to the ICU. Ann Emerg Med. JAMA Intern Med.

Emergency Department

Emergency Department ICU ALS ACS

Penetrating chest trauma

Don't Forget the Bubbles

JUNE 30, 2023

They found NO difference in drain failure rates ( 11% pigtail vs 13% chest tube P=0.74), total daily volume drained or length of ICU stay between groups. Interim results presented earlier this year show that REBOA performed within the Emergency Department increased mortality. c) Or, do both? Trauma Surg Acute Care Open.

E-9-1-1

E-9-1-1 FFP Plasma Emergency Department

EM@3AM: Basilar Artery Occlusion

EMDocs

OCTOBER 21, 2023

The NIHSS cutoff that predicts outcomes is 4 points higher in AC compared with PC infarctions. All patients who receive thrombolytics for ischemic stroke should be admitted to a neurosurgical, neurologic, or medical ICU for management and monitoring, as this is shown to decrease mortality and length of stay. Arch Neurol. ResearchGate.

EMS

EMS ALS OR ACS

A Seven-Step Approach to Massive Hemoptysis

ACEP Now

NOVEMBER 14, 2023

One of the most hair-raising presentations to the emergency department (ED) can be massive hemoptysis with respiratory failure. He is the founder and host of Emergency Medicine Cases podcast and website. References Deshwal H, Sinha A, Mehta AC. The emergency department evaluation and management of massive hemoptysis.

E-9-1-1

E-9-1-1 ALS Emergency Department Epinephrine

Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ALiEM

OCTOBER 30, 2024

Bupe Allergy Buprenorphine induction has been the mainstay of emergency department treatment of opioid use disorder for more than a decade [11, 12]. DOI: Papudesi BN, Malayala SV, Regina AC. Emergency department–initiated buprenorphine/naloxone treatment for opioid dependence: a randomized clinical trial.

E-9-1-1

E-9-1-1 Naloxone Emergency Department ALS

ABG Versus VBG in the Emergency Department

EMDocs

FEBRUARY 12, 2024

In this situation, an ABG should be obtained periodically for correlation, though this is more relevant for the intensive care unit (ICU) setting than in routine ED care (5, 9). Correlation and agreement between arterial and venous blood gas analysis in patients with hypotension-an emergency department-based cross-sectional study.

Emergency Department

Emergency Department E-9-1-1 ED ICU

EM@3AM: Cardiac Transplant Complications

EMDocs

JANUARY 6, 2024

10 Although this is not the same pathophysiology seen in ACS from an acute plaque rupture leading to coronary artery occlusion, patients can have relatively abrupt coronary ischemia causing ACS due to acute, concentric vessel narrowing. A 63-year-old man presents to the emergency department for dyspnea on exertion.

EMS

EMS E-9-1-1 ACS Coronary

EM@3AM: Crush Injury

EMDocs

OCTOBER 7, 2023

J Emerg Med. Goodman AD, Got CJ, Weiss AC. Clinical spectrum of rhabdomyolysis presented to pediatric emergency department. Int J Emerg Med. He has no medical problems. He sustained a crush injury to his left leg and a prolonged extraction time. He is agitated and reporting significant pain. Critical Care.

EMS

EMS E-9-1-1 Emergency Department ALS

The 70th Bubble Wrap – DFTB x MSc in PEM

Don't Forget the Bubbles

MAY 3, 2023

This single-centre academic urban institution in the United States (US) undertook a 10-year retrospective observational study of paediatric intubation and bougie use in their emergency department (ED). Garabon JJW, Gunz AC, Ali A, Lim R. Prehosp Emerg Care. 468 paediatric patients were intubated in this timeframe.

CPR

CPR Emergency Department ALS ICU

emDOCs Revamp – Acute Chest Syndrome

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

E-9-1-1 ICU ACS EMS

ToxCard: Acute Organophosphate Toxicity

EMDocs

JUNE 7, 2023

Disposition is often admission to an intensive care unit (ICU) setting. Further management and resuscitation were required, and she had a lengthy ICU stay of 21 days until she was extubated. Parenteral organophosphorus poisoning in a rural emergency department: a case report. Airway management should not be delayed.

E-9-1-1

E-9-1-1 ICU Emergency Department ED

Sickle Cell Disease Module

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

E-9-1-1 ACS OR ICU

Rethinking Fluid Resuscitation in Vaso-Occlusive Crisis: Is Lactated Ringer’s the Superior Choice?

REBEL EM

DECEMBER 23, 2024

Paper: Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. The characteristics that were significantly different between the LR and NS exposure groups race, organ dysfunction at presentation, ICU admission, hemoglobin SS genotype, discharge year, and hydroxyurea use were appropriately included as confounders in the TMLE analysis.

ALS

ALS ED ACS EMR

ED care of refugee populations from sub-Saharan Africa

EMDocs

JANUARY 6, 2025

84 All patients with severe malaria need inpatient admission, ideally to the intensive care unit (ICU). link] Hummell AC, Cummings M. HIV Prevention and Treatment: The Evolving Role of the Emergency Department. Ann Emerg Med. Use of Medical Interpreters in the Emergency Department.; 2022;37(1):41-49.

ED

ED E-9-1-1 ALS Emergency Department

Paramedicine Now

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

Amiodarone Versus Digoxin for Acute Rate Control of Atrial Fibrillation in the Emergency Department

Trending Sources

A man in his 60s with syncope and ST depression. What does the ECG mean?

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Beyond Ketamine: When to use Facilitated Intubation in the ED

Diagnostic Errors, Revisited: Where Do We Go Wrong, and How Can We Change?

Penetrating chest trauma

EM@3AM: Basilar Artery Occlusion

A Seven-Step Approach to Massive Hemoptysis

Tranq dope (fentanyl-xylazine combination): A new horizon in opioid withdrawal treatment

ABG Versus VBG in the Emergency Department

EM@3AM: Cardiac Transplant Complications

EM@3AM: Crush Injury

The 70th Bubble Wrap – DFTB x MSc in PEM

emDOCs Revamp – Acute Chest Syndrome

ToxCard: Acute Organophosphate Toxicity

Sickle Cell Disease Module

Rethinking Fluid Resuscitation in Vaso-Occlusive Crisis: Is Lactated Ringer’s the Superior Choice?

ED care of refugee populations from sub-Saharan Africa

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