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. In either case, prompt cardioversion is indicated.

Coronary 120

Coronary ACS ED OR 120

Dr. Smith's ECG Blog

JANUARY 6, 2023

Smith comment: We have shown that use of opiates is associated with worse outcomes in ACS: Bracey, A. The facility was not pressed to activate emergent transfer for PCI since the pain was improving and suggested we optimize pain control and admit to the Cardiac ICU. OMI is not just an ECG diagnosis.

ACS 52

ACS Coronary ICU STEMI 52

EMDocs

JANUARY 11, 2024

Hematologic Management Takeaway : They recommend a transfusion threshold < 9 g/dL in those with ACS, but several studies (MINT trial) and guidelines suggest 8 g/dL can be used. Digestive Management Takeaway: Start enteral feeds when the patient gets to the ICU. Administer VTE prophylaxis in the first 48 hours, preferably LMWH.

Critical Care 94

Critical Care E-9-1-1 OR ICU 94

ACEP Now

MAY 9, 2024

After developing encephalopathy and hypoxemic respiratory failure, the patient was transferred to the ICU. Further diagnostic testing in the ICU identified salicylate toxicity. Available from: [link] Newman-Toker DE, Nassery N, Schaffer AC, et al. Rockville (MD): Agency for Healthcare Research and Quality (US); 2022 Dec.

Emergency Department 52

Emergency Department ICU ALS ACS 52

Dr. Smith's ECG Blog

MARCH 12, 2018

It is also true that anterior and inferior T-wave inversion could be consistent with reperfusion of a type III wraparound LAD occlusion, despite the fact that Kosuge et al showed that T-wave inversion in lead III is much more likely to be PE than ACS if your differential contains nothing else. She was discharged and did well. Kosuge et al.

ACS 40

ACS Coronary ALS ICU 40

Emergency Medicine Ireland

DECEMBER 17, 2020

Intensivists have embraced the tracheostomy as an ICU procedure. doi: 10.21037/acs.2018.03.01. In a breaking from what could only loosely be described as tradition at this point, this podcast is going to be in 2 parts. It’s one of the most invasive and one of the riskier procedures we do. Surgical anatomy of the trachea.

Critical Care 40

Critical Care ACS ICU OR 40

AAEM RSA

APRIL 1, 2021

1 The American College of Surgeons’ (ACS) Trauma Quality Improvement Program (TQIP) Massive Transfusion in Trauma Guidelines leave a good amount of flexibility for hospitals regarding transfusion protocols, focusing more on systems-level aspects of designing and implementing MTPs.2,3 ACS TQIP Best Practice Guidelines. 248(3):447-58.

E-9-1-1 52

E-9-1-1 Plasma ACS ALS 52

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.

EMS 93

EMS ALS OR ACS 93

Dr. Smith's ECG Blog

MARCH 6, 2019

She did not receive any opioids (which would mask her pain without affecting any underlying ACS). If for some reason the angiogram is delayed, they should receive maximal medical therapy in an ICU setting with continuous 12-lead ST segment monitoring under the close attention of a practitioner with advanced ECG interpretation training.

STEMI 52

STEMI ALS ACS ICU 52

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. The primary outcome measure was chest drain failure, i.e., retained haemothorax requiring a secondary interventional procedure. Trauma Surg Acute Care Open.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

REBEL EM

JULY 14, 2022

An example using a real case I had while on call in the ICU: A 61-year-old female had a post-induction arrest on the wards/hospital telemetry floor after being intubated for airway protection. PMID: 30060961 Koller AC, et al. In a PCAC 1 or 2, we may prioritize a cath and tolerate a couple hours without ICU Neuroresuscitation.

ICU 52

ICU ALS OR CPR 52

REBEL EM

FEBRUARY 2, 2023

2 Amiodarone is commonly known for its anti-arrhythmic properties and a commonly used agent in the Intensive Care Unit (ICU). Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). However, digoxin is known for its rate-control properties and its direct vagal effect on the atrioventricular node.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. The cardiologists felt that the ECG did not represent ACS, and thought it was more likely pericarditis, so they did not take him to the cath lab. in the ICU but survived with excellent function.

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 52

ACEP Now

NOVEMBER 14, 2023

References Deshwal H, Sinha A, Mehta AC. If it is determined that the bleeding originates from one lung it is recommended to position the patient in lateral decubitus with the bleeding lung down to avoid contamination of the contralateral lung. Portable chest X-ray may help determine from which lung the bleeding originates.

E-9-1-1 52

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

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. Etomidate is likely an agent of last resort for monotherapy due to the short duration of action (12).

ED 84

ED Emergency Department ALS Paramedic 84

ECG & Echo Learning

OCTOBER 2, 2022

Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). Gordon AC, Mason AJ, Thirunavukkarasu N, et al. Several endogenous and synthetic agents exist and are frequently combined to achieve the desired hemodynamic outcome. Intensive Care Med 2004; 30:597.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

Dr. Smith's ECG Blog

APRIL 20, 2018

I took part in her ICU care and she was extubated and stable to transfer to a stepdown unit after a few days. Patients like her are the reason we are advocating for a change in the ACS paradigm from STEMI to OMI. Her repeat ECHO showed an improving EF of 37%.

Coronary 40

Coronary STEMI EMS ACS 40

Dr. Smith's ECG Blog

MARCH 11, 2019

The patient was managed in the ICU and had serial troponins. An angiogram confirmed ACS as the etiology. (THE PM CARDIO OMI AI APP) If you want this bot to help you make the early diagnosis of OMI and save your patient and his/her myocardium, you can sign up to get an early beta version of the bot here. He had no more ECGs recorded.

ACS 52

ACS OR ICU STEMI 52

ALiEM

OCTOBER 30, 2024

We have certainly seen patients who have pain which is controlled and still have psychomotor agitation and sympathetic activation, leading some to require ICU admission for dexmedetomidine and/or ketamine infusion. DOI: Papudesi BN, Malayala SV, Regina AC. This month in JAAD Case Reports: August 2023: Xylazine and skin necrosis.

E-9-1-1 161

E-9-1-1 Naloxone Emergency Department ALS 161

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. 3 Many will experience vague, nonspecific symptoms such as weakness or fatigue.

EMS 80

EMS E-9-1-1 ACS Coronary 80

EMDocs

OCTOBER 7, 2023

Goodman AD, Got CJ, Weiss AC. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. Critical Care. 2016;20(1):135. Genthon A, Wilcox SR. Crush syndrome: a case report and review of the literature. J Emerg Med. 2014;46(2):313-319. Crush Injuries of the Hand. J Hand Surg Am. 2017;42(6):456-463.

EMS 92

EMS E-9-1-1 Emergency Department ALS 92

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). 11) Webb RK, Ralston AC, Runciman WB. Are there circumstances where ABGs are necessary, and why may consultants specifically request them? PMID: 11685301. (10)

Emergency Department 98

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

Don't Forget the Bubbles

MAY 3, 2023

Garabon JJW, Gunz AC, Ali A, Lim R. This explorative review described insertion success rates, time to first insertion, and duration of IO function (time from insertion to IO failure, IV access insertion, transfer to ICU, or death). Prehosp Emerg Care. 2023;27(2):221-226. doi:10.1080/10903127.2022.2072553 What’s it about?

CPR 52

CPR Emergency Department ALS ICU 52

EMDocs

JUNE 27, 2024

Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 0.4 Am J Emerg Med.

E-9-1-1 94

E-9-1-1 ICU ACS EMS 94

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. 12784 Povey AC, Rees HG, Thompson JP, Watkins G, Stocks SJ, Karalliedde L. Airway management should not be delayed. Toxicology.

E-9-1-1 97

E-9-1-1 ICU Emergency Department ED 97

Don't Forget the Bubbles

JULY 5, 2023

Opioids do not cause ACS but they can exacerbate hypoxia in patients with ACS. Older children and adults usually present with ACS 2-3 days after hospitalisation due to pulmonary infarction (in situ sickling), hypoventilation due to rib infarction (which may be exacerbated by recent narcotic administration) or fat embolism.

E-9-1-1 126

E-9-1-1 ACS OR ICU 126

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 124

ALS ED ACS EMR 124

The Curious Clinicians

FEBRUARY 19, 2025

It’s easy to think of bacteria as always “wanting” to infect a host as quickly and aggressively as possible (and if you’ve ever taken care of someone with an acute PA bloodstream infection, you know how fast they can go from healthy to needing the ICU). 2-AA helps PA do just that. The Curious Clinicians Podcast.

ACS 52

ACS ICU OR 52

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. Severe malaria is typically caused by P. Uncomplicated malaria patients who are able to access prescription medication can be discharged home. Accessed October 5, 2024. Accessed October 5, 2024.

ED 72

ED E-9-1-1 ALS Emergency Department 72