The Skeptics' Guide to EM

MAY 28, 2022

Date: May 24th, 2022 Reference: Broder et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) 2: Low-Risk, Recurrent Abdominal Pain in the Emergency Department. Date: May 24th, 2022 Reference: Broder et al. Reference: Broder et al.

Emergency Department 100

Emergency Department ACS ALS Coronary 100

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. In fact, Kosuge et al. Stein et al. This is a paper worth reading : Marchik et al. What do you think?

E-9-1-1 137

E-9-1-1 ACS Emergency Department Coronary 137

The Skeptics' Guide to EM

OCTOBER 20, 2018

[display_podcast] Date: October 17th , 2018 Reference #1: Aycock, Westafer et al. Ann Emerg Med 2018 (CRD42017056195) Reference #2: Weisbord SD, Gallagher M, Jneid H, et al; PRESERVE Trial Group. first appeared on The Skeptics Guide to Emergency Medicine. Reference: Aycock, Westafer et al.

Coronary 174

Coronary Emergency Department ALS OR 174

Dr. Smith's ECG Blog

MAY 27, 2024

1] But there are multiple other abnormalities that make this ECG diagnostic of Occlusion MI, localized likely to the right coronary artery: 1. Systematic review and meta-analysis of diagnostic test accuracy of ST-segment elevation for acute coronary occlusion. Nikus et al. Kontos et al. Kontos et al. Bischof et al.

STEMI 119

STEMI Coronary ALS Emergency Department 119

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. References Tsao CW, et al. Benjamin EJ, et al. Kimblad H, et al. Adult cardiac arrest in the emergency department – A Swedish cohort study. Sakai T, et al. Kudenchuk PJ, et al.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. Amsterdam et al. Alencar et al. Lupu et al. But does this matter? Circulation 2014 2.

STEMI 118

STEMI Coronary ALS CAD 118

EMDocs

SEPTEMBER 26, 2024

Autopsy shows coronary atherosclerosis and marked cardiomegaly with a thickened left ventricular wall. References : System-Level Process Change Improves Communication and Follow-Up for Emergency Department Patients With Incidental Radiology Findings. Baccei SJ et al. Tyler W et al. Volume 80, no.

Emergency Department 74

Emergency Department ED Coronary ALS 74

The Skeptics' Guide to EM

JANUARY 18, 2020

Date: January 16th, 2020 Reference: Troponin Testing and Coronary Syndrome in Geriatric Patients With Nonspecific Complaints: Are We Overtesting? Andrew Huang: Andy is […] The post SGEM#280: This Old Heart of Mine and Troponin Testing first appeared on The Skeptics Guide to Emergency Medicine. Reference: Wang et al.

ACS 130

ACS Coronary Emergency Department OR 130

EM Didactic

OCTOBER 7, 2018

It is commonly used in Emergency Departments, especially in febrile and possibly infectious patients. Schillinger M, Domanovits H, Bayegan K, Hölzenbein T, Grabenw ö ger M, Thoenissen J, et al. Posted by: Lakshay Chanana ST4 Trainee Royal Infirmary of Edinburgh Department of Emergency Medicine Edinburgh Scotland @EMDidactic

Emergency Department 40

Emergency Department ACS Critical Care Coronary 40

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" Chris Mondie of the Newark Beth Israel Emergency Medicine Residency sent case 1 below of a 100% LM occlusion. Widimsky P et al.

Coronary 52

Coronary STEMI ACS ALS 52

EMS 12-Lead

MAY 20, 2022

Additional architectural changes include systolic anterior motion of the mitral valve, endothelial dysfunction at the level of the coronary arterial bed, and ventricular diastolic dysfunction. This worried the crew of potential acute coronary syndrome and STEMI was activated pre-hospital. It is spread to V2 and V3. References Naidu, S.

Coronary 130

Coronary STEMI Firefighter ED 130

EMS 12-Lead

APRIL 21, 2022

There is appreciable STE aVR with near-global STD that appropriately maximizes in Leads II and V5, and thus suggesting a circumstance of generic, diffusely populated, circumferential subendocardial ischemia versus occlusive coronary thrombus. [1] It’s judicious, then, to arrange for coronary angiogram. link] [1] Mirand, D.

Coronary 130

Coronary ALS OR ACS 130

The Skeptics' Guide to EM

MAY 19, 2018

[display_podcast] Date: May 16, 2018 Reference: Freund et al. Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events
 Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. display_podcast] Date: May 16, 2018 Reference: Freund et al. Reference: Freund et al.

Emergency Department 130

Emergency Department ALS Coronary OR 130

ACEP Now

DECEMBER 11, 2023

Many conditions outside of acute coronary syndrome (ACS) mimic ST-elevation myocardial infarction (STEMI), but only a handful of cases have reported ST-elevations (STE) in the setting of pancreatic inflammation where underlying ACS was excluded. 2 Proposed hypothesis as described by Hsu et al., Click to enlarge.)

STEMI 52

STEMI Coronary ACS Critical Care 52

Dr. Smith's ECG Blog

JUNE 21, 2023

Below is the version standardized by PM Cardio app Meyers interpretation: Findings are specific for posterior (and also likely inferior) wall transmural acute infarction, most likely due to acute coronary occlusion (OMI). Most OMI have a peak Troponin T over 1000 ng/L [reference: Baro R et al. Clinical Cardiology 2019.

STEMI 97

STEMI Coronary Defibrillator EMS 97

Dr. Smith's ECG Blog

OCTOBER 18, 2023

If you were working in a busy emergency department, would you like to be interrupted to interpret these ECGs or can these patients safely wait to be seen because of the normal computer interpretation? Emergent cardiac outcomes in patients with normal electrocardiograms in the emergency department. Am J Emerg Med.

STEMI 118

STEMI Emergency Department Coronary OR 118

ACEP Now

AUGUST 12, 2024

A 35-year-old male presented to the emergency department complaining of chest pain that started 1.5 5 Studies looking at this phenomenon in the emergency department setting for patients presenting with chest pain are lacking. Dr. Young is an emergency physician at Saint Francis Hospital and Medical Center, Hartford, Conn.

Emergency Department 52

Emergency Department STEMI ACS ED 52

EMS 12-Lead

APRIL 14, 2022

It should be emphasized here that this is a presentation of high-pretest probability for Acute Coronary Syndrome (ACS). link] [1] Zachary et al. Utility of the history and physical examination in the detection of Acute Coronary Syndromes in emergency department patients. 2] Costanzo, L. Physiology. 3] Parham, W.

ACS 130

ACS Paramedic Coronary ALS 130

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. Serial ECGs enhance the diagnosis of acute coronary syndrome. Bigger et al. Annals of Emergency Medicine , 31 (1), 3–11.

STEMI 85

STEMI Coronary Heart Attack ACS 85

Dr. Smith's ECG Blog

JANUARY 27, 2024

, tells us that we physicians do not need to even look at this ECG until the patient is placed in a room because the computer says it is normal: Validity of Computer-interpreted “Normal” and “Otherwise Normal” ECG in Emergency Department Triage Patients I reviewed this article for a different journal and recommended rejection and it was rejected.

STEMI 102

STEMI Coronary ACS ED 102

The Skeptics' Guide to EM

MARCH 10, 2018

[display_podcast] Date: March 6th, 2018 Reference: Zahed et al. Guest Skeptic: Dr. Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. display_podcast] Date: March 6th, 2018 Reference: Zahed et al. Reference: Zahed et al. AEM March 2018.

Emergency Department 100

Emergency Department ALS Coronary OR 100

EMDocs

OCTOBER 30, 2023

Background and Context Contrast-enhanced computed tomography (CECT) is of paramount importance in the emergency department (ED) due to its indispensable role in facilitating precise diagnostic outcomes. 16 In a study conducted by Millet et al. link] Bellolio MF, Heien HC, Sangaralingham LR, et al. West J Emerg Med.

E-9-1-1 73

E-9-1-1 Emergency Department ALS ED 73

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Hgb 11g/dL (110g/L) and leukocytosis, and a mildly elevated troponin (36 ng/L, with normal 1mm STE in aVR due to ACS will require coronary artery bypass surgery for revascularization, the infarct artery is often not the LM, but rather the LAD or severe 3-vessel disease. Harhash AA, Huang JJ, Reddy S, et al. Knotts et al.

ACS 52

ACS Coronary STEMI ALS 52

EMS 12-Lead

APRIL 28, 2022

Upon arrival at the receiving emergency department, however, she precipitously degenerated into VF and could not be resuscitated. In most cases, rather, the culprit is gross ischemia due to myocardial infarction, cardiomyopathy, or advanced coronary artery disease. Unfortunately, a post-conversion 12 Lead was not acquired.

E-9-1-1 130

E-9-1-1 ALS Coronary EMS 130

EMDocs

MARCH 25, 2024

2, 3 Biliary POCUS can help decrease patient length of stay in the Emergency Department. Video 3: Coronary approach to the gallbladder POCUS Findings Sonographically, the gallbladder is situated in the right upper quadrant as an elongated pear-shaped organ on the inferior surface of the liver. Acad Emerg Med. Ultrasound.

ALS 87

ALS Coronary Emergency Department ED 87

The Skeptics' Guide to EM

JUNE 14, 2017

It has been said that it can take 17 years for 14% of research to reach the patients’ bedside ( Morris et al 2011 ). Talk I: Knowledge Translation in the Digital Age The first talk was on knowledge translation (KT) in the digital age. A number of examples of the KT problem were provided.

Coronary 130

Coronary Emergency Department ALS 130

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. Tintinalli JE, Stapczynski J, Ma O, et al. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 8e.

Operating Room 52

Operating Room ACS Critical Care Coronary 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

AslangerE A 65-year-old gentleman presented to the emergency department after experiencing two recent ICD shocks in the preceding hours. A recent angiogram report indicated a totally occluded left anterior descending artery (LAD) and right coronary artery (RCA), with 30-40% narrowings in the left circumflex artery (LCx).

Coronary 97

Coronary EMR STEMI Emergency Department 97

ACEP Now

JUNE 6, 2023

Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. References Hansen MS, et al. Rogers AM, et al. Cecconi M, et al. Circulation.

ACS 85

ACS ALS ED OR 85

Dr. Smith's ECG Blog

JUNE 19, 2023

Written by Kaley El-Arab MD, edits by Pendell Meyers and Stephen Smith A 61-year-old male with hypertension and hyperlipidemia presented to the emergency department for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. Armstrong et al. What do you think? Just another NSTEMI.

STEMI 52

STEMI ACS Coronary Defibrillator 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

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. Guagliumi, G., Iwaoka, R.

E-9-1-1 117

E-9-1-1 OR Coronary ACS 117

REBEL EM

FEBRUARY 22, 2023

difficult to see due to corneal edema) Emergency Department Management All patients should get emergency ophthalmologic consultation Start with eye drops (see table below) and add systemic medications if severe or refractory symptoms/IOP. et al, Emergency Medicine Clinical Essentials ed 2. Cup to disc ratio >0.6

Emergency Department 52

Emergency Department ALS ED Coronary 52

Dr. Smith's ECG Blog

DECEMBER 29, 2023

It was ongoing on arrival in the emergency department. STEMI criteria is bad at differentiating between normal variant and acute coronary occlusion or reperfusion, and initial troponin levels don't differentiate between occlusive and non-occlusive MI 3. McLaren et al, including Meyers/Smith. Am J Emerg Med 2023 2.

STEMI 70

STEMI Coronary OR ALS 70

Core EM

JULY 23, 2024

Objective: Based on current evidence, this review article aims to guide the Emergency Department (ED) in providing care for patients with blast injuries. Cardiovascular: Injury: cardiac contusion, wall rupture, tamponade, papillary muscle rupture, valve injury, aortic arch injury, and coronary artery dissection. Nowadly C.D.,

EMS 100

EMS Emergency Medical Services OR Coronary 100

Dr. Smith's ECG Blog

MAY 23, 2023

Am J Emerg Med. I have here 38 cases of "Computer Normal" ECGs which were critically abnormal and the vast majority are missed acute coronary occlusions (Missed Acute OMI) and most were recognized by the physician. Of the Non-STEMI in our cohort, about 25% will actually have acute coronary occlusion. 2022 Jan;51:384-387.

STEMI 90

STEMI Coronary Paramedic OR 90

EMDocs

OCTOBER 21, 2023

A 68-year-old male with a past medical history of hypertension, diabetes mellitus, and coronary artery disease with a drug eluting stent placed 2 months ago presents with dizziness and vomiting that began 3 hours ago. References: Gaillard F, Glick Y, Tatco V, et al. 61.4.496 Navi BB, Kamel H, Shah MP, et al. Arch Neurol.

EMS 73

EMS ALS OR ACS 73

Core EM

MARCH 7, 2024

Objective: Based on current evidence, this review article aims to guide the Emergency Department (ED) in providing care for patients with blast injuries. Cardiovascular: Injury: cardiac contusion, wall rupture, tamponade, papillary muscle rupture, valve injury, aortic arch injury, and coronary artery dissection. Nowadly C.D.,

EMS 100

EMS Emergency Medical Services OR Coronary 100