REBEL EM

MARCH 30, 2023

Clinical Question : In patients who suffer an OHCA without ST-segment elevation on the post-resuscitation ECG, will early coronary angiogram (CAG) vs. delayed CAG improve outcomes? Article: How-Berlemont C, Lamhaut L, Diehl J, et al. Comparator: Delayed CAG: Patients were admitted to the ICU, and CAG was performed after 48-96 hours.

Coronary 66

Coronary CPR OR ICU 66

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). μg/kg/min + + + ++ Low dose dopamine stimulates D1 receptors and induces vasodilation in coronary, renal, cerebral and mesenteric vessels. Increases coronary blood flow. Coronary flow enhanced.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

AAEM RSA

AUGUST 27, 2020

1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Nielsen N, Wetterslev J, Cronberg T et al. By the time of the study by Nielsen et al. Kirkegaard et al.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

REBEL EM

SEPTEMBER 5, 2022

Paper 1: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Paper 2: Kjaergaard J et al. References: Schmidt HJ et al. PMID: 360027567 [ Access on Read by QxMD ] Kjaergaard J et al. A higher MAP may offer advantages due to improved cerebral perfusion pressure, however data is lacking. Liberal O2: 33.9%

ICU 52

ICU ALS OR CPR 52

Dr. Smith's ECG Blog

MAY 26, 2023

He was admitted to the ICU and was unstable, in shock, overnight. If the situation is not right for acute coronary occlusion, then the ECG findings probably do not represent acute coronary occlusion. Despite the eye-catching ST-T wave changes that came-and-went a number of times — there was no acute coronary occlusion.

Overdose 98

Overdose E-9-1-1 Coronary ICU 98

EMDocs

JANUARY 11, 2024

Early coronary angiography in post-CA patients with no ST-segment elevation on the presenting ECG may still be of benefit by potentially salvaging myocardium and decreasing the incidence of systolic heart failure in survivors (95.7%, 22/23). Digestive Management Takeaway: Start enteral feeds when the patient gets to the ICU.

Critical Care 98

Critical Care E-9-1-1 OR ICU 98

Dr. Smith's ECG Blog

OCTOBER 28, 2022

Learn about the Smith-Modified Sgarbossa Criteria for Diagnosis of OMI Paced Rhythm: Dodd, Meyers, Smith, et al. Electrocardiographic diagnosis of acute coronary Occlusion Myocardial Infarction in ventricular paced rhythm using the modified Sgarbossa criteria. He went into cardiogenic shock and is intubated in the cardiac ICU.

Coronary 52

Coronary Paramedic ICU EMS 52

Emergency Medicine Ireland

OCTOBER 30, 2023

This vasoconstriction affects pretty much all the vasculature including things like the coronaries (not so good) but does seem to spare the pulmonary arteries meaning it may be good in those with pulmonary hypertension. First up is the VASST trial, (Russel et al 2008 NEJM). This was closer to home in the UK, with 18 ICUs.

Critical Care 52

Critical Care ALS Coronary ICU 52

Dr. Smith's ECG Blog

MARCH 12, 2018

Wellens pattern is a term which refers to coronary reperfusion morphology in the anterior leads) The best answer is because the entire gestalt of the ECG shows acute right heart strain instead, and just does not look like Wellens after you've seen Wellens hundreds of times. Stein et al. This is a paper worth reading : Marchik et al.

ACS 40

ACS Coronary ALS ICU 40

Dr. Smith's ECG Blog

MARCH 6, 2019

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. Patel et al., Krucoff et al.) Patel et al. Krucoff et al. Schomig et al.

STEMI 52

STEMI ALS ACS ICU 52

Dr. Smith's ECG Blog

APRIL 20, 2018

If she had no risk factors, it is doubtful that she would have developed such extensive coronary artery disease as we see on the angiogram. I took part in her ICU care and she was extubated and stable to transfer to a stepdown unit after a few days. Her repeat ECHO showed an improving EF of 37%.

Coronary 40

Coronary STEMI EMS ACS 40

Dr. Smith's ECG Blog

JANUARY 6, 2023

Lupu L, et al. Immediate and early percutaneous coronary intervention in very high-risk and high-risk Non-STEMI patients. 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. mg/dL, K 3.5

ACS 52

ACS Coronary ICU STEMI 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

Fortunately, he was extubated several days later in the ICU with intact baseline mental status and was discharged shortly thereafter to subacute rehab. Herzog et al. His troponin I peaked at 97 ng/mL (very large MI!). His follow up ECHO the next day revealed an EF of 24% and a posterior wall motion abnormality.

CAD 52

CAD OR ED ALS 52

Dr. Smith's ECG Blog

JULY 12, 2020

A CT was obtained later and showed appropriate positioning of the catheter: She was admitted to the ICU and the catheter was used several times to withdraw more fluid. There are too-numerous-to-count cases on Dr. Smiths ECG Blog in which emergency providers diagnosed acute pericarditis that was really acute coronary syndrome.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40

EMDocs

JANUARY 6, 2024

3,10 Coronary Allograft Vasculopathy Nicknamed “The Achilles Heel of Heart Transplantation,” this accounts for the majority of patient mortality in the 5-10 year range. 10 It affects the whole length of the vessel and all layers of the coronary vasculature rather than just the intima, which is seen in non-transplant atherosclerosis.

EMS 91

EMS E-9-1-1 ACS Coronary 91

ACEP Now

JUNE 14, 2024

Some of the critical differentials include pulmonary embolism, acute decompensated heart failure, pneumonia, pneumothorax, and acute coronary syndrome. Anginal chest pain, chest heaviness, or evidence of fluid overload suggest acute coronary syndrome or acute decompensated heart failure. Adeloye D, Song P, Zhu Y, et al.

ALS 52

ALS Coronary OR ED 52

EMDocs

OCTOBER 29, 2024

He was started appropriately on vancomycin and cefepime and accepted for ICU admission but remains in the ED due to boarding and bed lock. Left ventricular outflow tract obstruction in ICU patients. doi:10.1016/S0033-0620(05)80036-2 Balik M, Novotny A, Suk D, et al. doi:10.3390/JCM13185344 Yamagishi T, Tanabe T, Fujita H, et al.

E-9-1-1 98

E-9-1-1 ICU Epinephrine EMS 98

Don't Forget the Bubbles

MARCH 24, 2025

This is likely because Dexmed helps dampen the sympathetic response to perioperative stress, improving coronary artery perfusion. Dexmedetomidine is currently licensed only for adult sedation in an ICU setting, but guidelines exist to support its off-licence use in paediatric intensive care (PICU). 13526 Zhang Q, Zhou J, He Q, et al.

E-9-1-1 59

E-9-1-1 Emergency Department ALS ICU 59