REBEL EM

SEPTEMBER 14, 2023

Control: 53.4% D ECLS: 18.2% Control 8.7% Control 38.0% Majority of patients had PCI performed (96.6%) Impella CP was most common mechanical circulatory support in patients without ECLS (85.7%) Death From Any Cause at 30d ECLS: 47.8% Control: 49.0% RR 0.98; 95% CI 0.80 to 1.19; p = 0.81 vs 13.9% (RR 0.58; 95% CI 0.33 vs 22.6% (RR 1.03; 95% CI 0.88

Life Support 137

Life Support Coronary CPR ICU 137

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?" Smith and Meyers answer: First , LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.

Coronary 52

Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

JUNE 23, 2024

His daughter immediately started CPR and another family member called EMS. The patient was treated as possible NSTEMI and underwent coronary angiography about 4 hours after presentation. TIMI 3 means the rate of passage of dye through the coronary artery is normal by angiography.) Initial hsTnI was 384 ng/L.

Coronary 108

Coronary CAD CPR Critical Care 108

REBEL EM

SEPTEMBER 28, 2023

STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. Based on this, the authors did a literature review and found that there is an increasing rate of ICH and major non-intracranial bleeding starting at ≈60 years of age.

STEMI 138

STEMI Allergic Reaction Coronary Ambulance 138

Dr. Smith's ECG Blog

APRIL 2, 2024

There was no bystander CPR. For this reason we did not believe this was an acute coronary event and did not activate the cath lab. Here is the troponin profile overnight: This is consistent with cardiac arrest without acute coronary occlusion. An elderly man collapsed. Medics found him in ventricular fibrillation.

Defibrillator 128

Defibrillator Coronary Epinephrine CPR 128

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. 3-vessel disease can make resuscitation very difficult, since CPR does not perfuse diseased vessels as well as one would like. He reports feeling nauseated with emesis.

Defibrillator 130

Defibrillator Coronary STEMI CPR 130

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? Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest: Results of the Randomized, Multicentric EMERGE Trial.

Coronary 83

Coronary CPR OR ICU 83

Don't Forget the Bubbles

OCTOBER 7, 2024

However, vertical flow can result in myocardial injury secondary to coronary artery spasm. Electrical injuries can range from something minor that needs no medical input to tetany of respiratory muscles through to cardiac arrest secondary to dysrhythmia (VF, VT or asystole). Was the voltage high or low (as below)?

ACS 80

ACS Life Support OR CPR 80

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

E-9-1-1 89

E-9-1-1 Defibrillator CPR STEMI 89

REBEL EM

JANUARY 29, 2024

in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 in the paper but 2.7% to ≈0.99 (p<0.001) Mean MPI/Tei Index≈ 0.47 to 4.0mg/hr typically given in EKOS therapy (See Below).

ALS 137

ALS ACS OR CPR 137

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He underwent CPR and then was shocked out of VF. At times — the initial subtle findings simply represent a phase of "pseudo-normalization" that may occur soon after spontaneous reopening of an acutely occluded coronary artery. Today's patient is high-risk ( ie, in a high "prevalence" group for having an acute coronary event ).

Coronary 52

Coronary Heart Attack ED CPR 52

EMDocs

JANUARY 11, 2024

Brain Oxygenation, Perfusion, Edema, and ICP Statements Takeaway: Avoid 100% oxygen saturation. Instead, target 92-98%. Keep hemoglobin > 7 g/dL. Consider lowering ICP if elevated (head of bed elevation, hyperosmolar therapy, etc.). Valproic acid and levetiracetam are reasonable first-line therapies for EEG or clinical seizure activity.

Critical Care 75

Critical Care E-9-1-1 OR ICU 75

Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. As in all ischemia interpretations with OMI findings, the findings can be due to type 1 AMI (example: acute coronary plaque rupture and thrombosis) or type 2 AMI (with or without fixed CAD, with severe regional supply/demand mismatch essentially equaling zero blood flow).

ACS 52

ACS CPR CAD Heart Attack 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

Furthermore, among 35 patients with acute left main coronary artery occlusion, 9 presented with RBBB (mostly with LAH) on the admission ECG. The computer read "Right Bundle Branch Block" There is RBBB and LAFB, which can make it difficult to see the end of the QRS. In RBBB, there should be no ST elevation, or minimal.

CPR 52

CPR STEMI Coronary ALS 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. Enrollees were then assigned to either TTM of 33ºC or 36ºC for 36 hours.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

Dr. Smith's ECG Blog

JUNE 11, 2021

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. This ALONE is very strong evidence of acute coronary occlusion. Learning points 1. VF arrest is of course "electrical instability"!

EMR 52

EMR STEMI CPR ED 52

REBEL EM

SEPTEMBER 5, 2022

Liberal O2 (PaO2 13 to 14kPa (98 to 105mmHg) Initial FiO2 set at 0.6 Liberal O2: 33.9% HR 0.95; 95% CI 0.75 to 1.21; p = 0.69 Results were consistent in all prespecified subgroups Death at 90d Restrictive O2: 28.7% Liberal O2: 31.1% HR 0.93; 95% CI 0.72 Higher MAP: 34.0% HR 1.08; 95% CI 0.84 to 1.37; p = 0.56 Liberal O2: 33.9% HR 0.95; 95% CI 0.75

ICU 52

ICU ALS OR CPR 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. And so it is wise to look at the coronary arteries. This ECG certainly looks like myocarditis, and was due to myocarditis, but missing acute coronary occlusion is not acceptable. 3–8 Shi et al.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

OCTOBER 24, 2013

He underwent immediate CPR, was found to be in ventricular fibrillation, and was successfully resuscitated. He underwent coronary stenting (uncertain which artery). See explanation below. The patient went home and, in front of his wife, he collapsed. I do not have the post-resuscitation ECG. Did the ECG offer unseen hints?

CPR 52

CPR ACS Coronary OR 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was Furthermore, among 35 patients with acute left main coronary artery occlusion, 9 presented with RBBB (mostly with LAFB) on the admission ECG. The QRS duration is slightly long even for RBBB, at 166 ms. Does he need a stress test? --Is

STEMI 52

STEMI CPR CAD Coronary 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts. Coronary spasm causing massive current of injury with shark fin ECG. I would not expect ST-E to vanish in four beats with dissolving thrombus (also we know that the coronaries were clean). I suspect LAD or LM.

Coronary 52

Coronary Defibrillator ACS CAD 52

Dr. Smith's ECG Blog

APRIL 29, 2020

CPR was started immediately. Angiogram --Minimal coronary atherosclerosis --No obstructive epicardial coronary artery disease or evidence of plaque rupture noted to explain prolonged QT or ventricular fibrillation cardiacarrest, suspect nonischemic mechanism Echo The estimated left ventricular ejection fraction is 45 %.

Defibrillator 52

Defibrillator Epinephrine Coronary Overdose 52

Dr. Smith's ECG Blog

MARCH 9, 2017

CPR was initiated and she subsequently entered into V-Fib storm. For example, a coronary plaque ruptures: the vessel can undergo occlusion, spontaneous reperfusion, maybe reocclusion, again reperfusion, etc. This was her ECG (it is unclear if this was with or without pain): Computerized ECG Read: “Normal sinus rhythm. Normal ECG.”

CPR 52

CPR ACS Coronary ED 52

Dr. Smith's ECG Blog

MARCH 11, 2016

Patients who received CPR or experienced reinfarction or very small infarcts due to thrombolysis also displayed Type II T-wave evolution. However, much ST elevation remains, and there is no re-constitution of R-waves. But the assessment was correct, as troponins continued to decline. T-waves remain upright. That remains to be seen.

ALS 52

ALS STEMI OR CPR 52

Don't Forget the Bubbles

DECEMBER 5, 2023

With millions of journal articles published yearly, it is impossible to keep up. Our team have scoured the literature, so you don’t have to… or it might spark an interest to go and have a look at the full article. A very Merry Christmas from the BW team, and all the Best Wishes for 2024! Br J Gen Pract. 2023 Oct 26;73(736):e850-e857.

Coronary 111

Coronary Epinephrine CPR Emergency Department 111