Core EM

JANUARY 25, 2024

Risk factors that increase the likelihood of VT include history of previous myocardial infarction, known coronary artery disease, and structural heart disease. The patient did not respond to medical therapies trialed in the emergency department and ultimately underwent radio-frequency ablation with the return of normal sinus rhythm.

Coronary 246

Coronary Emergency Department ED OR 246

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 ALS 130

Core EM

FEBRUARY 23, 2024

The Case A 71-year-old male with a history of chronic obstructive pulmonary disease, hyperlipidemia, and peptic ulcer disease presents to the emergency department with substernal chest pain radiating down the right arm and dyspnea that began acutely while “running” up the stairs from the subway.

STEMI 130

STEMI Coronary Emergency Department OR 130

The Skeptics' Guide to EM

MAY 19, 2018

Effect of the Pulmonary Embolism Rule-Out Criteria on Subsequent Thromboembolic Events
 Among Low-Risk Emergency Department Patients: The PROPER Randomized Clinical Trial. Case: A 47-year-old woman presents to the emergency department with a 24-hour history of chest pain and shortness of breath. JAMA February 2018.

Emergency Department 130

Emergency Department ALS Coronary OR 130

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). The patient was rushed to the nearest emergency department (non-PCI facility) for stabilization.

Coronary 130

Coronary ACS Emergency Department Epinephrine 130

EMDocs

DECEMBER 11, 2023

Emergency physicians have recognized for some time that there are many occlusions of the coronary arteries that do not present with classic STEMI criteria on the ECG. In October 2022, the American College of Cardiology released an updated expert consensus decision regarding the evaluation of chest pain in the emergency department.

STEMI 119

STEMI Coronary Emergency Department OR 119

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

She arrives in the emergency department (ED) with decreased level of consciousness and shock. Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients. She has a history of hypertension and non-insulin dependent diabetes mellitus.

EMR 130

EMR Coronary Defibrillator Life Support 130

The Skeptics' Guide to EM

APRIL 10, 2021

He is a GP by training but works in Emergency Department, Anaesthesia, Internal Medicine and Paediatrics. He has a wonderful #FOAMed blog and podcast called Broomedocs and also work […] The post SGEM#326: The SALSA Study: Hypertonic Saline to Treat Hyponatremia first appeared on The Skeptics Guide to Emergency Medicine.

Emergency Department 130

Emergency Department Coronary ED OR 130

Dr. Smith's ECG Blog

MARCH 10, 2025

But like many similar studies, the study was small (one year at one centre with no indication of the incidence of acute coronary occlusion), and it used as the gold standard the final cardiologist interpretation of the ECG - not the patient outcome! Am J Emerg Med. Am J Emerg Med. Acad Emerg Med [Internet] 2017;24(1):1204.

STEMI 89

STEMI OR Coronary Emergency Department 89

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. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think?

E-9-1-1 140

E-9-1-1 ACS Emergency Department Coronary 140

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

The Skeptics' Guide to EM

MAY 28, 2022

Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) 2: Low-Risk, Recurrent Abdominal Pain in the Emergency Department. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) 2: Low-Risk, Recurrent Abdominal Pain in the Emergency Department.

Emergency Department 100

Emergency Department ACS ALS Coronary 100

ALiEM

OCTOBER 20, 2023

A 50-year-old Caucasian female with a history of hypertension, coronary artery disease, and insulin-dependent diabetes mellitus presents to the emergency department with a complaint of painful sores on the top of her left foot.

Plasma 161

Plasma Coronary Emergency Department OR 161

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. 2014 AHA/ACC guideline for the management of patients with non-ST elevation acute coronary syndromes.

STEMI 122

STEMI Coronary ALS CAD 122

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

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. But STEMI criteria is only 43% sensitive for OMI.[1] Int J Cardiol 2024 2.

STEMI 124

STEMI Coronary ALS Emergency Department 124

The Skeptics' Guide to EM

JUNE 14, 2017

. * Five SGEM Episodes: * The HEART Pathway: The HEART Pathway appears to have the potential to safely decrease objective cardiac testing, increase early discharge rates and cut median length of stay in low risk chest pain patients presenting to the emergency department with suspicion of acute coronary syndrome.

Coronary 130

Coronary Emergency Department ALS 130

EM Didactic

OCTOBER 7, 2018

It is commonly used in Emergency Departments, especially in febrile and possibly infectious patients. C-reactive protein (CRP) is an acute phase protein synthesized in the liver. It is also used as a measure of tissue inflammation, a biomarker of disease activity and a prognostic tool of many acute and chronic diseases.

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

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting." Hospital Course The patient was taken emergently to the cath lab which did not reveal any significant coronary artery disease, but she was noted to have reduced EF consistent with Takotsubo cardiomyopathy.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

Dr. Smith's ECG Blog

MAY 20, 2024

The scan also showed “scattered coronary artery plaques”. __ Smith comment 1 : the appropriate management at this point is to lower the blood pressure (lower afterload, which increases myocardial oxygen demand). They too have dense white masses consistent with coronary atherosclerosis. The blue circle shows the LCx. Murakami MM.

CAD 127

CAD STEMI Coronary ACS 127

EMS 12-Lead

AUGUST 14, 2022

The specific ST/T pattern was not fully appreciated by the attending EMS personnel, yet alarming enough to convince the patient to be seen in the Emergency Department despite his intentions of seeking evaluation on his own accord through his respective family physician. But the lesion is still active! MICU transport was unremarkable.

MICU 130

MICU STEMI CAD Coronary 130

EMDocs

OCTOBER 28, 2023

Source STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. Circulation. 2023 Aug 29;148(9):753-764. doi: 10.1161/CIRCULATIONAHA.123.064521. 123.064521. Epub 2023 Jul 13. #3:

STEMI 85

STEMI Emergency Department Coronary OR 85

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 120

STEMI Emergency Department Coronary OR 120

EMDocs

SEPTEMBER 19, 2023

American College of Cardiology released a new consensus statement, “ Expert Consensus Decision Pathway on the Evaluation and Disposition of Acute Chest Pain in the Emergency Department: A Report of the American College of Cardiology Solution Set Oversight Committee “. J Am Coll Cardiol. 2022 Nov 15;80(20):1925-1960.

STEMI 90

STEMI Coronary Emergency Department ICU 90

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). link] ] Outcome The patient emerged neurologically intact. Clinical Cardiology 2019.

STEMI 98

STEMI Coronary Defibrillator EMS 98

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. It is unknown when this pain recurred and became constant.

Defibrillator 137

Defibrillator Coronary STEMI CPR 137

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). Utility of the history and physical examination in the detection of Acute Coronary Syndromes in emergency department patients. Western Journal of Emergency Medicine, 18 (4), 752-760. [2]

ACS 130

ACS Paramedic Coronary ALS 130

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion. The undergraduate is now willing to identify himself: Hans Helseth. No ECG was ordered on Day #1.

Coronary 121

Coronary STEMI Emergency Department OR 121

The Skeptics' Guide to EM

MARCH 10, 2018

Justin Morgenstern is an emergency physician and the Director of Simulation Education at Markham Stouffville Hospital in Ontario. He is the creator of the excellent #FOAMed project called First10EM.com Case: A 77-year-old woman with known coronary artery disease is on clopidogrel and aspirin because of a stent placed four month ago.

Emergency Department 100

Emergency Department ALS Coronary OR 100

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 118

STEMI Coronary ACS ED 118

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

Angiogram: Severe two-vessel coronary artery disease with possible co-culprits (90% proximal circumflex, 70% mid/distal RCA) in the setting of non-ST elevation myocardial infarction. Marked ST depression from multi-vessel coronary disease serves to attentuate what would have been ST elevation in leads II and aVF ).

ED 120

ED Coronary CAD STEMI 120

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. J Am Coll Rad 15:4;639-647, April 1, 2018. Tyler W et al.

Emergency Department 93

Emergency Department ED Coronary ALS 93

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Adult cardiac arrest in the emergency department – A Swedish cohort study. Coronary artery disease in patients with out-of-hospital refractory ventricular fibrillation cardiac arrest. Circulation.

Defibrillator 98

Defibrillator OR ALS Epinephrine 98

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-9-1-1 132

E-9-1-1 OR Coronary ACS 132

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. Written by Bobby Nicholson What do you think of this “STEMI”? Blood glucose was not low at 162 mg/dL.

STEMI 117

STEMI Coronary Emergency Department ACS 117

Dr. Smith's ECG Blog

MAY 13, 2024

Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain. 4) Lastly, the QRS amplitude in V2 (both the R- and S- waves) are measured.

OR 121

OR STEMI Heart Attack Coronary 121