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A 45-year-old male with a history of chronic obstructive pulmonary disease (COPD), asthma, amphetamine and tetrahydrocannabinol (THC) use, and coronary vasospasm presented to triage with chest pain. During assessment, the patient reported that a left heart catheterization six months prior indicated spasms but no coronary artery disease.
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 emergencydepartment (non-PCI facility) for stabilization.
emergencydepartments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2 Standard management for VT and VF involves the use of electrical defibrillation, high-quality chest compressions, and epinephrine. Adult cardiac arrest in the emergencydepartment – A Swedish cohort study.
He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. He arrived in the emergencydepartment hemodynamically stable. The next day, and angiogram showed normal coronary arteries. This young male had ventricular fibrillation during a triathlon. His initial ECG is shown here.
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 emergencydepartment for chest tightness radiating to the back of his neck that has been intermittent for the past day or two. What do you think? Just another NSTEMI.
With ventilations and epinephrine, she regained a pulse. Rather it is due to coronary insufficiency due to a tight left main or 3-vessel disease with inadequate coronary flow. Data collected included demographics, initial rhythm, EKG, emergencydepartment (ED) CT and outcomes. Results: Over 8.5
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.
This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST-segment elevations (i.e I B Patients transferred to PCI centres can bypass the emergencydepartment to undergo primary PCI without delay. STEMI , ST-segment elevation acute myocardial infarction ).
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. Interventions during the acute phase of treatment post return of spontaneous circulation (ROSC) are therefore critical.
Data was collected at 2 emergencydepartments in America and included assessment by both clinicians and patients for a total of 31 patients. The device was assessed by the clinicians (emergency medicine doctors) using it on ease of use, speed of use and the appearance of the closed wound. Why does it matter?
The catheterization lab is activated, but catheterization shows no coronary artery occlusion. ECG shows ST-segment elevation in V3-V6 only with depression in aVR. Initial troponin is mildly elevated. On further questioning, the patient denies recent illness but does mention that her daughter passed away in a car accident yesterday.
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