EMDocs

JANUARY 8, 2024

For patients with OHCA, use of steroids during CPR is of uncertain benefit. Extracorporeal CPR Use of ECPR for patients with cardiac arrest refractory to standard ACLS is reasonable in select patients when provided within an appropriately trained and equipped system of care. COR 2a, LOE B-R. COR 2a, LOE C-LD. COR 2b, LOE B-R.

Epinephrine 82

Epinephrine Defibrillator Coronary CPR 82

The Skeptics' Guide to EM

FEBRUARY 3, 2023

The nurses started CPR immediately and place pads before you even arrived. A post-arrest ECG doesn’t show any signs of STEMI. A 50-year-old man who was admitted to the hospital with a non-ST elevated myocardial infarction (NSTEMI) overnight was found unconscious and without a pulse. The patient is still unconscious.

CPR 130

CPR Critical Care STEMI ALS 130

NAEMSP

MARCH 5, 2024

Air medical transport has been utilized in multiple hospital based programs including trauma, STEMI, and stroke. Cardiac arrest has been proven difficult in flight, but research is still needed with mechanical CPR machines. They have also been utilized with high risk OB, specialized patients with IABP, ECMO, Impella’s etc.

Critical Care 52

Critical Care Medical Transportation CPR EMS 52

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

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

He reports that this chest pain feels different than prior chest pain when he had his STEMI/OMI, but is unable to further describe chest pain. Sensitivity was 87% for OMI in our validation study (it was 34% for STEMI criteria). He reports feeling nauseated with emesis. There is ischemic ST depression in V4-V6. So it can miss some OMI.

Defibrillator 131

Defibrillator Coronary STEMI CPR 131

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

ECG Medical Training

MAY 25, 2017

This is an extremely important topic especially for EMS systems that are implementing High Performance CPR , because it is very predictable that you are going to see a lot more patients with return of pulses in the field, and if you don’t have a plan, lots of things can go wrong before arriving at the hospital.

CPR 52

CPR STEMI EMS Ambulance 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. The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. Learning points 1.

EMR 52

EMR STEMI CPR ED 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

It may be difficult to read STEMI in the setting of RBBB. There is, however, a long QT also, with abnormal T-waves, but this is not STEMI. This ECG was recorded prehospital, and the computer read STEMI, so the medics activated the cath lab: What do you think? The ECG is consistent with high lateral STEMI. Called 911.

STEMI 52

STEMI CPR CAD Coronary 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

When total LM occlusion does present with STE in aVR, there is ALWAYS ST Elevation elsewhere which makes STEMI obvious; in other words, STE is never limited to only aVR but instead it is part of a massive and usually obvious STEMI. All are, however, clearly massive STEMI. This is her ECG: An obvious STEMI, but which artery?

Coronary 52

Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

Here are three more dramatic cases that illustrate RBBB + LAFB Case 1 of cardiac arrest with unrecognized STEMI, died. The computer read "Right Bundle Branch Block" There is RBBB and LAFB, which can make it difficult to see the end of the QRS. I have annotated it here: The lines mark the end of the QRS and beginning of the ST segment.

CPR 52

CPR STEMI Coronary ALS 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. He reportedly told his family "I think I'm having a heart attack", then they immediately drove him to the ED, and he was able to ambulate into the triage area before he collapsed and became unresponsive. It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation.

ACS 52

ACS CPR CAD Heart Attack 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 74

Critical Care E-9-1-1 OR ICU 74

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. In a series of 18 patients with COVID and ST elevation, 8 were diagnosed with STEMI, 6 of whom had an angiogram and it showed obstructive coronary disease. He was intubated and then went pulseless.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He underwent CPR and then was shocked out of VF. Both hyperacute T waves and posterior OMI are now formally endorsed as "STEMI equivalents" by the ACC. == MY Comment, by K EN G RAUER, MD ( 11/23 /2022 ): == Cases in which initial ECG findings are subtle before undergoing dramatic change, — are always impressive.

Coronary 52

Coronary Heart Attack ED CPR 52

AmboFOAM

MAY 7, 2017

Might be a good idea to revisit this) You likely practice CPR, cannulation, airway insertion and all the fun stuff, but I guarantee that you will spend more time talking on the radio than doing those things. Think about what you want to say before you say it, and try to get it as concise as possible. Learn it, use it.

Ambulance 40

Ambulance CPR Paramedicine Paramedicine 40

REBEL EM

JULY 14, 2022

Assigning a patient a single PCAC score upfront may implicitly bias clinicians familiar with the score in how they care for patients. This becomes even more problematic if a patient was made a PCAC III as opposed to a PCAC II simply because of the vasopressor chosen or if they made significant improvements immediately after being scored.

ICU 52

ICU ALS OR CPR 52

Dr. Smith's ECG Blog

MARCH 11, 2016

cm diameter in the apex The presence of thrombus led the clinicians to state that this was a "late presentation STEMI." It does take some time for thrombus to form, but the EKG and the troponin profile show that this was NOT a late presentation STEMI. However, much ST elevation remains, and there is no re-constitution of R-waves.

ALS 52

ALS STEMI OR ED 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

to greatly decrease risk (although in STEMI, the optimal level is about 4.0-4.5 We could not resuscitate her, but we did have excellent perfusion with LUCAS CPR, such that pulse oximetry had excellent waveform and 100% saturations, end tidal CO2 was 35, and cerebral perfusion monitoring was near normal throughout the attempted resuscitation.

Plasma 52

Plasma STEMI Defibrillator Overdose 52

Dr. Smith's ECG Blog

OCTOBER 24, 2013

He underwent immediate CPR, was found to be in ventricular fibrillation, and was successfully resuscitated. The physician recorded this ECG, interpreted it as normal, and sent the patient home on an antacid. See explanation below. The patient went home and, in front of his wife, he collapsed. I do not have the post-resuscitation ECG.

CPR 52

CPR ACS Coronary OR 52

The Good, The Bad & The Ugly Paramedic

OCTOBER 31, 2020

Stoic stalwarts are becoming more likely to call when they suffer a STEMI, rather than putting it off until it’s too late. Bystanders are growing to relish the thought of CPR and saving a life now that the concept is less foreign and frightening. Along with increased insight, however, comes expectation.

Paramedic 52

Paramedic Ambulance First Responder CPR 52