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She is the cofounder of FOAMcast and a […] The post SGEM#421: I Think I’d Have a HeartAttack – Maybe Not in a Rural Area? Background: We have covered the issue of heartattacks several times on the SGEM. These include looking at the HEART score, troponin testing and cardiovascular disease in women.
Case: You are working a shift in your local community emergency department (ED) when a 47-year-old male presents with chest pain. His father had a minor heartattack at the age of 63. With a negative initial troponin, this gives him a HEART score of 4. He is also the CME editor for Academic Emergency Medicine.
The concept of rapid assessment for heartattacks and strokes is not foreign to the general public, but these emergencies do not include rapid destruction of clothing, private examinations performed in front of audiences, or a quick succession of invasive procedures. References American College of Surgeons Committee on Trauma.
The conversation highlights the need for a broader approach to chest pain, beyond just focusing on heartattacks. Takeaways EMS education should focus on a broader approach to chest pain, beyond just heartattacks. Mike Berkenbush joins the podcast to discuss the challenges in EMS education on differentiating chest pain.
His family had insurance for just two years when his father had a heartattack and needed open heart surgery. For example, he knows follow-up care is critical for many ED patients, but it can be challenging to find transportation to in-person care. Inspired, he carried that problem-solver energy into medical school.
He stated it was similar to prior heartattacks. About an hour later, he was then found on the floor in cardiac arrest in the ED. The history in today's case — was that of a man in his 70s who presented to the ED for 2 hours of chest pain , that was still present on arrival in the ED.
Data from the National Institutes of Health suggests that up to three percent of ED visits result in a weapon being confiscated, and there has been an increase of 20 percent of firearm deaths since 2019. 1 The questions raised by this tragedy are many: How did a gun make its way into the emergency department in the first place?
He reportedly told his family "I think I'm having a heartattack", then they immediately drove him to the ED, and he was able to ambulate into the triage area before he collapsed and became unresponsive. The value of Stat Echo in the ED for confirming clinical and ECG suspicion of acute PE cannot be overstated!
And, like most diagnostic considerations in medicine — if the differential diagnosis excludes such “other potential etiologies” simply because they are not common, or because the patient is “too young to have a heartattack” — then these other potential etiologies will be missed!
Author: Joshua Lowe, MD (EM Attending Physician, San Antonio, TX) // Reviewed by: Alex Koyfman, MD (@EMHighAK); Manpreet Singh, MD (@MPrizzleER); Brit Long, MD (@long_brit) The fluorescent lights above cast a clinical pallor over the bustling ED. Stay Calm Under Pressure: The ED can be chaotic, and emotions can run high.
A 50 something male presented in the evening to ED for evaluation of chest pain that started at 1600. He reports this was similar to how he felt when he had his heartattack 4 years prior, now s/p 4 stents. MY Thoughts on What Should Have Been Done Sooner: It took 16 minutes after arrival in the ED to record the 1st ECG.
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