REBEL EM

JUNE 30, 2025

EDACS is broader—captures symptoms suspicious for ACS, not just chest pain, and performs well in low-risk patients. Clinical Bottom Line Both HEART and EDACS are best utilized for identifying patients with suspected ACS who are at low risk for MACE. Cardiovascular Read More REBEL Cast Ep114: High Flow O2, Suspected ACS, and Mortality?

ACS 80

ACS Coronary ED EMS 80

Emergency Medicine Cases

JULY 30, 2019

What are the most useful historical factors to increase and decrease your pretest probability for ACS? Which cardiac risk factors have predictive value for ACS? In the age of high sensitivity troponins and the HEART pathway, which patients are safe to discharge home from the ED?

ACS 130

ACS ED OR EMS 130

REBEL EM

NOVEMBER 6, 2024

PMID: 32644703 Robinson PM, Griffiths E, Watts AC. PMID: 27227986 Glover NM, Black AC, Murphy PB. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. Simple elbow dislocation. Shoulder Elbow. 2017 Jul;9(3):195-204. PMID: 28588660 Donohue KW, Mehlhoff TL. Chronic Elbow Dislocation: Evaluation and Management. J Am Acad Orthop Surg.

E-9-1-1 106

E-9-1-1 ACS OR Emergency Department 106

Dr. Smith's ECG Blog

DECEMBER 3, 2024

This dynamic change is diagnostic of ACS. Cardiology was consulted and agreed that his history was high risk for ACS and a next-day angiogram was merited. This was also non-diagnostic for OMI, although the dynamic changes are diagnostic of ACS. ECG at time 82 minutes: What do you think?

ED 116

ED Coronary ACS STEMI 116

The Skeptics' Guide to EM

JANUARY 18, 2020

You turn to the attending and ask, “do you really think this could be acute coronary syndrome (ACS)?” ACS is usually amongst this differential, as cardiovascular disease is a leading cause of morbidity and mortality in this population. The proportion of patients with ACS at the index visit or within 30 days. *

ACS 130

ACS Coronary Emergency Department ALS 130

Pediatric EM Morsels

APRIL 19, 2024

J Bone Joint Surg Br. 2001;83:1173-5. Oakley EA, Ooi KS, Barnett PLJ. A randomized controlled trial of 2 methods of immobilizing torus fractures of the distal forearm. Pediatr Emerg Care. 2008;24:65–70. A randomized, controlled trial of removable splinting versus casting for wrist buckle fractures in children. Pediatrics. 2006;117:691–697.

ALS 293

ALS ACS Emergency Department ED 293

REBEL EM

DECEMBER 23, 2024

Paper: Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. PMID: 28106307 Alwang AK, Law AC, Klings ES, Cohen RT, Bosch NA. To assess the clinical impact and relevance of these concerns, Alwang et al. performed the retrospective cohort study below ( Alwang 2024 ). JAMA Intern Med. 2024;184(11):1365-1372. Microcirculation.

ALS 122

ALS ED ACS EMR 122

Dr. Smith's ECG Blog

OCTOBER 26, 2010

ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. Then ACS (STEMI) might be primary; this might be cardiogenic shock. One must clearly rule out these processes before jumping on the ACS diagnosis. Are the lungs clear? Is the patient cool and pale?

ACS 52

ACS STEMI OR Critical Care 52

Dr. Smith's ECG Blog

JULY 2, 2023

This was texted to me from a former resident, while working at a small rural hospital, with the statement: "I can’t convince myself of anything here, but he’s a 63-year-old guy with prior stents and a good story for ACS." Chest pain or discomfort) What do you think? Here was my response: "Suspicious for inferior posterior OMI.

ACS 52

ACS Coronary OR 52

Emergency Medicine Cases

APRIL 14, 2020

In this ECG Cases blog we look at 6 patients who presented with cardiorespiratory symptoms, possibly from COVID and illustrate the dangers of anchoring, being hypervigilant for cardiovascular complications, and why testing for COVID in patients being admitted for ACS is important.

ACS 130

ACS STEMI 130

Dr. Smith's ECG Blog

OCTOBER 4, 2010

ACS would be highly unusual in a young athlete, and given the information on his race bib, one must first suspect that the abnormal ST elevation is due to demand ischemia, not ACS. A bedside echo performed by the emergency physician showed no wall motion abnormality and confirmed LVH.

ACS 52

ACS Defibrillator Epinephrine STEMI 52

Dr. Smith's ECG Blog

JULY 25, 2024

Then assume there is ACS. Therefore — recognition of DSI on ECG should prompt consideration of 2 Categories of diagnostic entities : Severe Coronary Disease ( due to LMain, proximal LAD, and/or severe 2- or 3-vessel disease ) — which in the right clinical context may indicate ACS ( A cute C oronary S yndrome ).

Defibrillator 131

Defibrillator Coronary ACS Epinephrine 131

ESO

JUNE 20, 2025

Big changes are on the horizon for trauma centers participating in the American College of Surgeons (ACS) Trauma Quality Programs (TQP). We’ve been working closely with the ACS to prepare for this transition. The ACS is aware that we are not updating the legacy registry products. What’s changing?

ACS 52

ACS 52

Don't Forget the Bubbles

MAY 19, 2025

Pain episodes, or vaso-occlusive crises (VOC), are a hallmark of sickle cell disease, often leading to prolonged hospital stays and serious complications like acute chest syndrome (ACS). While small studies suggest that early pain relief can shorten hospitalisation, the evidence remains limited.

Emergency Department 62

Emergency Department ACS EMS OR 62

Critical Care Scenarios

APRIL 26, 2023

Takeaway lessons * If considering ACS in any post-menopausal woman, you should also consider stress cardiomyopathy. Of course, atypical anatomical distributions can also occur in ACS due to distinct anatomy. ACE inhibition). * In general, TCM is a diagnosis of exclusion after ruling out ACS. Find us on Patreon here!

ACS 100

ACS OR 100

EMS 12-Lead

AUGUST 18, 2024

I interpreted the ECG as VT with two primary etiological possibilities: 1. Abrupt plaque ulceration of Type 1 ACS leading to VT. Of interest, he specified that he awoke earlier that morning in his usual state of health, then developed chest discomfort, then developed palpitations.

CAD 147

CAD ACS EMT EMT 147

Dr. Smith's ECG Blog

NOVEMBER 16, 2016

It is important to note that these findings, if due to atherothrombotic acute coronary syndrome (ACS), are NOT due to occlusion of the left main, as is frequently stated in online postings and in literature. It is most commonly due to demand ischemia, not due to ACS! If it were ACS, what reperfusion options were available?

ACS 52

ACS Coronary ICU STEMI 52

Dr. Smith's ECG Blog

MAY 20, 2025

ACS is dynamic. interesting spontaneous reperfusion case 1413140 prehospital STEMI first ED ECG is here, with 3/10 pain: But this is the same patient just 10 minutes before, with 7/10 pain Isn't it ridiculous to say that the patient has both a STEMI and an NSTEMI? It can't be given one static name. Now the patient has one disease: OMI.

STEMI 59

STEMI OR ACS ED 59

EMS 12-Lead

JUNE 20, 2022

Although the attending crews did not consider the ECG pathognomonic for occlusive thrombosis, they nonetheless considered the patient high-risk for ACS and implored him to reconsider. The attending crews were concerned for an ACS-equivalent of LAD occlusion and initiated a prehospital STEMI activation to the closest PCI center.

ACS 130

ACS Coronary STEMI CAD 130

Dr. Smith's ECG Blog

MAY 20, 2019

One must remember that acute pulmonary edema is frequently triggered by ACS. In this case, it is reasonable to assume that there is no ACS. Here is the troponin profile: Troponins this high are almost always due to type 1 MI (ACS, plaque rupture) This was a surprise. Severe, life threatening ACS may have no ST Segment shifts.

ACS 52

ACS Coronary OR ALS 52

Dr. Smith's ECG Blog

MARCH 14, 2024

These have all been small studies, studying very few patients with ACS, and often used final cardiology interpretation rather than patient outcome. Smith : This study had such low risk patients that not a single patient was ultimately diagnosed with ACS. It is well known that NOMI usually has a normal ECG or nonspecific ECG.

STEMI 126

STEMI ACS Coronary Emergency Department 126

FOAMfrat

APRIL 25, 2024

References: Kimbrell J, Kreinbrook J, Poke D, Kalosza B, Geldner J, Shekhar AC, Miele A, Bouthillet T, Vega J. The conversation concludes with a discussion on the transfer of pacing from one device to another and the importance of verifying capture during the process. Check out more from Josh, Judah, and Tom at EMS12LEAD.com. 2024 Mar 15:1-9.

Paramedic 128

Paramedic ACS ED EMS 128

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). ACS and hyperkalemia both have lethal downstream consequences, so it is imperative for the clinician to acclimate to the presentation, or developing, features of each. ECG's are difficult.

ACS 130

ACS Coronary Paramedic ALS 130

Medgadget

AUGUST 29, 2022

” The researchers presented their technology at the 2022 fall meeting of the American Chemical Society (ACS). Via: ACS. . “We already interact with a lot of touch-based electronics, such as smart phones and keyboards, so this sensor could integrate seamlessly into daily life.”

ACS 115

ACS 115

Dr. Smith's ECG Blog

JANUARY 25, 2016

3) ACS with possible additional ischemia from atrial fib with RVR 4) Hemorrhage/dehydration/sepsis/etc., I was fairly certain that this was a type II (demand ischemia) MI and that this patient was not having ACS. He did not have ACS. Not all myocardial infarction is due to ACS 2. He was treated for urosepsis and did well.

ACS 40

ACS OR 40

ALiEM

AUGUST 30, 2024

Jonklaas J, Bianco AC, Bauer AJ, Burman KD, Cappola AR, Celi FS, Cooper DS, Kim BW, Peeters RP, Rosenthal MS, Sawka AM; American Thyroid Association Task Force on Thyroid Hormone Replacement. References Geddes G, Butterly MM, Patel SM, Marra S. Pediatric neck masses. Pediatr Rev. 2013 Mar;34(3):115-24; quiz 125. doi: 10.1542/pir.34-3-115.

ACS 161

ACS Emergency Department ED OR 161

Dr. Smith's ECG Blog

MARCH 31, 2024

The person I was texting knows implicitly based on our experience together that I mean "Definite posterior OMI, assuming the patient's clinical presentation is consistent with ACS." The patient was a middle-aged female who had acute chest pain of approximately 6 hours duration. The pain was still active at the time of evaluation.

STEMI 116

STEMI ACS ED 116

Dr. Smith's ECG Blog

DECEMBER 22, 2023

Comment : ACS with persistent symptoms is a guideline recommended indication for ＜2 hour angio (both ACC/AHA and ESC). The ESC states that patients with suspected ACS should go to the cath lab in ＜2 hours "regardless of ECG or biomarker evidence of MI!!"

ACS 123

ACS STEMI OR 123

Dr. Smith's ECG Blog

FEBRUARY 9, 2024

If there were diffuse ischemic STD, with precordial STDmaxV5-6 and reciprocal STE-aVR, this would be non-specific subendocardial ischemia from ACS or supply-demand mismatch. The new ESC guidelines has for the first time merged both STEMI and non-STEMI in the same guideline because they are both on the spectrum of ACS.

STEMI 120

STEMI ACS Coronary OR 120

The Skeptics' Guide to EM

JULY 2, 2022

The bottom line from that episode was that 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 ED with suspicion of ACS. If we thought about ACS, we brought them in. AEM June 2022.

Coronary 100

Coronary Heart Attack ACS CAD 100

ALiEM

OCTOBER 30, 2024

DOI: Papudesi BN, Malayala SV, Regina AC. This month in JAAD Case Reports: August 2023: Xylazine and skin necrosis. Journal of the American Academy of Dermatology. 2023 Aug 1;89(2):231. Xylazine toxicity. 2023 [book]. PMID 37603662 Rose L, Kirven R, Tyler K, Chung C, Korman AM. JAAD Case Reports. 2023 Jun 1;36:113-5.

E-9-1-1 161

E-9-1-1 Naloxone Emergency Department ALS 161

EMS 12-Lead

JULY 30, 2023

This should prompt immediate investigation into supply-demand mismatching, or ACS. There is bradycardic Atrial Fibrillation with broad ST-depression in most leads and perceptible ST-elevation in aVR. But there’s some peculiar features about this ECG: The unusually short QT The “scooped out” appearance of the ST-segments.

ACS 130

ACS EMT EMT Coronary 130

EMCrit Project

MAY 15, 2025

Blood sampled from existing peripheral IV cannulae yields results equivalent to venepuncture: a systematic review [ 10.1177/2054270419894817 ] Second Line 18 G Should we be placing in the AC? Future Show: Upping your IV Game Fluids Get dinged for 4, rectal temps on elderly, etc.

ACS 56

ACS Critical Care Emergency Department ED 56

Dr. Smith's ECG Blog

OCTOBER 7, 2022

One study found that the best discrimination of stress cardiomyopathy from ACS was possible with the ratio of NT-proBNP/cTnT on the 2nd day. and an accuracy of ∼96% in detecting stress cardiomyopathy as opposed to ACS. NT-proBNP and CTnT in ACS and Takotsubo) Smith : However, this is not of any help with the acute diagnosis!

ACS 52

ACS Coronary CAD OR 52

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. Most studies examine undifferentiated ACS cohorts, with only a handful providing separate data. References: 1.

Coronary 114

Coronary E-9-1-1 STEMI ACS 114

Dr. Smith's ECG Blog

JANUARY 6, 2016

He was started on ACS therapy and loaded with Plavix. This procedures were done due to prior similar presentations and concern of ACS. This is the most likely caused of his fixed ST elevation and no concern for ACS. Initial ECG showed ST elevation with progression of biphasic T wave concerning for reperfusion injury.

CAD 52

CAD ACS ICU STEMI 52

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

References: 1) See this study showing an association between morphine and mortality in Non-STE-ACS: Meine TJ, Roe M, Chen A, Patel M, Washam J, Ohman E, Peacock W, Pollack C, Gibler W, Peterson E. Link to abstract Link to full text 2) Use of Morphine in Non-STE-ACS is independently associated with mortality, at odds ratio of 1.4

E-9-1-1 85

E-9-1-1 ACS STEMI Coronary 85