Broome Docs

JANUARY 27, 2025

100% seems too good to be true Morello et al., Clin Exp Allergy. 2024 Oct 9. doi: 10.1111/cea.14565. Epub ahead of print. PMID: 39383344 Profundus Trial – Can we actually exclude acute aortic syndromes with this protocol? Diagnosis of acute aortic syndromes with ultrasound and D-dimer: the PROFUNDUS study. Emerg Med J. Epub 2018 Oct 25.

ED

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

EMDocs

JULY 21, 2025

Causes: ACS, arrhythmia, valvular dysfunction, infection, nonadherence to meds, myocarditis, volume overload. Heidenreich PA, Bozkurt B, Aguilar D, et al. Collins S, Storrow AB, Albert NM, et al. Yancy CW, Jessup M, Bozkurt B, et al. Yancy CW, Jessup M, Bozkurt B, et al. Ponikowski P, Voors AA, Anker SD, et al.

E-9-1-1

JEMS

JUNE 13, 2025

ACS Chemical Neuroscience, 15(21), 3874–3883. References 1. de Andrade Horn, P., Berida, T. Bouchard, J. Jayakodiarachchi, N., Schultz, D. Lindsley, C. & Crowley, M. Classics in Chemical Neuroscience: Medetomidine. doi.org/10.1021/acschemneuro.4c00583 Centers for Disease Control and Prevention. Thomas, S.

Naloxone

EMDocs

NOVEMBER 25, 2024

Open-access image reference: By Giovanni Maki, derived from a CDC image at [link] – Basáñez M-G, Pion SDS, Churcher TS, Breitling LP, Little MP, et al. Ehrlich JR, Ramke J, Macleod D, et al. link] Vinkeles Melchers NVS, Stolk WA, Van Loon W, et al. 0009604 Taylor MJ, Awadzi K, Basáñez MG, et al. volvulus life cycle.

E-9-1-1

Don't Forget the Bubbles

JULY 15, 2025

Available from: [link] Desai V, Hernandez Conte A, Nguyen VT et al. Govindraj R, Binda DD, Harris AC et al. Workforce Race Equality Standard: 2020 Data Analysis Report for NHS Trusts and Clinical Commissioning Groups. February 2021. Veiled harm: Impacts of Microaggressions on Psychological Safety and Physician Burnout.

OR

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. Rallidis Et al. This patient never had ACS. A cut-off value of NT-proBNP/cTnT ratio >7.5

ACS

Don't Forget the Bubbles

JULY 28, 2025

van Hasselt TJ, Gale C, Battersby C, et al. van Hasselt TJ, Kanthimathinathan HK, Kothari T, et al. Wilkinson K, Freeth H, Mahoney N, et al. Weiss SL, Peters MJ, Alhazzani W, et al. Darnell R, Brown A, Laing E, et al. Peters MJ, Ramnarayan P, Scholefield BR, et al. Peters MJ, Gould DW, Ray S, et al.

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Broome Docs

DECEMBER 22, 2024

PECARN looks at probiotics for toddlers diarrhea… Schnadower D, Tarr PI, Casper TC, Gorelick MH, Dean JM, O’Connell KJ, Mahajan P, Levine AC, Bhatt SR, Roskind CG, Powell EC, Rogers AJ, Vance C, Sapien RE, Olsen CS, Metheney M, Dickey VP, Hall-Moore C, Freedman SB.

E-9-1-1

Dr. Smith's ECG Blog

JUNE 10, 2025

When seeing a South Asian patient with chest pain, concern for ACS must be heightened, given their disproportionately higher risk of CAD, despite often lacking traditional risk factors.) Transient STEMI was studied by Lemkes et al. Lemkes JS, Janssens GN, van der Hoeven NW, et al. Available from: [link] Lemkes et al.

STEMI

Don't Forget the Bubbles

AUGUST 3, 2025

Efrem E, et al. Maria Giovanna P, et al. Cristofori F, et al. Derbie AY, et al. Beard LA, et al. Piske M, et al. Pratt MTG, et al. Drummond H, et al. Assaad MA, et al. Dokousli V, et al. Daves G, et al. Heldbjerg AR, et al. Sanchez LM, et al. Pediatrics.

E-9-1-1

EMDocs

JUNE 28, 2025

doi:10.1056/NEJMra1802529 Berry RB, Budhiraja R, Gottlieb DJ, et al. 2172 Fleming S, Thompson M, Stevens R, et al. doi:10.1016/S0140-6736(10)62226-X Rückert-Eheberg IM, Steger A, Müller A, et al. 0318502 Lorenzi-Filho G, Genta PR, Figueiredo AC, Inoue D. 160357 Lavonas EJ, Akpunonu PD, Arens AM, et al. The Lancet.

EMS

Dr. Smith's ECG Blog

APRIL 4, 2011

65 y old male, hypt, IHD, smoker, central chest pain, was in pulm oedema Killip III Great recent article relevant to this: Kosuge M, Ebina T, Hibi K, et al. They show that if there is not >/= 1 mm STE in aVR, then ACS is highly unlikely to be due to severe 3-Vessel disease or Left Main. Am J Cardiol;107(4):495-500.

CAD

EMDocs

MARCH 24, 2025

doi:10.3390/v3050586 Myburgh D, Rabie H, Slogrove AL, Edson C, Cotton MF, Dramowski A. 2020.06.081 Balkhair AA, Al-Muharrmi ZK, Ganguly S, Al-Jabri AA. doi:10.12816/0003169 Stanley K, Lora M, Merjavy S, et al. 13077 Bozzette SA, Berry SH, Duan N, et al. link] Jung AC, Paauw DS. 2011;3(5):586-612.

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This Podcast Will Kill You

JULY 1, 2025

Scientific Opinion on the re‐evaluation of Allura Red AC (E 129) as a food additive. Refined exposure assessment for Allura Red AC (E 129). .” Heliyon (2024). From FDA News release “HHS, FDA to phase out petroleum-based synthetic dyes in nation’s food supply” released April 22,2025 [link]. Ardila-Leal, Leidy D.,

E-9-1-1

The Curious Clinicians

JULY 2, 2025

Merz LE, Osei MA, Story CM, et al. Credits & Suggested Citation Episode written by Tony Breu Show notes written by Millennium Manna and Tony Breu Audio edited by Clair Morgan of nodderly.com Breu AC, Abrams HR, Buonomo G, Cooper AZ, Manna M. Development of Duffy Null–Specific Absolute Neutrophil Count Reference Ranges.

ACS

Pediatric EM Morsels

APRIL 19, 2024

Davidson JS, Brown DJ, Barnes SN, et al. West S, Andrews J, Bebbington A, et al. Symons S, Rowsell M, Bhowal B, et al. J Pediatr Orthop. 2018;Volume 00(00):DOI:10.1097/BPO.0000000000001169. 0000000000001169. Simple treatment for torus fractures of the distal radius. J Bone Joint Surg Br. 2001;83:1173-5. Pediatr Emerg Care.

ALS

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

Studies such as those by Moise et al 14 and Ellis et al 39 have shown that the relative risk of developing an acute myocardial infarction in the territory supplied by an artery with a 70%. years, with the interval as long as 12 or 18 years in some studies. Nor was there a challenge to look for coronary spasm.

Coronary

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. Reference: Wang et al. The utility of troponin testing to diagnose or exclude ACS. *

ACS

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

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Date: September 8th, 2021 Reference: Desch et al. Date: September 8th, 2021 Reference: Desch et al. Defibrillation is the treatment of choice in these cases but does not often result in sustained ROSC ( Kudenchuk et al 2006). Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients.

Coronary

Dr. Smith's ECG Blog

JUNE 5, 2024

As per my review of this subject ( Check out My Comment at the bottom of the page in the November 16, 2023 post in Dr. Smith's ECG Blog ) — the 3 most common Causes of ACS ( A cute C oronary S yndrome ) with a "negative" cath are: i ) Myocarditis; ii ) Takotsubo cardiomyopathy; and , iii ) MINOCA.

Coronary

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. link] [1] Zachary et al. 2] Costanzo, L.

ACS

The Skeptics' Guide to EM

JULY 2, 2022

Date: June 30th, 2022 Reference: McGinnis et al. Date: June 30th, 2022 Reference: McGinnis et al. If we thought about ACS, we brought them in. Reference: McGinnis et al. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? AEM June 2022. AEM June 2022. AEM June 2022.

Coronary

The Skeptics' Guide to EM

FEBRUARY 27, 2021

Reference: Brichko et al. Reference: Brichko et al. Reference: Brichko et al. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. He is also an avid FOAM supporter/producer through various online outlets including TheSGEM. AEM Feb 2021. AEM Feb 2021.

Emergency Department

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. Lindahl et al. From Gue at al. Most studies examine undifferentiated ACS cohorts, with only a handful providing separate data.

Coronary

The Skeptics' Guide to EM

MAY 28, 2022

Date: May 24th, 2022 Reference: Broder et al. Date: May 24th, 2022 Reference: Broder et al. Reference: Broder et al. Guidelines for Reasonable and Appropriate Care in the Emergency Department (GRACE) 2: Low-Risk, Recurrent Abdominal Pain in the Emergency Department.

Emergency Department

Dr. Smith's ECG Blog

JANUARY 5, 2024

Thus, these troponins are very concerning for ACS, and subsequent ones will probably be diagnostic of acute MI. Heitner et al. For this test it is VERY low (very good) at 4% at the 99th percentile -- 26 ng/L, but it will not be so good at a level of 9 ng/L. The troponin is trapped in the myocardium that is not being perfused.

ACS

REBEL EM

MAY 29, 2024

VS abnormalities can drive this as well Strongly consider reversal of AC (this will typically come after control) Stopping the Bleeding PPE: these things bleed like stink. EMRAP HD: Epistaxis Posterior Pack References Cassisi NJ et al. PMID: 5569677 Zeyyan E et al. PMID: 20938948 Loftus BC et al.

ICU

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

In our opinion it should not be given in ACS unless you are committed to the cath lab. Learning Point: Any NSTEMI patient with active ongoing ACS symptoms refractory to medical management is supposed to go to the cath lab within 2 hours if available, per all guidelines in world, regardless of ECG findings. Am J Emerg Med.

ACS

Don't Forget the Bubbles

SEPTEMBER 13, 2023

doi:10.1093/tropej/fmz071 Expert Panel on Pediatric Imaging, Trofimova A, Milla SS, et al. 2019-0134 Hirtz D, Ashwal S, Berg A, et al. Riviello JJ Jr, Ashwal S, Hirtz D, et al; American Academy of Neurology Subcommittee; Practice Committee of the Child Neurology Society. J Trop Pediatr. 2020;66(3):299-314. J Am Coll Radiol.

E-9-1-1

Don't Forget the Bubbles

MAY 17, 2023

Antonaci L, et al. Tritos NA, et al. Levi M, et al. Fishbein MH, et al. Cetinkaya PG, et al. Niu T, et al. Verkuijl SJ, et al. Varni JW, et al. Dias FC, et al. Peter C, et al. Ahlberg R, et al. Shir A, et al. Kuypers KLAM, et al. Hegeman EM, et al.

ALS

Dr. Smith's ECG Blog

DECEMBER 27, 2023

The original term " benign early repolarization" has fallen out of favor since the seminal paper by Haïssaguerre et al. As a result, even before looking at this patient's initial ECG — he falls into a high -prevalence likelihood group for ACS ( for an A cute C oronary S yndrome ). per 100,000 to 11 per 100,000 [Rosso].

E-9-1-1

Dr. Smith's ECG Blog

APRIL 18, 2024

Non-STEMI guidelines call for “urgent/immediate invasive strategy is indicated in patients with NSTE-ACS who have refractory angina or hemodynamic or electrical instability,” regardless of ECG findings.[1] Amsterdam et al. Alencar et al. Lupu et al. Herman, Meyers, Smith et al. But only 6.4% link] References 1.

STEMI

The Curious Clinicians

OCTOBER 2, 2024

Growdon ME, Jing B, Morris EJ, Deardorff WJ, Boscardin WJ, Byers AL, Boockvar KS, Steinman MA. Credits & Suggested Citation Episode written by Tony Breu Show notes written by Giancarlo Buonomo and Tony Breu Audio edited by Clair Morgan of nodderly.com Breu AC, Abrams HR, Cooper AZ, Buonomo G. J Am Geriatr Soc. October 2nd, 2024.

ACS

Dr. Smith's ECG Blog

MARCH 19, 2024

The cath report showed: Significant stenosis with subtotal occlusion (99%) in the prox to mid Lcx, culprit of ACS, TIMI flow 1. Available from: [link] If you are wondering about the Barcelona rule, then you should read the above paper by Khawaja et al. Cardiac catheterization occurred around 1pm (18 hours after arrival). 2021;23:187.

CAD

EMOttawa

DECEMBER 18, 2023

Methodology: 3/5 Usefulness: 1/5 Georgiopoulos G, et al. 2023 Oct 1;8(10):946-956 Question: Does the modified GRACE score incorporating continuous troponin improve ACS risk prediction? JAMA Cardiol. Methods: Retrospective.

Coronary