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

Emergency Medicine Ireland

DECEMBER 17, 2020

Welcome back to the tasty morsels of critical care podcast. Read More » Welcome back to the tasty morsels of critical care podcast. doi: 10.21037/acs.2018.03.01. In a breaking from what could only loosely be described as tradition at this point, this podcast is going to be in 2 parts. Ann Cardiothorac Surg.

Critical Care 40

Critical Care ICU ACS OR 40

Broome Docs

JANUARY 27, 2025

Emerg Med J. 2019 Jan;36(1):2-3. doi: 10.1136/emermed-2018-208151. Epub 2018 Oct 25.

ED 100

ED OR ACS Critical Care 100

FOAMcast

MARCH 27, 2023

In 2019, the Infectious Disease Society of America recommended against the routine use of steroids in hospitalized patients with community-acquired pneumonia (CAP) while the Society for Critical Care Medicine recommends steroids in these patients. References: Metlay JP, Waterer GW, Long AC, et al. Intensive Care Med.

Critical Care 52

Critical Care ACS ALS 52

EMDocs

AUGUST 17, 2023

This collection of posts features recently published must-know articles. Today we look at the CENSER trial. mL/kg/hr for 2 consecutive hours OR Decrease in serum lactate by more than 10% from initial level Primary outcome – Early norepinephrine group vs. the control group demonstrated higher rates of shock control at 6 hours: 76.1%

Overdose 86

Overdose ACS Critical Care ED 86

ACEP Now

DECEMBER 11, 2023

Many conditions outside of acute coronary syndrome (ACS) mimic ST-elevation myocardial infarction (STEMI), but only a handful of cases have reported ST-elevations (STE) in the setting of pancreatic inflammation where underlying ACS was excluded. Journal of Critical Care. Click to enlarge.) Case Rep Gastroenterol.

STEMI 52

STEMI Coronary ACS Critical Care 52

FOAMfrat

APRIL 22, 2024

While one may argue that nitro really has no mortality benefit in ACS, I have seen patients with CHF present with hyper tension and inferior S-T elevation, in which the providers were scared to even look at the bottle of nitro. References Kimbrell J, Kreinbrook J, Poke D, Kalosza B, Geldner J, Shekhar AC, Miele A, Bouthillet T, Vega J.

E-9-1-1 78

E-9-1-1 ACS Paramedic Critical Care 78

Dr. Smith's ECG Blog

SEPTEMBER 7, 2024

No wall motion abnormality This shows that significant ACS can have ZERO WMA!! Then the patient's pain then resolved spontaneously after 2 sublingual nitroglycerine and another ECG was recorded ECG 2 at 16 minutes ST ELEVATION CONSISTENT WITH INJURY, PERICARDITIS, OR EARLY REPOLARIZATION Overread same Smith : The T-waves are now MUCH smaller.

STEMI 121

STEMI ACS Critical Care Coronary 121

EM Didactic

OCTOBER 7, 2018

ACS and Aortic Dissection - For ACS and Dissection, the higher CRP levels, the worse prognosis. It is not used to diagnose ACS/Dissection. For diagnostic and prognostic purposes in critical care, PCT is superior to CRP and other traditional markers of sepsis. Utility of CRP 1.

Emergency Department 40

Emergency Department ACS Critical Care Coronary 40

ESO

OCTOBER 18, 2024

EHR | Critical Care While rolling out Longitudinal Record in beta, we’ve also continued to expand our Critical Care offering. Injury Prevention Summary ACS PRQ- Hospice ACS PRQ – Solid organ injuries PtReg: 2.5 Neurosurgeon Response PRQ- 2.12

Mobile Integrated Health 52

Mobile Integrated Health Critical Care MIH Community Paramedicine 52

REBEL EM

FEBRUARY 2, 2023

Sepsis, hyperthyroidism, dehydration, heart failure, ACS, etc). Amiodarone versus Digoxin for Rate Control in Critically Ill Patients with Rapid Atrial Fibrillation or Flutter.” Journal of Emergency and Critical Care Medicine , vol. Circulation , 5 Nov. 2018, PMID: 30571262 Gritsenko, Diana, et al. 2, 2018, pp.

Emergency Department 52

Emergency Department ALS Critical Care ED 52

Dr. Smith's ECG Blog

MARCH 8, 2021

Since ACS is so dynamic, with thrombi forming and lysing continuously, and because the ECG and angiogram are rarely simultaneous, it is probable that de Winter's T-waves are recorded in a window when the artery is barely open. A male in his 30's complained of sudden severe substernal chest pain.

STEMI 52

STEMI ACS Critical Care OR 52

Critical Care Scenarios

APRIL 16, 2025

We discuss the basics of EEG in the ICU, including when to do it, selecting the appropriate study, and the basics of bedside interpretation, with Carolina B Maciel, MD, MSCR, FAAN, triple boarded in neurology, neurocritical care, and critical care EEG. Learn more at the Intensive Care Academy! Find us on Patreon here!

ICU 164

ICU Critical Care ACS OR 164

ACEP Now

NOVEMBER 7, 2023

Emmerson AC, Whitbread M, Fothergill RT. P029: A descriptive analysis of defibrillation vector change for prehospital refractory ventricular fibrillation. Canadian Journal of Emergency Medicine. 20(S1):S67. Double sequential defibrillation therapy for out-of-hospital cardiac arrests: The London experience. Resuscitation. 2017;117:97-101.

Defibrillator 52

Defibrillator E-9-1-1 ALS Epinephrine 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

He was brought to the critical care area where these rhythms were seen on the monitor: Wide complex tachycardia with no apparent P-waves, and very irregular Consistent with atrial fibrillation with aberrancy A Regular wide complex tachycardia. Instead, he complained of left chest "itchiness". Learning Points: 1.

Critical Care 52

Critical Care OR ACS STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

This EKG was recorded as part of a standing order for critical care. Of course this depends on many factors: 1) duration of occlusion, 2) whether full or near occlusion with zero flow or some flow -- the flow in the artery is the critical factor, measured by "TIMI" flow, 3) presence of collateral circulation and others.

Overdose 52

Overdose OR Coronary ACS 52

Dr. Smith's ECG Blog

OCTOBER 6, 2018

We brought the patient into one of our critical care rooms and immediately got more history while recording this repeat ECG: The STE in I has greatly diminished or entirely disappeared. Let's zoom in on I and aVL: Lead I (top panel) has less than 1mm of STE. aVL is also less dramatic but still abnormal.

STEMI 40

STEMI Coronary ALS OR 40

REBEL EM

NOVEMBER 30, 2023

Article: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM. Until then, this study emphasizes the importance of individualized patient care, urging clinicians to weigh guidelines against the specific circumstances and needs of each patient. References: Vaeli Zadeh A, Wong A, Crawford AC, Collado E, Larned JM.

E-9-1-1 113

E-9-1-1 ALS ICU ACS 113

EMCrit Project

JUNE 23, 2025

Episode 400 was a special one though, and buried in its dying minutes are Scotts four goals of resuscitation: Save lives / provide curative care Relieve suffering Enhance dignity Find connection Arguably in no particular order, and none are to the exclusion of the next. Questions Before Joining (FAQ) Join Now!

Operating Room 85

Operating Room Critical Care Emergency Department OR 85

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This is diagnostic of ACS; it appears to be a reperfused acute inferior OMI. Then the patient would have been taken to the critical care area with a defibrillator at his side while waiting for the cath lab to be ready. In aVF it is "coved" (upwardly convex). There is ischemic ST depression in V4-V6.

Defibrillator 141

Defibrillator Coronary STEMI CPR 141

ACEP Now

JUNE 6, 2023

Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. The patient is admitted for ACS to a cardiologist who says he will see the patient in the morning.

ACS 85

ACS ALS ED Coronary 85

ACEP Now

MARCH 14, 2024

Current can be alternating current (AC) or direct current (DC) with AC typically more dangerous as it is more likely to cause tetanic contractions and increase contact time with the electrical source. 2,3,5 Except for laundry or electrical car outlets (240 V AC), all U.S. household outlets are rated at 120 V AC.

Operating Room 52

Operating Room ACS Critical Care Coronary 52

The Curious Clinicians

JANUARY 16, 2024

In 1999, the TRICC ( Transfusion Requirements in Critical Care) trial was published in The New England Journal of Medicine. This study took 838 critically-ill patients and randomized them to either a liberal (target Hgb 10-12 g/dL) or conservative ( 7-9 d/gL) transfusion strategy. When Normal Labs Aren’t Necessary.

Plasma 52

Plasma ACS Critical Care OR 52

ECG & Echo Learning

OCTOBER 2, 2022

Use of inotropes in the critical care setting. Crit Care Med 1990; 18:S56. Curr Opin Crit Care 2000; 6:347. Intensive Care Med 2004; 30:597. Intensive Care Med 2012; 38:9. Gordon AC, Mason AJ, Thirunavukkarasu N, et al. MacGregor DA, Smith TE, Prielipp RC, et al. Anesthesiology 2000; 92:338.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 52

EMDocs

OCTOBER 7, 2023

Critical Care. Goodman AD, Got CJ, Weiss AC. Acute kidney injury due to rhabdomyolysis and renal replacement therapy: a critical review. Critical Care. Chavez LO, Leon M, Einav S, Varon J. Beyond muscle destruction: a systematic review of rhabdomyolysis for clinical practice. 2016;20(1):135. J Emerg Med.

EMS 93

EMS E-9-1-1 Emergency Department ALS 93

EMDocs

FEBRUARY 12, 2024

Intensive Care Med. 11) Webb RK, Ralston AC, Runciman WB. PMID: 11685301. (10) 10) Jubran A. Pulse oximetry. 2004 Nov;30(11):2017-20. doi: 10.1007/s00134-004-2399-x. Epub 2004 Jul 24. PMID: 15278272. (11) Potential errors in pulse oximetry. Effects of changes in saturation and signal quality. Anaesthesia. 1991 Mar;46(3):207-12.

Emergency Department 98

Emergency Department E-9-1-1 ED ICU 98

ACEP Now

FEBRUARY 11, 2025

Darling is a third-year emergency medicine resident at Riverside Regional Medical Center, who will continue her training at the University of Wisconsin with a fellowship in retrieval and critical care transport. Kruegel AC, Gassaway MM, Kapoor A, et al. Gold MS, Pottash AC. J Med Chem. 2020;63(1):433-439. J Am Chem Soc.

NARCAN 89

NARCAN Naloxone Overdose Mental Health Services 89

EMOttawa

JUNE 17, 2025

Findings: AMICS mortality was between 45-55% regardless of MCS vs. usual care, however STEMI-related cardiogenic […] The post Temporary mechanical circulatory support in infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials with 6-month follow-up appeared first on EMOttawa Blog.

STEMI 108

STEMI ALS Critical Care ACS 108

EMDocs

JUNE 27, 2024

Critical Care Medicine 41(12):p A191, December 2013. Chinawa JM, Ubesie AC, Chukwu BF, Ikefuna AN, Emodi IJ. -smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 mg/kg, max 4 mg per dose q20-30min) or hydromorphone (0.01-0.02

E-9-1-1 94

E-9-1-1 ICU ACS EMS 94

Dr. Smith's ECG Blog

MARCH 8, 2025

After completing the ACS algorithm with amiodarone and lidocaine, there are diminishing returns on further treatments. Multidisciplinary critical care management of electrical storm. Or was it out of proportion, perhaps worsened by the sympathetic surge? We will never know for certain. link] Jentzer, J. Noseworthy, P.

E-9-1-1 82

E-9-1-1 OR Defibrillator Coronary 82