EMS 12-Lead

JUNE 20, 2022

Moreover, he had no pertinent medical history to report in terms of CAD, HTN, HLD, or DM, for example. CASE 1 A 45 y/o Male called 911 for new onset central chest discomfort, non-radiating, 5/10 pain scale, and without any vomiting, diaphoresis, or pallor. A 12 Lead ECG was recorded. There is no dramatic change, or evolution. 2] Driver, B.

ACS 130

ACS Coronary STEMI CAD 130

Dr. Smith's ECG Blog

APRIL 18, 2024

Similarly, if a patient with known CAD presents with refractory ischemic chest pain, the ECG barely matters: the pre-test likelihood of acute coronary occlusion is so high that they need an emergent angiogram. Amsterdam et al. Alencar et al. Lupu et al. Herman, Meyers, Smith et al. link] References 1.

STEMI 128

STEMI Coronary ALS CAD 128

EMDocs

FEBRUARY 7, 2024

Increased risk in those with preexisting CKD, other risk factors for renal disease (HTN or CAD), and those on ACEIs/ARBs. The effects of GLP-1 agonists are associated with the dose. Higher doses of GLP-1 agonists are associated with weight loss. Take for example semaglutide. Ozempic is utilized for DM2 in doses of 0.5, mg SQ every week.

Allergic Reaction 95

Allergic Reaction ALS CAD OR 95

Dr. Smith's ECG Blog

OCTOBER 24, 2019

However, a smooth tapering of the mid-RCA was seen, highlighted in red below: How do we explain the MI if no sign of CAD was found? This MI wasn’t caused by a ruptured plaque of CAD - it was a coronary artery dissection of the RCA. A study by Hassan et al. Lobo et al. This case occurred 10+ years ago.

CAD 52

CAD Coronary ACS STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

A man in his 70s with past medical history of hypertension, dyslipidemia, CAD s/p left circumflex stent 2 years prior presented to the ED with worsening intermittent exertional chest pain relieved by rest. Hayakawa A, Tsukahara K, Miyagawa S, et al. Written by Nathanael Franks MD, reviewed by Meyers, Smith, Grauer, etc. Am J Emerg Med.

ACS 89

ACS Coronary ALS CAD 89

Dr. Smith's ECG Blog

JANUARY 1, 2013

A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. Conversely, Matetzky et al.

STEMI 52

STEMI ACS CAD Coronary 52

Dr. Smith's ECG Blog

JUNE 18, 2013

So I went to look at the chart and here is the history: This patient with no h/o CAD had a couple of episodes of chest pain during the day, then presented with one hour of substernal chest pain that had some reproducibility but also improved from 10/10 to 5/10 with nitroglycerine. Fesmire et al. Wang T, Zhang M, Fu Y, et al.

STEMI 52

STEMI Coronary ALS CAD 52

Dr. Smith's ECG Blog

JUNE 12, 2017

He had a family history of early CAD and occasional drug and tobacco use. Mawri S, Michaels A, Gibbs J, et al. An ECG is recorded and the computer reads it as "normal". Do you want to see it? Or would you rather not be bothered? I'd rather be bothered. Here it is: Computer read: "Normal ECG" Aren't you glad that you looked at it?

STEMI 52

STEMI CAD Coronary ALS 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. J Electrocardiol [Internet] 2022;Available from: [link] Cardiology opinion: Takotsubo Cardiomyopathy (EF 30-35%) V Fib Cardiac arrest Prolonged QTC NSTEMI (Smith comment: is it NSTEMI or is it Takotsubo? -- these are entirely different) Moderate single-vessel CAD.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

As I met the paramedics and cath team in the lab, I was ready to see severe coronary disease (CAD), but the vessels were non-obstructive. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58).

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

DECEMBER 29, 2015

Case history A middle-aged woman with a history of HTN, but no prior CAD, presented to the ED with chest pain. The criteria of Armstrong et al. One retrospective analysis by Armstrong et al. There is ST elevation, but also high voltage (though the high voltage is NOT in the leads with worrisome STE, rather, it is in aVL).

STEMI 40

STEMI Coronary ALS CAD 40

Dr. Smith's ECG Blog

JULY 11, 2019

He also had non-acute CAD of the RCA (50%) and LCX (50%). CLICK HERE — for a brief article by Rowlands et al that explains these concepts in more detail. Cardiology was called and the patient was taken for urgent catheterization with the time from ED arrival to cath about 1 hour and 45 minutes. Cath images: Before intervention.

STEMI 52

STEMI ACS CAD ED 52

EMS 12-Lead

APRIL 8, 2022

Furthermore, there was no family history of early CAD, MI, or sudden cardiac death. A 56 y/o Male called 911 from his hotel room in the early morning hours after abruptly awakening from sleep with crushing chest discomfort and difficulty breathing. He reported to EMS a medical history of GERD only. He left AMA and is lost to follow-up.

STEMI 130

STEMI ALS Coronary CAD 130

Dr. Smith's ECG Blog

JANUARY 20, 2024

Scattered other nonobstructive CAD. de Winter et al in N Engl J Med 359:2071-2073, 2008. Angiogram around 9am: Culprit lesion mid LAD 100% stenosis TIMI 0 TIMI 3 after PCI Severe apical dyskinesis, severe anteroapical akinesis. When you register on the app, you need to say you are from a supported country in the EU.

STEMI 127

STEMI CAD ED ALS 127

Dr. Smith's ECG Blog

JUNE 2, 2023

Late Gadolinium enhancement: Multifocal scarring of the septum (including RV septum), basal anterior wall and transmural mid inferior region scarring - a non-CAD hyperenhacement pattern. There is clearly a wide complex tachcyardia (although the QRS duration is not far above 120msec). Or it could simply still be classic VT. RVEF 100 ml/m2.

ED 96

ED OR ALS CAD 96

EMDocs

NOVEMBER 29, 2023

EBM Update: Steroids in Severe CAP and CT in Post ROSC OHCA #1: Dequin PF, Meziani F, Quenot JP, et al; CRICS-TriGGERSep Network. Author Takeaway: No difference in mortality at 60 days with methylprednisolone vs. placebo in severe CAP #3: Wu JY, Tsai YW, Hsu WH, et al. Reyes LF, Garcia E, Ibáñez-Prada ED, et al. N Engl J Med.

ICU 80

ICU CAD ALS ED 80

Dr. Smith's ECG Blog

JULY 22, 2023

The patient proceeded to cath where all coronaries were described as normal with no evidence of any CAD, spasm, or any other abnormality. In the largest study looking at this topic by Mizusawa et al., Written by Pendell Meyers A man in his 70s with no cardiac history presented with acute weakness, syncope, and fever. There was a 0.9%

E-9-1-1 92

E-9-1-1 CAD STEMI OR 92

Dr. Smith's ECG Blog

AUGUST 9, 2019

She had a proven 100% Left Main occlusion No ST shift in aVR This pattern of RBBB/LAFB was also the most common pattern in Fiol et al. See this paper by Widimsky et al, which shows the high association of RBBB, especially with LAFB, with LAD occlusion. Widimsky P et al. Total LM occlusion can present with STE or STD in aVR.

Coronary 52

Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

This study from Herzog et al (from our own Hennepin County Medical Center) included patients from a national registry and compared 3049 patients on dialysis admitted and eventually found to have acute MI compared with 534,395 patients not on dialysis admitted with an eventual diagnosis of acute MI. Herzog et al. What can we learn?

CAD 52

CAD ED OR ALS 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

A formal echocardiogram was completed the next day and again showed a normal ejection fraction without any focal wall motion abnormalities to suggest CAD. In the largest study looking at this topic by Mizusawa et al., Schick is a PGY3 at the Brown Emergency Medicine Residency in Rhode Island. The article is edited by Smith.

E-9-1-1 52

E-9-1-1 CAD STEMI Defibrillator 52

Dr. Smith's ECG Blog

APRIL 8, 2016

He had significant history of CAD with CABG x5, and repeat CABG x 2 as well as a subsequent PCI of the graft to the RCA (twice) and of the graft to the Diagonal. the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. A late middle-aged man presented with one hour of chest pain. Most recent echo showed EF of 60%.

STEMI 52

STEMI Plasma Defibrillator OR 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She also had non-acute CAD of the left main (50%) and LCX (75%). Patel et al., Krucoff et al.) Patel et al. Krucoff et al. Back to the case: The providers recognized persistent ischemia and likely occlusion, and discussed this with cardiology who took the patient immediately for cath. They opened it. Heart 1996.

STEMI 52

STEMI ALS ACS ICU 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

A middle-aged male with h/o CAD and stents presented with typical chest pressure. See this paper by Widimsky et al, which shows the high association of RBBB, especially with LAFB, with LAD occlusion. Here is his ECG: The resident was alarmed at the "ST elevation in III with reciprocal ST depression in aVL" Are you alarmed?

STEMI 40

STEMI CPR CAD Coronary 40

Dr. Smith's ECG Blog

JANUARY 9, 2023

No family history of sudden cardiac death, cardiomyopathy, premature CAD, or other cardiac issues. No similar symptoms in the past. No prior exertional complaints of chest pain, dizziness, lightheadedness, or undue shortness of breath. He denied headache or neck pain associated with exertion. No further troponins were measured. Pericarditis?

Coronary 52

Coronary STEMI Heart Attack CAD 52

ECG & Echo Learning

JANUARY 18, 2023

I C Blood samples Management Recommendation Level of evidence Serum biomarkers of myocardial infarction ( troponin ) should be sampled as early as possible without delaying reperfusion therapy. I C Symptom relief Symptom Management Recommendation Level of evidence Hypoxia Oxygen is indicated if SaO2 < 90% or PaO2 < 60 mmHg.

STEMI 40

STEMI Coronary Defibrillator OR 40

Dr. Smith's ECG Blog

DECEMBER 5, 2023

He did have a family history notable for early CAD. hematological disorder like sickle cell or antiphospholipid syndome, family history of CAD or hypercholesterolemia, prior history of vasculopathies such as Kawasaki Disease, MIS-C, prior cardiac surgery, etc.) He denied drug or alcohol use.

Coronary 127

Coronary CAD ACS ALS 127

FirstWatch

APRIL 29, 2025

The big fear with any significant change is that we could miss a critical patient and send them a BLS crew non-emergent or to nurse advice when they really need a lifesaving ALS treatment. Adding BLS units, nurse advice lines, and telehealth are a few of the many options on the table.

BLS 40

BLS EMS ALS OR 40

ESO

APRIL 29, 2025

Here are some key features to look out for: CAD & Cardiac Monitor Integration: The application supports integration with cardiac monitors and CAD systems, enhancing your ability to swiftly monitor and respond to patient needs.

CAD 52

CAD MIH Defibrillator OR 52

Dr. Smith's ECG Blog

MAY 17, 2025

In this study, using risk scores had very little utility Chapman AR, Hesse K, Andrews J, et al. Here is an interesting study from Circulation: rnadttir , Pedersen S, Bo Hasselbalch R, et al. High-Sensitivity Cardiac Troponin I and Clinical Risk Scores in Patients With Suspected Acute Coronary Syndrome. Why use the scores then?

Coronary 76

Coronary CAD ED OR 76