From surgical airways to the undifferentiated shock patient, this week’s Grand Rounds was packed full of clinical pearls. Dr. Carleton started with a discussion of a tachycardia-inducing failed airway requiring cricothyrotomy. Drs. Jensen and Makinen presented a very detailed review of the literature and their proposed algorithm on infective endocarditis. Dr. Harty reviews a fascinating case of cecal volvulus that was identified early with the aid of a RUSH exam, while Dr. Liebman walked us through an approach to the patient with inhalation injuries. Finally, Dr. Roblee led an excellent review of SBP. The discussion was full of information you might use on your next shift!Read More
"IN JEOPARDY", AN ACS REVIEW - DR. FERMANN
- According to the AHA, there are no diagnostic EKG changes for NSTEMI
- ST elevations in II, III and aVF with depression in V2 represents and inferior-posterior STEMI
- ST depressions in the precordial leads may represent posterior MI
- Continuous ST segment trend monitoring may pick up very dynamic ischemic changes (though this is almost never done anymore)
Morbidity and Mortality Conference with Dr. Curry
Acute Coronary Syndrome in Pregnancy
- Incidence reported at about 6/100,000 deliveries
- Maternal mortality is between 5-9%
- 75% are STEMI
- 2/3rds are anterior wall MI (LAD or LM as the culprit vessel)
Many of these are typical ACS risk factors but are less prevalent in the pregnant population
- Older age (>35 years old for pregnancy is considered older age....yikes)
Morbidity and Mortality Learning Points with Dr. Stull
1. Should Post-ROSC patients get cardiac cath?
- Cardiac arrest patients who have STEMI on EKG after ROSC tend to have good outcomes (overall survival and intact neurologic survival) if they get cath'ed.
- According to latest Australian study (all patients with ROSC from OHCA, not STEMI) OR for overall survival is 2.77 and OR 2.2 for good neurologic outcome
- VT/VF cardiac arrest patients who do not have a STEMI on EKG: improved survival and likelihood of good neurologic outcomes if cath'ed within 24 hours.
- Our cardiology department wants all post-ROSC VF/VT patients to have cath lab activation. All other post-ROSC cases, call cardiology to discuss need for cath lab
- All post-ROSC STEMI should go to cath lab no matter what their neuro status is