EKG to Activation - A Quality, Quality Metric?

EKG to Activation - A Quality, Quality Metric?

Time is myocardium, and minimizing door-to-activation time improves outcomes in patients with acute coronary occlusion. There are a number of existing quality metrics used to help drive improvements in the time-based care of STEMI patients. Could a new quality metric help the decision making time of Emergency Physicians?

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Is a STEMI a STEMI in Post-ROSC Patients?

Is a STEMI a STEMI in Post-ROSC Patients?

One of the first tests ordered for a patient with ROSC following cardiac arrest is an EKG. Many of these EKGs are profoundly abnormal. Current practice is to evaluate for STEMI and to activate the cardiac cath lab if one is found. But, the test characteristics (sensitivity and specificity) of post-ROSC EKGs are likely different than the test characteristics for patients presenting to the ED with complaints of chest pain/symptoms concerning for ACS. This meta-analysis looked to pull together the existing literature and determine those test characteristics for this critically ill patient population. Read the summary after the link and listen to the podcast to hear a breakdown of this study.

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Grand Rounds Recap 5.5.21

Grand Rounds Recap 5.5.21

This week’s Grand Rounds started off with a journal club on various aspects of emergent heart catheterization with Drs. Berger, Roblee and Thode. This was followed by some evidence by Dr. Sams on the evidence and feasibility of proning in the prehospital setting. Dr. Knight gave a case-based lesson in neuroimaging and finally Drs. Gleimer, Shaw and Hughes gave a sim on buproprion overdose and a guest lecturer on Human Trafficking.

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Grand Rounds Recap 04.14.21

Grand Rounds Recap 04.14.21

This week’s Grand Rounds was jam-packed with great morsels for all! Dr. Finney kicked us off with a discussion on orbital infections, Dr. Frederick discussed the nuances of dynamic EKG changes in the ED and consultation etiquette in her R3 Taming the SRU lecture, Dr. Iparraguirre discussed pearls of wisdom for his R4 Capstone, Dr. Kein expertly discussed the literature behind the most commonly used medications for agitation in the ED, Drs. Mullen and Ham battled head-to-head in a CPC case highlighting ethylene glycol toxicity, Dr. LaFollette presented a rare case of metformin-associated lactic acidosis, and lastly Dr. Runkle wrapped the day up with pearls for rural PEM.

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STEMIs in Disguise

STEMIs in Disguise

The 2013 ACC/AHA STEMI guidelines outline, with specific age and gender-related cutoffs for ST segment elevation in certain leads. While these are clinically important, there are several STEMI equivalents or EKG patterns that do not meet these criteria but should point the practitioner to consult with an interventional cardiologist.  These STEMI equivalents are found in 10-25% of cases of coronary occlusion, making it imperative that emergency personnel be familiar with these patterns. 

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Grand Rounds Recap 11.13.19

Grand Rounds Recap 11.13.19

This week was filled with Ultrasound pearls, starting with our guest lecture from Dr. Avila (5minutesono) on ocular ultrasound. We then covered how and when to perform musculoskeletal ultrasound with Dr. Broadstock, and witnessed a battle of wits between Dr. Urbanowicz and Dr. Minges over a case of uremic pericarditis. Dr. Humphries then showed us how to perform a flawless consultation, and several residents presented interesting learning points from the recent ACEP conference in Denver. Finally, Dr. Gray gave us a thorough review on the pearls and pitfalls of pediatric sedation.

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Is the Cath Lab the Place to be after V fib VTac Cardiac Arrest?

Is the Cath Lab the Place to be after V fib VTac Cardiac Arrest?

Ventricular dysrhythmias are commonly caused by coronary ischemia which is most frequently caused by acute coronary artery occlusions in the setting of coronary artery disease. It would seem somewhat logical that patients who suffer a V fib or V Tach cardiac arrest would benefit from a trip to the cardiac catheterization lab to identify and treat these possible acute coronary artery occlusions. Patient’s with EKGs showing ST-elevations following ROSC already go to the Cath lab. Since the EKG is not terrifically sensitive for MI, should V fib V Tach cardiac arrest patients without ST-elevations make a trip to the Cath lab? In this breakdown of our most recent journal club we look at several papers covering this topic. In the podcast below we also talk with Justin Benoit, MD the site PI for the ongoing ACCESS trial which is also looking into this question.

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Air Care Orientation Case #3

Air Care Orientation Case #3

April brought the third case of our Air Care Flight Physician Orientation Case Series with the goal of preparing our first year residents for their roles as Flight Physicians. This is a monthly series that will continue through the R1’s Flight Physician Orientation Day in June. First year residents discuss the case and its associated questions on our internal asynchronous learning forum, Slack. This month, a case of STEMI, seemingly simple, right… but what happens next?

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Grand Rounds Recap 1.31.18

Grand Rounds Recap 1.31.18

In this week's grand rounds, Dr. Stolz discussed all things DVT and the modified two-point compression study for lower extremity clots. In our recurring EM-neuro combined conference, Dr. Stettler discussed the recent DAWN trial results, and how to incorporate CT perfusion studies into our acute ischemic stroke decision trees. In our Quarterly Sim, we discussed the management of the crashing patient from a house fire, and practiced our escharotomy skills. In our mock oral boards, we went through cases on STEMI, carbon monoxide exposure and limb ischemia. Finally, Dr. Lane discussed the workup of acute diarrhea in the adult population, and Dr. Shah went through a particularly unique toxidrome presentation in his R4 Case Follow Up. 

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Grand Rounds Recap 1.10.18

Grand Rounds Recap 1.10.18

Grand rounds this week started off with a review of the EMTALA law with Dr. Hinckley, as well as some case discussion.  This was followed by a presentation from our clinical pharmacists, PharmD's Nicole Harger and Madeline Stephens, on anti-epileptic medications and their uses, as well as an update on our medication supplies in the ED.  Drs. Murphy-Crews and Scanlon then presented their evidenced based algorithm for the management of STEMI, followed by our combined peds EM lecture with Dr. Kevin Overmann on the evaluation of the pale child and pediatric anemia.  This was followed by Dr. Ludmer's R4 case follow up/best of residency cases.  The day finished up with Dr. Sim Mand presenting her clinical diagnostics lecture on the assessment and management of the non-pregnant patient with abnormal uterine bleeding. 

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Grand Rounds Recap 7.5.17

Grand Rounds Recap 7.5.17

In our first Grand Rounds of the academic year, we started with Dr. Pancioli teaching us about the history of Emergency Medicine. Dr. Palmer discussed team work and the case for building social capital and Dr. LaFollette worked through the disposition of patients with chest pain. Our clinical pharmacist Chris Droege, PharmD discussed the evolving landscape of agents we have to reverse oral anticoagulants.

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Cardiac Biomarkers

Cardiac Biomarkers

Real time, high sensitivity serum biomarkers have played an enormous part in the timely identification and intervention on of cardiac pathology in the Emergency Department. These biomarkers have sufficient sensitivity to identify cardiomyocyte injury even in the absence of physical exam, radiographic, or electrocardiographic findings. Unfortunately, the utility of these studies may be limited or obfuscated in certain clinical contexts. This article will discuss the possible pitfalls and obstacles physicians may encounter in interpreting cardiac biomarkers

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Pre-Hospital STEMI Care

Pre-Hospital STEMI Care

The UC Division of EMS has recorded a series of podcasts to celebrate EMS Week 2016.  We are honored to be able to engage EMS Providers throughout the world with this forum.  If you practice pre-hospital medicine, we would like to say thank you and that we appreciate everything you do to provide a high level of care to ill and injured patients in a wide variety of austere environments.  For this podcast, we were joined by Dr. Tim Smith, an Interventional Cardiologist and Director of the Cardiovascular Intensive Care Unit at the University of Cincinnati Medical Center.  Dr. Smith joined us to discuss our region’s partnership with the American Heart Association’s Mission Lifeline program to bring a regionalized system of care for STEMI patients to our area.  

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A Look into the Code STEMI - Flights Case 2 Recap

A Look into the Code STEMI - Flights Case 2 Recap

It’s true that sometimes critical care transport missions to transport STEMI patients to PCI are fairly uneventful.  But if we allow ourselves to get lulled into a “Milk Run” mindset, it will most definitely come back to bite us.  The jovial, normotensive, fairly comfortable-appearing STEMI patient may be only a couple of minutes away from V Fib arrest or florid cardiogenic shock.  When that occurs, if we have expected and prepared for such a complication, it’s likely that we’ll be able to manage it successfully.

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