71 year old male: Chest Discomfort
This very interesting case comes from Bryan F, a Paramedic from Long Island.
A 71 year old male is cooking breakfast when he experiences sudden onset of 10/10 chest discomfort. He waits 20 minutes or so for it to subside, but it does not and he calls 911.
EMS arrives to find him lying in bed, stating the chest “pressure” has subsided somewhat (6/10), but he now feels some discomfort in his left shoulder. He has never experienced this before.
He denies any shortness of breath, diaphoresis, n/v, or numbness/tingling.
His Vitals:
HR: 74, slight sinus arrhythmia
BP: 178/96
RR: 20, regular, lungs clear, SpO2 97% o...
Source: EMS 12-Lead - March 18, 2018 Category: Cardiology Authors: David Baumrind Tags: 12 lead ecg Cases ems-topics patient-management Training 12-Lead ECG case study David Baumrind EMS 12-Lead ems12lead.com Paramedic Prehospital 12-Lead ECG blog Source Type: research
In Defense of Morphine (Part 2)
This study examined the effects of pre-PCI fentanyl on plasma concentrations of ticagrelor (another P2Y12 inhibitor) and platelet function. Guess what: it showed the same effect we’ve seen in morphine. Fentanyl delayed platelet inhibition with a lower area under the curve for the ticagrelor concentrations, but these differences narrowed after 4 hours.
I prefer fentanyl and I think you should too. There are a lot of things to like about it, but please, don’t make unsubstantiated claims that morphine is hurting patients; it’s a lazy, myopic misuse of the evidence.
References
Meine TJ, Roe MT, Che...
Source: EMS 12-Lead - February 18, 2018 Category: Cardiology Authors: Vince DiGiulio Tags: Original Articles Vince DiGiulio Source Type: research
In Defense of Morphine (Part 1)
Discussion, we all know why they performed this study, what they expected it to show, and how it will be cited for years to come. It demonstrates an association between morphine and worse outcomes in patients with ST-elevation acute myocardial infarction (STEMI).
I don’t know why everyone has been ganging up on poor old morphine for acute coronary syndrome (ACS)—maybe because it’s been beloved by so many for so long—but while I may not be able to empathize with the hardships of being popular, I sympathize with the hate it’s been receiving and hope to offer some exculpation.
How did we get here?...
Source: EMS 12-Lead - February 17, 2018 Category: Cardiology Authors: Vince DiGiulio Tags: Original Articles Vince DiGiulio Source Type: research
In Defense of Morphine (Part 1)
Discussion, we all know why they performed this study, what they expected it to show, and how it will be cited for years to come. It demonstrates an association between morphine and worse outcomes in patients with ST-elevation acute myocardial infarction (STEMI).
I don’t know why everyone has been ganging up on poor old morphine for acute coronary syndrome (ACS)—maybe because it’s been beloved by so many for so long—but while I may not be able to empathize with the hardships of being popular, I sympathize with the hate it’s been receiving and hope to offer some exculpation.
How did we get here?...
Source: EMS 12-Lead - February 17, 2018 Category: Cardiology Authors: Vince DiGiulio Tags: Original Articles Source Type: research
50 Year Old Male: Chest Pain, Hypotension, Pulmonary Edema (Conclusion)
Conclusion of Our Case
Oh yeah! We were discussing a real patient. What happened there?
The patient was intubated for pulmonary edema complicating cardiogenic shock and taken immediately to the cath lab. Angiography of the right coronary artery was grossly normal, showing a dominant RCA.
pic.twitter.com/3zzlMdQbhv
— Musa A. Sharkawi (@MusaSharkawi) December 21, 2017
When they shot the left coronary system, however, only a stump was visible due to a thrombotic 100% occlusion of the left main coronary artery.
LM pic.twitter.com/bGJsplQcwp
— Musa A. Sharkawi (@MusaSharkawi) December 21, 2017
Balloon angiop...
Source: EMS 12-Lead - January 9, 2018 Category: Cardiology Authors: Vince DiGiulio Tags: Cases Vince DiGiulio Source Type: research
50 Year Old Male: Chest Pain, Hypotension, Pulmonary Edema (Conclusion)
Conclusion of Our Case
Oh yeah! We were discussing a real patient. What happened there?
The patient was intubated for pulmonary edema complicating cardiogenic shock and taken immediately to the cath lab. Angiography of the right coronary artery was grossly normal, showing a dominant RCA.
pic.twitter.com/3zzlMdQbhv
— Musa A. Sharkawi (@MusaSharkawi) December 21, 2017
When they shot the left coronary system, however, only a stump was visible due to a thrombotic 100% occlusion of the left main coronary artery.
LM pic.twitter.com/bGJsplQcwp
— Musa A. Sharkawi (@MusaSharkawi) December 21, 2017
Balloon angiop...
Source: EMS 12-Lead - January 9, 2018 Category: Cardiology Authors: Vince DiGiulio Tags: Cases Vince DiGiulio Source Type: research
50 Year Old Male: Chest Pain, Hypotension, Pulmonary Edema
Physician and cardiovascular fellow Dr. Musa A. Sharkawi shared this ECG on Twitter (@MusaSharkawi) and has graciously allowed us to reproduce it here.
A 50-year-old male presents with a chief complaint of abrupt-onset severe chest pain. He is pale, diaphoretic, and ill-appearing—in moderate respiratory distress with extensive biateral crackles and a low blood pressure. Further history is limited by the patient’s condition but listed below:
Onset – 30 min ago
Provocation/Palliation – None
Quality – Severe “crushing” pressure
Radiation – None
Severity – 10/10
Timing – Constant
Signs/Symptoms ...
Source: EMS 12-Lead - January 5, 2018 Category: Cardiology Authors: Vince DiGiulio Tags: Cases Vince DiGiulio Source Type: research
