A 41 year old with chest pain and a Nondiagnostic Triage ECG. Thrombolytics prior to transfer for PCI.

Conclusion:Transfer for PCI without thrombolytics is best if PCI at receiving facility can be done in less than 120 minutes from first medical contact, or less than 90 minutes from STEMI diagnosis in first ED.Thrombolytics prior to Transfer to a PCI capable facility, then rescue PCI if no reperfusion for STEMITRANSFER AMI(Cantor et al. 2009).High risk STEMI: BP less than 100, HR greater than 100 Killip class II, III, ST depression of at least 2 mm in precordial leads, ST elevation in right precordial leads (right ventricular MIAll patients get TNK-tPA.80-90% received clopidogrel 300 mg (75 mg for age over 75).Enoxaparin (not for age over 75) or UFH (50-50).  Doses not specified, presumably standard doses.Patients randomized to: 1) Standard Rx:Transfer only if there is persistent ST elevation (less than 50% ST resolution)No transfer if thereis reperfusion (ST resolution)2) Transfer with immediate PCI regardless of reperfusion.Results:Intervention group had PCI a median of 2.8 hours after randomization30-day severe adverse outcomes 17.2% vs. 11.0% (NNT = 16)Conclusion:All high risk STEMI should be immediately transferred after thrombolyticsThrombolytics prior to transfer to a PCI capable facility, thenroutine PCI regardless of reperfusion for STEMICARESS-in-AMI(Di Mario et al. 2008)Patients: High risk STEMI, had at least one high risk feature treated initially at non-PCI hospitalExtensive ST elevation, new LBBB, previous MI, Killip class greater t...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

Related Links:

Publication date: November–December 2020Source: Heart &Lung, Volume 49, Issue 6Author(s): Linda Clements, Susan K. Frazier, Debra K. Moser, Terry A. Lennie, Misook L. Chung
Source: Heart and Lung: The Journal of Acute and Critical Care - Category: Respiratory Medicine Source Type: research
CONCLUSIONS: Elevated plasma TMAO level in patients with heart failure is associated with poorer prognoses. This association is only partially mediated by renal dysfunction. PMID: 32959366 [PubMed - as supplied by publisher]
Source: Medical Journal of Australia - Category: General Medicine Tags: Med J Aust Source Type: research
Publication date: Available online 21 September 2020Source: Journal of Vascular and Interventional RadiologyAuthor(s): Sipan Mathevosian, Lucas R. Cusumano, Nathaniel Moradzadeh, Arjun Ranade, Adam N. Plotnik, Justin P. McWilliams
Source: Journal of Vascular and Interventional Radiology - Category: Radiology Source Type: research
Publication date: 1 January 2021Source: Personality and Individual Differences, Volume 168Author(s): Feizhong Zheng, Wenting Wu, Lijing Wang, Arlette J. Ngoubene-Atioky, Li Chen
Source: Personality and Individual Differences - Category: Psychiatry & Psychology Source Type: research
Getting the right care in a timely manner is important in medical emergencies. In the event that you or a loved one suffers a stroke, time is especially critical. “In the event of a stroke, a delay of only 15 minutes in treatment greatly decreases your chances not only of making a full recovery, but also being able to walk or live independently, and in many cases, of survival,” says Christopher Zammit, MD, a critical care specialist and emergency physic ian with TriHealth, which offers a network…
Source: bizjournals.com Health Care:Pharmaceuticals headlines - Category: Pharmaceuticals Authors: Source Type: news
CONCLUSION: In a NHP ARS model, sargramostim administered starting at 48 h post-radiation was effective to improve survival, while beneficial hematological effects were observed with sargramostim initiated up to 120 h post exposure. PMID: 32960660 [PubMed - as supplied by publisher]
Source: International Journal of Radiation Biology - Category: Radiology Tags: Int J Radiat Biol Source Type: research
CONCLUSIONS: Under a real-life clinical practice setting, SSTS provides effective pain management and is easy to use for patients and nurses. PMID: 32959632 [PubMed - as supplied by publisher]
Source: Minerva Anestesiologica - Category: Anesthesiology Tags: Minerva Anestesiol Source Type: research
In 2019, before the pandemic hit, nearly 1 in 5 adults had depression and nearly 1 in 6 had anxiety, with dramatic increases seen in 2020.Medscape Medical News
Source: Medscape FamilyMedicine Headlines - Category: Primary Care Tags: Psychiatry News Source Type: news
Authors: Wong A, Keith C, Gregory H, Liew D Abstract COVID-19 brings with it unprecedented challenges in clinical management. An important component of care is the provision of safe and effective symptom control. Given the emerging literature reporting on the risk of QT prolongation and arrhythmias associated with COVID-19 disease and experimental therapies, we highlight some considerations for the prescribing of palliative care medications in this context. Based on the experience gained from palliative care referrals at our institution prior to and during the COVID-19 pandemic, and in collaboration with our clinic...
Source: Journal of Pain and Palliative Care Pharmacotherapy - Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research
We report a case of using ketamine as a patient-controlled analgesia (PCA) for the treatment of CPS. A 58-year-old male with CPS presented with severe generalized body pain refractory to multiple pharmacological interventions. He was started on a basal infusion rate at 0.3 mg/kg/h with a ketamine PCA bolus of 10 mg with a 10-minute lockout period. Over the next 7 days, the basal infusion rate was titrated up to 2.1 mg/kg/h relative to the number of times the patient pressed the PCA. At the end of the trial, the patient reported 0/10 pain with lightheadedness on the first day being the only side ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research
More News: Abciximab | Amphetamine | Angiography | Aspirin | Bleeding | Blogging | Cardiology | Clopidogrel | Congestive Heart Failure | Depression | Emergency Medicine | Heart | Heart Failure | Hemorrhagic Stroke | Lovenox | Nurses | Nursing | Pain | Plavix | Stroke | Study | Thrombosis