Even when the story is obvious, with intractable pain, the STEMI paradigm can cause preventable delays

 Written by Pendell MeyersA man in his early 60s presented with acute chest pain rated 10/10 with associated nausea and vomiting with known history of multivessel CAD. He presented at 2300 with onset of symptoms at 2230. He was awoken from sleep by the symptoms, which were identical to prior MI for which he received a stent years ago. On arrival his heart rate was 43 bpm and blood pressure 91/62. Atropine and IV fluid was given.Here was his triage ECG:What do you think? Baseline below for comparison, but try first without it.His baseline ECG was available on file:The presentation ECG shows diagnostic evidence of posterolateral OMI. There is sinus bradycardia with a relatively normal QRS complex, followed by some STE in aVL, with upright hyperacute T wave, with reciprocal STD in the inferior leads and negative hyperacute T waves. The posterior involvement is suggested by STD in V3-V4, which is highly specific for posterior OMI in the setting of ACS and no QRS explanation (RVH, RBBB, etc.) for such STD. This ECG is very easy for readers of this blog. But it does not meet STEMI criteria. The EM providers evaluated the patient and concluded, easily, that the patient was having ACS. But they did not understand the ECG, documenting " no clear STEMI. " CT pulmonary angiogram was chest negative for PE.Initial troponin I was 15 ng/L (99% upper reference limit for men is 20 ng/L for this assay). Remember how his symptoms started just 30 minutes prior to ar...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs

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CONCLUSION: In our sample, percentages of variation in PLR and PD were found to be directly representative of TBI patients’ fentanyl blood concentration. Considering information about blood drug concentration is generally not available at bedside, PLR could be used as a proxy to assess analgesia requirements before a nociceptive procedure in critically ill sedated TBI patients who are vulnerable to stress.
Source: Journal of Neuroscience Nursing - Category: Neuroscience Tags: Articles Source Type: research
ConclusionFrequent alcohol consumption is associated with increased risk of self-harm and suicidality for young women and men. Associations between illicit substance use and self-harm and suicidality appear stronger in women compared to men.
Source: Social Psychiatry and Psychiatric Epidemiology - Category: Psychiatry Source Type: research
People who experience debilitating back pain come to their doctors with one pressing question: Do I need back surgery? Often, they are surprised to hear me, a neurosurgeon, answer, “No.” In many cases, physical therapy, pain management, weight loss management, and physiatry can help people to delay – and in some cases avoid – backRead more …Expertise is the backbone of successful spine treatment originally appeared inKevinMD.com.
Source: Kevin, M.D. - Medical Weblog - Category: General Medicine Authors: Tags: Conditions Neurosurgery Orthopedics Source Type: blogs
Source: Risk Management and Healthcare Policy - Category: Health Management Tags: Risk Management and Healthcare Policy Source Type: research
This study aimed to evaluate the effectiveness and safety of gastric decontamination by paraffin oil in cases with acute ALP poisoning. This study was a randomized, controlled, parallel-group, single-blind, phase II clinical trial conducted over a period of 6 months. Sixty-two patients with acute ALP poisoning were randomly allocated into two equivalent groups. In both groups, the standard ALP treatment was given. Gastric decontamination in the control group was performed by saline and sodium bicarbonate 8.4%, while in the intervention group, it was done by paraffin oil and sodium bicarbonate 8.4%. All patients were subjec...
Source: Environmental Science and Pollution Research International - Category: Environmental Health Authors: Source Type: research
In conclusion, neurovascular imaging in Loeys Dietz syndrome type III patients revealed abnormalities such as aneurysm, tortuosity, coiling and kinking in the vast majority of patients, but clinical events were rare. Neurovascular screening and follow up is advised in all Loeys Dietz syndrome type III patients.PMID:35031499 | DOI:10.1016/j.ejmg.2022.104424
Source: European Journal of Medical Genetics - Category: Genetics & Stem Cells Authors: Source Type: research
CONCLUSIONS: The free antegrade palmaris longus tendocutaneous venous flap enabled the repair of compound tissue defects of the dorsal digit, resulting in acceptable aesthetics, repaired tendon defects, and wound coverage. This surgical method is an option for the reconstruction of small compound defects of digits with extensor defects.TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.PMID:35031123 | DOI:10.1016/j.jhsa.2021.11.023
Source: Hand Surgery - Category: Surgery Authors: Source Type: research
Mol Med. 2022 Jan 14;28(1):3. doi: 10.1186/s10020-021-00427-8.ABSTRACTThe mechanisms of chronic intermittent hypoxia (CIH)-induced cognitive deficits remain unclear. Here, our study found that about 3 months CIH treatment induced lipid droplets (LDs) accumulation in hippocampal nerve and glia cells of C57BL/6 mice, and caused severe neuro damage including neuron lesions, neuroblast (NB) apoptosis and abnormal glial activation. Studies have shown that the neuronal metabolism disorders might contribute to the CIH induced-hippocampal impairment. Mechanistically, the results showed that pyruvate dehydrogenase complex E1ɑ subu...
Source: Molecular Medicine - Category: Molecular Biology Authors: Source Type: research
Pflugers Arch. 2022 Jan 15. doi: 10.1007/s00424-021-02656-6. Online ahead of print.ABSTRACTSensory neurons are responsible for the generation and transmission of nociceptive signals from the periphery to the central nervous system. They encompass a broadly heterogeneous population of highly specialized neurons. The understanding of the molecular choreography of individual subpopulations is essential to understand physiological and pathological pain states. Recently, it became evident that species differences limit transferability of research findings between human and rodents in pain research. Thus, it is necessary to syst...
Source: Pflugers Archiv : European Journal of Physiology - Category: Physiology Authors: Source Type: research
Asian J Surg. 2022 Jan 12:S1015-9584(21)00850-2. doi: 10.1016/j.asjsur.2021.12.068. Online ahead of print.NO ABSTRACTPMID:35031179 | DOI:10.1016/j.asjsur.2021.12.068
Source: Asian Journal of Surgery - Category: Surgery Authors: Source Type: research
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