See Part I First; you'll find the shownotes there as well
Part I of Who Needs an Acute PCI?
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Latest posts by Scott Weingart, MD FCCM (see all)
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HOW DO I GET PODCAST #147. I HAVE PART 1 SHOWING UP BUT NOT PART 2
not sure I understand. You are actually commenting on the page of podcast 147
audio is here, in itunes, and in the rss feed. let me know if you are still having trouble.
A great couple of episodes – thank you to both Scott and Steve. The subtleSTEMI iphone app is a great idea – but useless for us android users. Any plans to make an android version? I was just wondering what are Steve’s thoughts about pre-hospital treatment of the confirmed STEMI. 12 lead ECG and notification, aspirin and analgesia are common practice. Is there any benefit in adding therapies such as pre-hospital heparin/ clopidogrel etc. when the cath lab can be reached within 60 minutes – my service uses this time frame as a cut off for pre-hospital thrombolysis. I have… Read more »
Here is Steve’s response: As with all these findings, the clinical context is crucial. This paper does not examine the ED population we are talking about. We should have stated that we are talking about patients who present to the ED with reasonably high suspicion of acute coronary syndrome. Then, you have to exclude patients with demand ischemia (tachy, hypertensive, anemic, septic, etc.), all of whom can have ischemia without ACS. Then, in this study, everyone had sigificant cardiac disease, which causes false positives. severe LVH, cardiomyopathy, etc. Patients who have severe previous cardiac disease who develop severe ACS generaly… Read more »
Author: Andrew DeWolf Comment: Scott: Thank you for this phenomenal update in one place. Wondered if you or Dr Smith could address what seems to be a bit of a controversial finding currently and give us some context or further information – Diffuse ST depression leads V2-v7, I, AVL with AVR ST elevations … but in presence of LVH factors? Here’s a paper discussing that our current understanding and concerns about proximal LCA/LAD disease may be skewed. . Amal Mattu’s presentations don’t seem to have addressed the AVR ST elevations in presence of LVH either? Wonder your thoughts or where… Read more »
Great post! Could you comment on your algorithm to get patients pain free? Many of the topics depended on getting patients pain free. What therapy do you use and when do you say medical therapy is failing?
This is my exact question as well. Specifically, I am wondering whether narcotics such as morphine are appropriate. Does it mask ischemic pain? What do you do about the patient who says, “the chest pain is still there, but it’s a lot better” after nitro is given?
If the patient’s pain is due to ischemia, I do not give morphine or similar until I am committed to the cath lab. It just hides the pathology.