EM Quick Hits 38 ACS in Older Patients, Rural Neonatal Resuscitation, Hemophilia, Hiccups, ECG Computer Interpretation

Topics in this EM Quick Hits podcast Christina Shenvi on ACS in older people (00:37) Nour Khatib on rural NRP (11:40) Jess McLaren on how not to get fooled by ECG computer interpretation (23:44) Brit Long on hemophilia recognition and workup (30:10) Maria Ivankovic on persistent and intractable hiccups from EM Cases Summit 2021 (36:20) Podcast production, editing and sound design by Anton Helman Podcast content, written summary & blog post by Kate Dillon, edited by Anton Helman Cite this podcast as: Helman, A. Shenvi, C. McLaren, J. Long, B. Ivankovic, M. EM Quick Hits 38 - ACS in Older Patients, Rural Neonatal Resuscitation, Hemophilia, Hiccups, ECG Computer Interpretation. Emergency Medicine Cases. May, 2022. https://emergencymedicinecases.com/em-quick-hits-may-2022/. Accessed [date]. How not to miss ACS in older patients * 65% of STEMIs and 80% of deaths from MIs occur in older patients * The term “atypical” symptoms should be abandoned, as presentations of ACS without chest pain and presenting symptoms such as fatigue, weakness, dizziness and shortness of breath are common in older adults * The most common presenting complaint in patients who have an MI who do not present with chest pain is dyspnea (followed by diaphoresis, nausea, vomiting and syncope) * There are significant delays to assessment, obtaining ECG, diagnosis, treatment (i.e., delay to receiving ASA, longer door to PCI time) in older patients * ECG interpretation is often more complicated in older patients who are more likely to have a pacemaker, ectopy, bundle branch blocks, LVH, dysrhythmias, atrial fibrillation, and pre-existing Q-waves * Be proactive about obtaining and interpreting ECGs early and initiating treatment rapidly as these patients benefit from early PCI/fibrinolysis if it is within their goals of care Expand to view reference list * Engberding N, Wenger NK. Acute Coronary Syndromes in the Elderly. F1000Res. 2017;6:1791. Published 2017 Oct 2. * Bendz B, Aaberge, L. Acute coronary syndromes in older patients: does older age matter? Lancet. 2020;396:10251, 585-587. * Canto J, Rogers W, Goldberg R, et al. Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA. 2012;307(8):813-822. Practical tips for NRP in the ED/rural/remote settings * Generally neonatal distress is caused by respiratory compromise and therefore resuscitation is ABC, not CAB * Ensure equipment is prepared in advance: NRP algorithm on the wall, Miller zero and 1 blades, appropriately sized ET tubes, oxygen mask and BVM, smallest supraglottic airway, towels, plastic bag, umbilical vein catheter kit, scissors, clamp, IO * Heat loss is a problem in premature babies; use the warmer, set to 25C, and put neonates <32 weeks GA in a plastic bag up to their neck without towel drying; target 36.5-37.5C * Suctioning: nasopharyngeal and oral suctioning is no longer routinely recommended and is recommended only if there is airway obstruction; suction the mouth first and then the nose (think alphabetical order M-N) * Monitors and positioning: place rolls under the shoulders, 3-lead ECG, SpO2 monitor, listen to the heart with stethoscope for HR, consider jaw thrust