Podcasts about stemi

Show notes at pharmacyjoe.com/episode1137 In this episode, I'll discuss using a heparin bolus in the prehospital setting for patients with STEMI.

The following question refers to Section 7.1 of the 2025 ACS Guidelines. The question is asked by Thomas Jefferson medical student and CardioNerds Academy Intern Dr. Grace Qiu, answered first by University of Michigan fellow and CardioNerds FIT Ambassador Dr. Kayla Secrest, and then by expert faculty Dr. Sunil Rao. Dr. Rao is an interventional cardiologist, Professor of Medicine at NYU Grossman School of Medicine, Deputy Director of the Leon H. Charney Division of Cardiology, and the Director of Interventional Cardiology for the NYU Langone Health System. He is the Editor-in-Chief for Circulation Cardiovascular Interventions and was the Chair of the Writing Committee for the 2025 ACS Guidelines. This episode is part of our comprehensive Decipher the Guidelines Series covering the 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes. Question #1 A 68-year-old man with a history of hypertension, hyperlipidemia, stage III chronic kidney disease, and prior tobacco use presents to a local emergency department with reports of chest pain while raking leaves at home. Upon arrival, he is hemodynamically stable with a heart rate of 86 beats per minute and a blood pressure of 133/85 mmHg. His EKG reveals ST elevations in the septal and anterior leads (V1-V4). He is given 324mg of aspirin and is promptly evaluated by the interventional cardiology team, who elects to take him emergently to the catheterization lab. Upon arrival to the catheterization lab, the nurse asks the interventional fellow which access sites they should prep for this case? How should the interventional fellow respond? A Right radial artery only B Radial + bilateral femoral C Bilateral femoral only Answer #1 Explanation  The correct answer is B. Radial and bilateral femoral Radial artery access is the preferred vascular access site for coronary angiography and PCI in patients with ACS. Transradial access has been shown to reduce mortality, bleeding, and vascular complications compared with transfemoral access (Class I, LOE A). Radial access also allows earlier ambulation and is associated with greater patient comfort. Although the right radial artery is the most widely studied upper-extremity access site, alternative sites such as the ulnar and distal radial arteries have demonstrated similar outcomes. However, the radial artery may be required as a bypass conduit for CABG. In institutions where the radial artery is routinely used for surgical grafting, this potential future use should be considered when selecting vascular access. In addition, transfemoral access—preferably performed with ultrasound guidance—should be considered in patients in whom temporary mechanical circulatory support (MCS) is anticipated or in those for whom radial access is not feasible due to anatomical or technical constraints. Prepping bilateral groins in addition to the radial artery provides a backup strategy for urgent MCS placement or for transition to femoral access should radial access fail. For these reasons, prepping both the radial artery and bilateral groins is the most appropriate response. Radial-only preparation is incorrect because, although radial access is preferred, patients with STEMI may still require emergent MCS or alternative access if the radial artery is unsuitable. Preparing only the wrist without backup femoral access may delay care should hemodynamic instability occur. Femoral-only preparation is incorrect because transradial access provides superior outcomes in ACS, including significant reductions in all-cause mortality, major bleeding, and vascular complications. RCTs and meta-analyses, including MATRIX (which showed lower MACE and net adverse clinical events with radial access) and SAFARI-STEMI (which showed no difference in mortality but was underpowered)—support radial as first-line access when feasible. Main Takeaway For patients with ACS undergoing PCI, radial access is strongly preferred to reduce mortality, bleeding, and vascular complications. Guideline Loc. Section 7.1  

CardioNerds (Dr. Billy-Joe Mullinax, Dr. Dinu Balanescu, and Dr. Jane Ehret) discuss risk stratification in acute pulmonary embolism with Dr. Stavros Konstantinides, Chair of the 2019 ESC Pulmonary Embolism Guidelines. Using a real-world case, this episode explores how modern PE care has moved beyond “massive” and “submassive” labels toward a dynamic, physiology-based approach. The discussion highlights the limitations of static risk scores, the importance of right ventricular dysfunction and biomarkers, and why normotension does not imply stability. Special emphasis is placed on intermediate-high risk PE, early identification of impending hemodynamic collapse, and the role of lactate, serial reassessment, and PERT teams in guiding escalation of care. Audio editing by CardioNerds intern, Joshua Khorsandi.The 2026 American multi-society PE guidelines were published after this episode was recorded. Dr. Dinu Balanescu and Dr. Billy-Joe Mullinax are Co-chairs for the CardioNerds PE Series, developed in collaboration with the PERT Consortium.   Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. CardioNerds Pulmonary Embolism PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron! Pearls Stable blood pressure does not mean low risk in PEHypotension is a late finding. Patients may have severe RV failure, hypoxia, and tissue hypoperfusion while remaining normotensive — a key concept behind “normotensive shock.” Risk stratification in PE must be dynamic, not staticLegacy scores like PESI and Bova provide a snapshot and predict 30-day mortality, but they do not capture short-term trajectory or impending hemodynamic collapse. Intermediate-high risk PE is a dangerous and heterogeneous groupPatients with RV dysfunction, positive biomarkers, tachycardia, hypoxemia, and elevated lactate may have in-hospital mortality approaching 15%, rivaling STEMI. Lactate is a critical but underutilized marker in PEElevated lactate reflects tissue hypoxia and early circulatory failure and may identify patients at risk for collapse before blood pressure declines. PERT enables physiology-driven, patient-centered PE carePERT teams operationalize continuous reassessment, integrate imaging, labs, and clinical trajectory, and allow timely escalation — shifting PE management from rigid categories to real-time decision-making. Notes Drafted by Dr. Jane Ehret. 1. What is the contemporary framework for risk stratification in acute pulmonary embolism? Modern PE risk stratification prioritizes hemodynamics and right ventricular (RV) function rather than clot burden. The 2019 ESC Guidelines classify PE into high risk, intermediate risk (low vs high), and low risk, based on: Hemodynamic status, RV dysfunction on imaging, and Cardiac biomarkers. This framework emphasizes early mortality risk but requires clinical context to guide escalation decisions. 2. Why is normotension insufficient to define “stability” in PE? Blood pressure is a late marker of circulatory failure in PE. Patients can maintain normal BP through Tachycardia, Increased sympathetic tone, and RV compensation. Many patients with preserved BP may already have shock physiology, including hypoxemia, elevated lactate, and RV failure — sometimes referred to as “normotensive shock.” 3. How should intermediate-risk PE be conceptualized clinically? Intermediate-risk PE is heterogeneous, ranging from patients who do well on anticoagulation to those who deteriorate rapidly. Intermediate-high risk PE is defined by RV dysfunction on imaging and positive cardiac biomarkers. Clinical features such as tachycardia, increasing oxygen requirement, and elevated lactate identify patients at highest risk within this group. 4. What are the strengths and limitations of commonly used PE risk scores? Legacy scores are useful for initial risk categorization but are static and limited in predicting short-term deterioration. Most scores were developed to predict mortality or complications at fixed time points rather than dynamic clinical trajectory. 5. What are the commonly used risk scores and clinical tools in PE, and what is each designed to predict? ESC Risk Stratification Algorithm: Identifies high-risk PE by hemodynamics. Uses PESI or sPESI in normotensive patients to distinguish low-risk from non–low-risk PE. Uses RV dysfunction and biomarkers to differentiate intermediate-low from intermediate-high risk. Forms the basis of many institutional PE pathways. PESI and sPESI: Validated to predict 30-day mortality. Widely used to identify low-risk patients appropriate for outpatient management. Heavily influenced by age and comorbidities. Bova Score: Predicts 30-day PE-related complications in normotensive patients. Composite PE Shock Score (CPES): Predicts normotensive shock in hemodynamically stable PE patients. Pulmonary Embolism Progression (PEP) Score: Predicts progression from intermediate-risk to high-risk PE within 72 hours of diagnosis. PE Short-term Clinical Outcomes Risk Estimation (PE-SCORE): Predicts clinical deterioration or death within 5 days of PE diagnosis. Hestia Criteria: Identifies low-risk PE patients safe for outpatient treatment. Wells' Criteria and Revised Geneva Score: Determine pretest probability for diagnostic triage. PERC Score: Rules out PE in very low-risk patients. 6. What is the role of biomarkers in PE risk stratification? Troponin and natriuretic peptides reflect RV myocardial injury and strain. Current guidelines treat biomarkers as binary (positive vs negative), despite risk being continuous. Biomarkers are most helpful for: Initial risk classification. They are less useful for: Short-interval monitoring and Detecting rapid clinical deterioration. 7. Why is lactate an important physiologic marker in PE? Lactate reflects global tissue hypoxia and impaired perfusion. Elevated lactate may identify patients with: Early circulatory failure and Increased risk of imminent hemodynamic collapse. Lactate is not currently included in ESC risk algorithms but may add important prognostic information in intermediate-risk patients. 8. How does trajectory influence decision-making in PE management? Risk stratification should be viewed as a dynamic process, not a one-time label. Worsening clinical trajectory may include: Rising heart rate, Increasing oxygen needs, Rising lactate, and Progressive RV dysfunction. Serial reassessment is essential for timely escalation of care. 9. What role do Pulmonary Embolism Response Teams (PERT) play in risk stratification? PERT facilitates: Multidisciplinary decision-making and Integration of imaging, biomarkers, and clinical physiology. PERT is most valuable for: Intermediate-risk and high-risk PE and Patients with complex comorbidities or uncertain trajectory. PERT enables a shift from category-based to physiology-driven PE care. References 1. Konstantinides SV, Meyer G, Becattini C, et al. 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J. 2019;54(3):1901647. Published 2019 Oct 9. doi:10.1183/13993003.01647-2019 2. Leidi A, Bex S, Righini M, Berner A, Grosgurin O, Marti C. Risk Stratification in Patients with Acute Pulmonary Embolism: Current Evidence and Perspectives. J Clin Med. 2022;11(9):2533. Published 2022 Apr 30. doi:10.3390/jcm11092533 3. Choi WH, Kwon SU, Jwa YJ, et al. The pulmonary embolism severity index in predicting the prognosis of patients with pulmonary embolism. Korean J Intern Med. 2009;24(2):123-127. doi:10.3904/kjim.2009.24.2.123 4. Jiménez D, Aujesky D, Moores L, et al. Simplification of the pulmonary embolism severity index for prognostication in patients with acute symptomatic pulmonary embolism. Arch Intern Med. 2010;170(15):1383-1389. doi:10.1001/archinternmed.2010.199 5. Chen X, Shao X, Zhang Y, et al. Assessment of the Bova score for risk stratification of acute normotensive pulmonary embolism: A systematic review and meta-analysis. Thromb Res. 2020;193:99-106. doi:10.1016/j.thromres.2020.05.047 6. Zhang RS, Yuriditsky E, Zhang P, et al. Composite Pulmonary Embolism Shock Score and Risk of Adverse Outcomes in Patients With Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(8):e014088. doi:10.1161/CIRCINTERVENTIONS.124.014088 7. Zhang RS, Alam U, Sharp ASP, et al. Validating the Composite Pulmonary Embolism Shock Score for Predicting Normotensive Shock in Intermediate-Risk Pulmonary Embolism. Circ Cardiovasc Interv. 2024;17(2):e013399. doi:10.1161/CIRCINTERVENTIONS.123.013399 8. Ehret J, Wakefield D, Badlam J, Antkowiak M, Erdreich B. Development of the Pulmonary Embolism Progression (PEP) score for predicting short-term clinical deterioration in intermediate-risk pulmonary embolism: a single-center retrospective study. J Thromb Thrombolysis. 2025;58(2):243-253. doi:10.1007/s11239-024-03051-5 9. Weekes AJ, Raper JD, Lupez K, et al. Development and validation of a prognostic tool: Pulmonary embolism short-term clinical outcomes risk estimation (PE-SCORE). PLoS One. 2021;16(11):e0260036. Published 2021 Nov 18. doi:10.1371/journal.pone.0260036 10. Zondag W, Hiddinga BI, Crobach MJ, et al. Hestia criteria can discriminate high- from low-risk patients with pulmonary embolism. Eur Respir J. 2013;41(3):588-592. doi:10.1183/09031936.00030412 11. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and d-dimer. Ann Intern Med. 2001;135(2):98-107. doi:10.7326/0003-4819-135-2-200107170-00010 12. Wolf SJ, McCubbin TR, Feldhaus KM, Faragher JP, Adcock DM. Prospective validation of Wells Criteria in the evaluation of patients with suspected pulmonary embolism. Ann Emerg Med. 2004;44(5):503-510. doi:10.1016/j.annemergmed.2004.04.002 13. Le Gal G, Righini M, Roy PM, et al. Prediction of pulmonary embolism in the emergency department: the revised Geneva score. Ann Intern Med. 2006;144(3):165-171. doi:10.7326/0003-4819-144-3-200602070-00004 14. Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2(8):1247-1255. doi:10.1111/j.1538-7836.2004.00790.x 15. Kline JA, Courtney DM, Kabrhel C, et al. Prospective multicenter evaluation of the pulmonary embolism rule-out criteria. J Thromb Haemost. 2008;6(5):772-780. doi:10.1111/j.1538-7836.2008.02944.x

Akutt koronarsyndrom er en tilstand som Iegevakten bør være særlig oppmerksom på fordi det er alvorlig, og det haster å komme i gang med behandling. Få med deg flere viktige kliniske poeng om håndtering av STEMI og NSTEMI infarkt, hvorfor lav-sensitive troponiner ikke bør brukes på legevakt, og om bruk av fentanyl i stedet for morfin. Bent Håkan Lindberg og Jesper Blinkenberg diskuterer. De er redaktører for Legevakthåndboken, samt leger og forskere ved Nasjonalt kompetansesenter for legevaktmedisin (NKLM).    Podkastvert: Tone Morken. Produsent: Nathalie Sandal 

In this hard-hitting episode of the PFC Podcast, Dennis sits down with Doug, a cardiothoracic ICU physician, for a no-fluff deep dive into ACLS with a heavy focus on pulseless VT and VFib in austere, military, and prolonged field care environments.From deciding when CPR is worth it under fire or in a mass casualty scenario, to running a lean team code with minimal personnel, nailing high-quality BLS, working the H's and T's under chaos, post-ROSC pitfalls, antiarrhythmics, and the gut-wrenching decision of when to call it — this conversation delivers practical, experience-based wisdom you won't find in standard ACLS class.Whether you're a medic, PA, physician, or team leader operating far from a hospital, this episode gives you the mental framework and tactical edge to give your teammate the best possible shot at survival.Key Takeaways:Scene safety and triage realities — when not to start CPRHow one knowledgeable person can effectively run an entire code by delegating roles (CPR rotations, timer, airway, meds, defibrillator)Prioritizing actions in resource-limited environments: early high-quality CPR + epi > everything elseWhen and how to practically apply the H's and T's (especially hypovolemia, acidosis, hypoxia, and tension pneumo)Post-ROSC critical care: preventing rearrest, airway management, sedation, and treating the “two patients” (heart + brain)Amiodarone vs Lidocaine — when to use whatRealistic termination of resuscitation guidelines, the difference between witnessed vs unwitnessed arrest, and the value of objective outside input (telemedicine)The power of bringing the team in for closure when the fight is overChapters00:00 – Intro & Welcome00:57 – Can you really do CPR in the field? Safety, triage, and mass casualty realities02:57 – Running a code with minimal trained personnel – how one leader directs chaos06:02 – Essential team roles: CPR rotation, AED/pads, airway, access, and early epi09:08 – Making the H's and T's actually useful (hypovolemia, acidosis, hypoxia, tension physiology)16:53 – Post-ROSC care: Preventing rearrest, airway security, sedation, and neuroprotection20:41 – Antiarrhythmics – Amiodarone vs Lidocaine, dosing, and post-arrest infusions22:53 – The hard call: When to terminate resuscitation (witnessed vs unwitnessed, resources, hypothermia exception)28:19 – Emotional reality of coding teammates and giving families/teammates closure33:21 – Final pearls: Telemedicine, ultrasound/video for handoff, STEMI considerations, and medevac prep36:03 – Closing thoughts & resourcesFor more content, go to ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.prolongedfieldcare.org⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Consider supporting us: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠patreon.com/ProlongedFieldCareCollective⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.lobocoffeeco.com/product-page/prolonged-field-care⁠

Special Guest GEOFF MURPHY of Master Your Medics fame joins the guys for a trip around the game board as a Canadian crew navigate the harsh realities of the unknown reasons someone could be altered... with a STEMI. Maybe.

Listener feedback from the DanGer Shock investigators, complete vs staged revascularization, polygenic risk scores, and quality improvement failure in an RCT are the topics John Mandrola, MD, discusses in this week's podcast.   This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback DanGer Shock Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2312572 CHIP-BCIS 3 Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2515704 II Immediate Complete vs Staged Revascularization in STEMI Meta-analysis: Timing of Complete Revasc in Patients with STEMI and Multivessel Disease https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.126.016601 COMPLETE Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1907775 FULL REVASC Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2314149 iMODERN Trial https://www.nejm.org/doi/full/10.1056/NEJMoa2512918 III Polygenic Risk Scores for Prediction Polygenic Risk Report in US-Based Hospitals for 8 CV Conditions  https://www.jacc.org/doi/10.1016/j.jacc.2026.03.035 IV Practice Improvement Policies Undergo the Proper Test – Randomization Quality Improvement on Hospitalizations and Health Outcomes for People with CHD https://www.ahajournals.org/doi/10.1161/CIRCOUTCOMES.125.012904 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

Στο επεισόδιο συζητάμε τις σημαντικότερες μελέτες του ACC 2026:Τι νέο μαθαίνουμε από τη CHAMPION AF για τον ρόλο του LAAO έναντι της αντιπηκτικης αγωγής στην κολπική μαρμαρυγή;Μπορεί η HI-PEITHO να αλλάξει τη διαχείριση της πνευμονικής εμβολής ενδιάμεσου κινδύνου;Ποιος είναι τελικά ο ρόλος της Impella σε υψηλού κινδύνου PCI και σε anterior STEMI;Τι μαθαίνουμε για τη χρήση του IVUS στη βελτιστοποίηση της PCI, ειδικά σε στελεχιαία νόσο και πιο σύνθετες βλάβες;Τι προσφερει η σπινορολακτόνη στη θεραπεία της καρδιακής ανεπάρκειας με διατηρημένο κλάσμα εξώθησης;Θα έρθει το sotatercpert σε cpcPH-HFPEF?

In this episode of Parallax, Dr Ankur Kalra is joined by Dr Michelle Kittleson, Professor of Medicine and Advanced Heart Failure Cardiologist at Cedars-Sinai Medical Center, for a clinically rich breakdown of her standout trial picks from the 2026 ACC Annual Scientific Sessions. Dr Kittleson brings her characteristic precision to four landmark studies spanning heart failure and atrial fibrillation. She unpacks the SPIRIT HF trial — a negative study of spironolactone in HFpEF that, she argues, does not consign the drug to the shelf — and explains why its high discontinuation rate and pandemic-era disruptions complicate the headline result. For clinicians managing cost-conscious patients, her take on spironolactone as a practical alternative to finerenone is a perspective worth hearing. The conversation turns to the CADENCE trial, a Phase 2 study of sotatercept in Group 2 pulmonary hypertension secondary to HFpEF — a phenotype Dr Kittleson treats with particular caution given the risks of misdirected pulmonary vasodilator therapy. She offers measured optimism about what these early results might mean for future treatment of HFpEF-related lung remodelling. Dr Kalra and Dr Kittleson also enter the ongoing debate around left atrial appendage closure, weighing the contrasting conclusions of the CLOSURE AF and CHAMPION AF trials against each other — and against a shared conviction that anticoagulation remains the standard of care for the vast majority of patients with atrial fibrillation. Finally, they examine the STEMI Door to Unload trial, a cautionary study in indication creep: the microaxial flow pump that proves life-saving in cardiogenic shock offered no infarct-size benefit in haemodynamically stable STEMI patients — and came with a meaningful increase in bleeding and vascular complications. Dr Kittleson also shares her stepwise outpatient algorithm for a new HFpEF diagnosis, from ruling out mimics such as cardiac amyloidosis to sequencing SGLT2 inhibitors, MRAs, GLP-1 agonists, and ARNIs based on individual patient profile. The episode closes with a discussion of her new column for NEJM Voices, where she writes on the art of medicine. Questions and comments can be sent to podcast@radcliffe-group.com and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

A fascinating and somewhat unsettling observation from JACC: Asia: nearly 1 in 4 STEMI patients in New Delhi had no traditional risk factors—no hypertension, diabetes, dyslipidemia, or smoking. Yet outcomes tell a different story. Despite fewer signs of heart failure at presentation, these patients had worse left ventricular dysfunction and identical in-hospital and 1-year mortality compared with those with standard risk factors. This "SMuRF-less paradox" challenges our conventional risk models. It reminds us that absence of risk factors is not absence of risk. We may need to think beyond the usual suspects—toward genetics, inflammation, lipoprotein(a), and healthcare access delays—to truly understand and prevent cardiovascular disease. A humbling lesson: treat aggressively, think broadly, and never be reassured by a "clean" risk profile.

How has the pharmacotherapy for STEMI changed over the past 46 years? Ginger Jiang and C. Michael Gibson discuss treating patients with zalunfiban at first medical contact.

Nyrada Inc CEO & Managing Director James Bonnar talked with Kerry Stevenson from Proactive at the ASX Small and Mid-Cap Conference about the company's upcoming Phase 2 clinical trial for its lead drug candidate, Zoltrip, and the broader growth outlook for the business. Bonnar explained that the company is preparing to initiate a Phase 2 study in Australia targeting patients who have suffered a severe heart attack known as STEMI. The trial will recruit 100 patients across seven sites, with the primary goal of assessing safety while also identifying early signs of efficacy. As Bonnar stated, “we're hoping to show in this study that the drug is, first of all, safe… but also that the drug is efficacious.” The drug is being developed as an adjunct therapy to standard treatments such as angioplasty, addressing the problem of reperfusion injury — a condition that can worsen heart damage when blood flow is restored. Nyrada is targeting a significant global market, with around 4 million angioplasty procedures performed annually. Importantly, Bonnar highlighted that there are currently no approved treatments for reperfusion injury, positioning Zoltrip as a potential first-in-class therapy. The drug targets TRP ion channels, a novel biological pathway with limited competition in clinical development. Beyond cardiac applications, Nyrada has also demonstrated promising results in traumatic brain injury and ischemic stroke, suggesting broader potential across multiple indications. Bonnar emphasised that the company expects strong news flow in the year ahead as trials progress and additional studies expand the drug's application. #proactiveinvestors #ASX #NYR #Nyrada #ASX #NYR #Biotech #ClinicalTrials #Phase2 #HeartAttack #DrugDevelopment #HealthcareInnovation #Investing #SmallCaps #BiotechStocks #MedicalResearch #Stroke #TBI

In this EMRA*Cast episode of Bridging Health and Humanity, host Natalie Hernandez speaks with Dr. Maya Yiadom, MD, MPH, MSCI, an associate professor and director of Precision Analytics and Data Integration in Emergency Medicine at Stanford, about how artificial intelligence is reshaping emergency care.  They discuss practical AI already in use (predictive analytics and ambient AI scribes), how AI can be designed from clinical workflows to improve detection and timeliness (for example, speeding recognition of STEMI), and the promise of tools that reduce documentation burden and support decision-making.  Dr. Yiadom also grapples with real risks — biased training data, subgroup performance, privacy and cloud constraints — and emphasizes protecting trainee learning while teaching residents how to use AI responsibly. She closes on an optimistic note: AI as a fail-safe that augments clinicians' judgment rather than replaces the human art of medicine.  

This week, we explore a phase 3 trial of finerenone in type 1 diabetes and chronic kidney disease and guidance on timing of nonculprit-lesion PCI after STEMI. We cover an investigational therapy for Dravet syndrome and neoadjuvant treatment for high-risk intrahepatic cholangiocarcinoma. We review the effects of radiotherapy on normal tissue, a puzzling case of progressive neurologic decline after suspected foodborne illness, and Perspectives on private equity, the AHEAD model, and medical credit cards.

This episode of VHHA's Patients Come First podcast features Dr. Ara Maranian, an interventional cardiologist at UVA Health Prince William Medical Center in Manassas. He joins us for a conversation about his work, heart health, cardiac catheterization and STEMI procedures, and more. Send questions, comments, feedback, or guest suggestions to pcfpodcast@vhha.com or contact on X (Twitter) (https://x.com/VirginiaHHA) or Instagram using the #PatientsComeFirst hashtag.

In this episode of Parallax, Dr Ankur Kalra welcomes Dr Rakesh Shah, a former interventional cardiologist, Oxford MBA graduate, and founder of DRS.LINQ. Dr Shah brings a unique perspective on addressing critical delays in heart attack diagnosis through the intersection of clinical medicine, engineering, and business strategy. The conversation explores a pressing challenge in cardiovascular care: the majority of cardiac damage occurs within the first hour of symptom onset, yet treatment activation often takes several hours. Dr Shah introduces mHeart, a mobile EKG platform designed to create a "virtual cardiology office." Unlike consumer wearables that lack critical chest leads, this technology enables patients to initiate comprehensive cardiac evaluation anywhere—at home, at work, or while traveling—transmitting diagnostic-quality data directly to cardiologists. The episode delves into Dr Shah's diverse career path and offers candid advice for physician-entrepreneurs, emphasizing the importance of collaboration with professional business leaders to achieve scalability. Looking ahead, Dr Shah discusses the integration of AI and machine learning into mobile diagnostic platforms as essential tools for an aging workforce and overstretched healthcare system. Questions and comments can be sent to "podcast@radcliffe-group.com" and may be answered by Ankur in the next episode. Host: @AnkurKalraMD and produced by: @RadcliffeCardio Parallax is Ranked in the Top 100 Health Science Podcasts (#48) by Million Podcasts.

Date: January 3, 2026  Reference: Shroyer et al. Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio). Am J Emerg Med. 2025 Nov. Guest Skeptic: Dr. Amal Mattu has been on the faculty at the University of Maryland since 1996. He has developed an academic […] The post SGEM#502: Playing with the Queen of Hearts – AI, Is It Very Smart (for ECG Interpretation)? first appeared on The Skeptics Guide to Emergency Medicine.

Fri, Feb 6 8:52 PM → 8:54 PM LGHM has a catastrophic power failure and diverts all STEMI trauma stroke or critical patients to other hospitals in the area. This specific audio clip is of NRV - the local dispatch center - toning out rescue personnel advising them of this update. Radio Systems: - New River Valley Emergency Communications

🧭 REBEL Rundown 📌 Key Points 💀 Mortality: No statistically significant difference in 28-day mortality between ketamine vs etomidate for intubation in critically ill patients, though there was a ~1% absolute difference favoring ketamine. 📉🫀⚠️ Hemodynamics: Ketamine induction was associated with more cardiovascular collapse, mainly driven by new/increased vasopressor use (dose escalation or addition of a vasoactive agent). 💉⬆️ Click here for Direct Download of the Podcast. 📝 Introduction Etomidate or ketamine? The debate over the ideal agent for emergency rapid sequence intubation (RSI) has raged for years with no clear winner. Etomidate has been touted in the past for its rapid onset and minimal intrinsic effects on hemodynamics. However, the drug is well known as a transient adrenal suppressant though the impact of this suppression isn’t clear. Ketamine has risen in recent years as an alternative, due to its perceived hemodynamic stability, analgesic properties and absence of adrenal suppression. Additionally, recent data points towards improved mortality when ketamine was selected over etomidate (Kotani 2023). High quality randomized controlled trials are needed to further elucidate which agent should be selected in critically ill patients. 🧾 Paper Casey JD et al. Ketamine or etomidate for tracheal intubation of critically ill adults. NEJM 2025. PMID: 41369227 🔙Previously Covered On REBEL REBEL EM: The EvK Trial: Ketamine vs Etomidate for Rapid Sequence IntubationREBEL EM: From Debate to Data: Emerging Insights into RSI Induction with Ketamine vs Etomidate ️ What They Did CLINICAL QUESTION In critically ill adults undergoing tracheal intubation, does the use of ketamine instead of etomidate result in improved 28 day mortality? STUDY DESIGN Multicenter, randomized, open-label trial in both emergency departments and ICUs. POPULATION Inclusion Criteria:Critically ill patients > 18 years of age undergoing tracheal intubation with the use of an induction agentExclusion Criteria:Known pregnancyPrisonersPrimary diagnosis of traumaNeed for immediate intubation precluding randomizationClinicians determined that the use of ketamine or etomidate was either necessary or contraindicated INTERVENTION & COMPARATOR Intervention (HFNC Group):Ketamine administered based on a provided nomogram: full dose (2.0 mg/kg), intermediate dose (1.5 mg/kg) or reduced dose (1.0 mg/kg)Comparator (BPAP Group):Etomidate administered based on a provided nomogram: full dose (0.3 mg/kg), intermediate dose (0.25 mg/kg) or reduced dose (0.2 mg/kg) OUTCOMES Primary: In-hospital death from any cause by day 28.Secondary:Cardiovascular collapse during intubation defined as SBP < 65 mm Hg, receipt of new or increased dose of vasopressors or cardiac arrest.Exploratory Procedural:Lowest systolic blood pressureLowest systolic blood pressure below 80 mmHgHighest systolic blood pressure above 180 mmHgLowest oxygen saturationLowest oxygen saturation below 80%Successful first attempt intubationTime from induction to intubationExploratory Clinical:Number of ventilator free daysVasopressor-free daysICU free days Safety: Systolic blood pressure at 24 hours after enrollmentOngoing receipt of vasopressors at 24 hours 📈 Results: 2365 patients were randomizedKetamine: 1176Etomidate: 1189> 99% of patients received the drug they were randomized to receiveNMBA: 69% of patients in both groups received rocuronium~ 95% of patients had video laryngoscopy for the primary intubation attempt 💥 Critical Results 💪 Strengths Multicenter ED + ICU cohort of critically ill patients → improves external validityStrong randomization → balanced baseline characteristicsRight population for the question → appropriately focused on a sick cohort where induction choice matters mostHigh protocol adherence → most patients received the agent they were randomized toExcellent follow-up → minimal loss to follow-up / outcome capture ⚠️ Limitations No blinding → potential performance/resuscitation biasTrauma excluded → limits applicability to peri-intubation trauma careCase-mix skewed toward septic shock → may reduce generalizability to other shock etiologiesPower assumptions → designed to detect a 5% mortality difference (possibly overly ambitious)Equipoise-only enrollment → excluded patients with clear indication/contraindication → selection bias + reduced real-world applicabilityComposite secondary outcome with non-equivalent endpoints (e.g., cardiac arrest vs vasopressor titration)Ketamine dosing by actual body weight (vs ideal) → may have increased dose/exposure in some patients 🗣️ Discussion The increase in cardiovascular collapse seen with ketamine was driven by the “new or increased vasopressor use” piece of the composite outcome not by the more clinically relevant severe hypotension (SBP < 65 mm Hg) or cardiac arrest.The increase in CV collapse is a secondary outcome and hypothesis generating onlyCare beyond induction agent isn’t clearly delineated and may have varied between groupsReasons why there was more CV collapse in the ketamine group:Patients in the etomidate group were more likely to be on pressors or have pressor increases prior to induction agent administrationKetamine has analgesic properties which may affect hemodynamics (etomidate does not have analgesic effects)The standard ketamine dose of 2 mg/kg is higher than the induction dose used by most (1-1.5 mg/kg)Ketamine dosing was based on actual body weight though ideal body weight dosing is more accepted. This may have resulted in unnecessarily large ketamine doses that may have had a greater effect on hemodynamics.This is a study of patients with clinical equipoisePatients who the clinician determined would clearly benefit from one agent or the other or in whom one agent or the other was contraindicated were excluded from the study.This may add a selection bias to the results.Clinicians were not blinded to the induction agent administeredThe absence of blinding can introduce bias.For instance, knowledge of the agent the patient was randomized to may result in different resuscitative treatment prior to intubation.An induction agent nomorgram was provided to allow clinicians to choose their induction dose depending on patient stability.A 5% difference in mortality may be overly ambitious. As Josh Farkas points out in his post on this article, PCI for STEMI only has a 3% absolute difference in mortality versus standard care.The 1% absolute difference in mortality while not statistically significant would be clinically significant if it was real. The study would have to be much larger to show a statistically significant 1% difference.About 2% of patients in each group received additional medications during induction (propofol, benzodiazepines, opiates). It is unclear why these agents were selected in specific cases and how they may have affected the outcomes in question. 📘 Author's Conclusion “Among critically ill adults undergoing tracheal intubation, the use of ketamine to induce anesthesia did not result in a significantly lower incidence of in-hospital death by day 28 than etomidate.“ 💬 Our Conclusion In this well done RCT, induction with ketamine did not result in a lower 28-day mortality when compared to induction with etomidate in critically ill adults. The secondary outcome of an increase in cardiovascular collapse is interesting and should be studied more in the future. 🚨 Clinical Bottom Line This data should not drive clinicians to abandon the use of ketamine in RSI. To the contrary, the study leaves open the possibility of a clinically meaningful difference in mortality favoring ketamine that may be borne out in a larger study. However, etomidate can be considered as a first-line option for RSI and may be the superior drug in patients at high-risk for cardiovascular decompensation. Post Peer Reviewed By: Post Peer Reviewed By: Mark Ramzy, DO (X: @MRamzyDO), Frank Lodeserto, MD and Anand Swaminathan, MD (X: @EMSwami) 📚 References Kotani Y et al. Etomidate as an induction agent for endotracheal intubation in critically ill patients: a meta-analysis of randomized trials J Crit Care 2023;77:154317. PMID: 37127020 👤Associate Author Anand Swaminathan MD, MPH All Things REBEL EM Meet The Team 🔎 Your Deep-Dive Starts Here The RSI Trial: Ketamine vs Etomidate in Rapid Sequence Intubation Etomidate or ketamine? The debate over the ideal agent for emergency rapid sequence ... Resuscitation Read More REBEL Cast Ep120: Etomidate vs Ketamine for RSI in the ED? Background: Standard rapid sequence intubation (RSI) in the emergency department involves administration of ... Procedures and Skills Read More The post The RSI Trial: Ketamine vs Etomidate in Rapid Sequence Intubation appeared first on REBEL EM - Emergency Medicine Blog.

Full article: Persistence of Microvascular Obstruction From Early to Late Gadolinium Enhancement Images on Cardiac MRI: Prognostic Utility After STEMI—Analysis of EARLY-MYO-CMR Registry Data What is the role of early gadolinium enhancement images after STEMI? Radhika Rajeev, MD, discusses the AJR article by Xiang et al. evaluating the prognostic impact of persistence of microvascular obstruction between early and late gadolinium enhancement on cardiac MRI.

AI-Enabled ECG Interpretation in STEMI: Findings from a Multicenter U.S. Registry

STRIVE: Low-Dose Alteplase Ineffective in STEMI Patients With Large Thrombus

Acute Coronary Syndrome refers to a spectrum of conditions including Unstable Angina, Non ST Elevation Myocardial Infarction and ST Elevation Myocardial Infarction. In this video we look at the pathology behind acute coronary syndrome, the differences between Unstable angina, NSTEMI and STEMI, as well as the signs and symptoms, diagnosis (including ECG changes!) and treatment of each. PDFs available here: https://rhesusmedicine.com/pages/cardiologyConsider subscribing (if you found any of the info useful!): https://www.youtube.com/channel/UCRks8wB6vgz0E7buP0L_5RQ?sub_confirmation=1Buy Us A Coffee!: https://www.buymeacoffee.com/rhesusmedicineTimestamps:0:00 What is Acute Coronary Syndrome - Acute Coronary Syndrome Definition0:25 Coronary Artery Anatomy1:17 Acute Coronary Syndrome Pathology - Atherosclerosis 2:08 Acute Coronary Syndrome Pathology - Unstable Angina vs Non ST Elevation Myocardial Infarction vs ST Elevation Myocardial Infarction3:00 Acute Coronary Syndrome Risk Factors3:23 Signs and Symptoms of Acute Coronary Syndrome4:17 Acute Coronary Syndrome Diagnosis - ECG STEMI5:45 Acute Coronary Syndrome Diagnosis - ECG NSTEMI and Unstable Angina6:42 Acute Coronary Syndrome Diagnosis - Cardiac Troponin I 7:11 Acute Coronary Syndrome Diagnosis - Imaging7:42 Treatment of Acute Coronary SyndromeLINK TO SOCIAL MEDIA: https://www.instagram.com/rhesusmedicine/ReferencesBritish National Formulary (BNF), 2015. Acute coronary syndromes – treatment summary. [online] Available at: https://bnf.nice.org.uk/treatment-summary/acute-coronary-syndromes.html. BNFTeachMeAnatomy, 2025. Heart vasculature. [online] Available at: https://teachmeanatomy.info/thorax/organs/heart/heart-vasculature/. TeachMeAnatomy+1DeVon, H.A., 2020. Typical and atypical symptoms of acute coronary syndrome. Journal of the American Heart Association, 9:e015539. [online] Available at: https://www.ahajournals.org/doi/10.1161/JAHA.119.015539. AHA JournalsWarren, A., 2020. Acute coronary syndrome: risk factors, diagnosis and treatment. The Pharmaceutical Journal. [online] Available at: https://pharmaceutical-journal.com/article/ld/acute-coronary-syndrome-risk-factors-diagnosis-and-treatment. The Pharmaceutical JournalLife in the Fast Lane (LITFL), 2021. Acute coronary syndromes. [online] Available at: https://litfl.com/acute-coronary-syndromes/. Life in the Fast Lane • LITFLDisclaimer: Please remember this podcast and all content from Rhesus Medicine is for educational and entertainment purposes only and is not a guide to diagnose or to treat any form of condition. The content is not to be used to guide clinical practice and is not medical advice. Please consult a healthcare professional for medical advice.

An EMS medic, an MVA, a STEMI, a stroke—and everyone's still playing “telephone” with the hospital. In this episode of EMS World Podcasts, host Mike McCabe sits down with Mitch Scott, Solutions Architect at General Devices, to tackle one of EMS's biggest headaches: communication and coordination with the emergency department and specialty teams. Scott breaks down how GD's e-Bridge platform lets crews securely send photos, EKGs, videos, and patient data straight from the field to the ED, cath lab, stroke team, transfer centers, and more—all in one HIPAA-compliant app that never stores images on personal devices. They dig into real-world pain points: long wall times, “we never got your call,” lack of accountability, rural agencies with hour-long transports, and busy EDs juggling multiple priorities. You'll hear how features like GPS tracking, acknowledgement alerts, and detailed timestamps create a defensible QA/QI trail and give everyone—from medics to cardiologists—a shared, real-time view of the patient before they hit the door. If you've ever felt unheard on the radio or wished you could “show, not tell” your next handoff, this episode is for you.  

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Listener feedback on non-culprit PCI in STEMI, a major cardiac result in patients on hemodialysis, news on GLP-1 agonists, a dubious stroke trial, and an AHA preview are the topics John Mandrola, MD, discusses in this week's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I Listener Feedback Meta-analysis of MI as a surrogate https://pubmed.ncbi.nlm.nih.gov/34694318/ Compare Acute Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1701067 DANAMI-3–PRIMULTI 10.1016/S0140-6736(15)60648-1 External Link CULPRIT-SHOCK https://www.nejm.org/doi/full/10.1056/NEJMoa1710261   II  Huge Cardiac News for Patients with ESRD PISCES article EMBARGOED Till 1130 AM EST PISCES Trial www.nejm.org/doi/full/10.1056/NEJMoa2513032 REDUCE-IT Trial https://www.nejm.org/doi/full/10.1056/NEJMoa1812792 STRENGTH Trial https://jamanetwork.com/journals/jama/fullarticle/2773120 FISH trial https://jamanetwork.com/journals/jama/fullarticle/1150094 III Obesity Agents White House announces deal with Lilly and Novo on GLP-1 drugs https://www.reuters.com/business/healthcare-pharmaceuticals/novo-lilly-shares-rise-trump-obesity-drug-deal-nears-2025-11-06/ Amylin Agonists Amylin Analog Eloralintide Reduces Weight in Phase 2 Trial https://www.medscape.com/viewarticle/amylin-analog-eloralintide-reduces-weight-phase-2-trial-2025a1000uqf Eloralintide Phase 2 Study https://doi.org/10.1016/S0140-6736(25)02155-5 GLP-1 Comparisons SURMOUNT-5 Trial https://www.nejm.org/doi/10.1056/NEJMoa2416394 Tirzepatide vs Semaglutide in 10-year CVD Risk Reduction https://doi.org/10.1093/ehjopen/oeaf117 IV A Problematic Trial in Stroke Care LAMP trial https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2840370 V AHA Preview AHA 2025: Mandrola's Four Trials to Look For https://www.medscape.com/viewarticle/aha-2025-mandrolas-four-trials-look-2025a1000u80 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net

OPTION-STEMI: Timing of Complete Revascularization During Index Hospitalization in Patients with STEMI and Multivessel Disease

Abdullah Al-Abcha, MD, social media editor of JACC: Cardiovascular Interventions, and Robert Herman, MD, PhD discuss AI-Enabled ECG Analysis Improves Diagnostic Accuracy and Reduces False STEMI Activations: A Multicenter U.S. Registry, presented as a Late Breaking Clinical Trial at TCT 2025.

Review the chain of survival for cardiac and stroke emergencies and describe why strong EMS relations and specialized teams have better patient outcomes.The chain of survival for ACLS is the same as was learned in your BLS class.The beginning steps of the Cardiac Emergency and Stroke chain of survival.ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.Characteristics of areas that have significantly better stroke and out-of-hospital cardiac arrest outcomes.**American Cancer Society (ACS) Fundraiser This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.I hope you'll consider contributing.Every donation makes a difference in the fight against breast cancer! Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylorTHANK YOU for your support! Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

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Prehospital EMS capabilities and why paramedic-staffed ALS ambulances make a difference in the early identification & treatment of STEMI and stroke.The chain of survival for a cardiac emergency and stroke.ALS ambulances are staffed with paramedics who have training in ACLS skills.Why EMS Destination Protocols for suspected stroke and STEMI make a difference.ACLS's timed benchmarks for:point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center.Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.**American Cancer Society (ACS) Fundraiser This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.I hope you'll consider contributing.Every donation makes a difference in the fight against breast cancer! Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylorTHANK YOU for your support! Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

Chief nursing officer Rhonda Collins discusses her article "Nurse-initiated protocols for sepsis: a strategic imperative for patient care and hospital operations." Rhonda explains why sepsis, the leading cause of death in U.S. hospitals and a $62 billion annual burden, demands the same urgency as stroke and STEMI. She highlights the power of nurse-initiated standing orders to speed recognition and treatment, reduce ED congestion, improve outcomes and cut costs. Drawing on real-world results from Franciscan Missionaries of Our Lady Health System, she shows how standardized sepsis protocols supported by FDA-cleared technology reduced mortality by 39 percent, shortened length of stay and saved thousands per patient. Rhonda emphasizes that national standardization, objective tools and empowering nurses to practice at the top of their license are essential to making sepsis the "third S" in emergency care. Our presenting sponsor is Microsoft Dragon Copilot. Microsoft Dragon Copilot, your AI assistant for clinical workflow, is transforming how clinicians work. Now you can streamline and customize documentation, surface information right at the point of care, and automate tasks with just a click. Part of Microsoft Cloud for Healthcare, Dragon Copilot offers an extensible AI workspace and a single, integrated platform to help unlock new levels of efficiency. Plus, it's backed by a proven track record and decades of clinical expertise, and it's built on a foundation of trust. It's time to ease your administrative burdens and stay focused on what matters most with Dragon Copilot, your AI assistant for clinical workflow. VISIT SPONSOR → https://aka.ms/kevinmd SUBSCRIBE TO THE PODCAST → https://www.kevinmd.com/podcast RECOMMENDED BY KEVINMD → https://www.kevinmd.com/recommended

Happy September! This month for the September 2025 episode of the RCEM Learning Podcast Andy and Dave are talking about AI interpretation of ECG findings and managing acute asthma exacerbations. We are then going back to Becky and Chris rounding off the second part of their guideline on atrial fibrillation. We'll then end with New Online. If you'd like to email us, please feel free to do so here. After listening, complete a short quiz to have your time accredited for CPD at the RCEMLearning website! (02:13) New in EM - AI vs doctor in cath lab activations Accuracy of cath lab activation decisions for STEMI-equivalent and mimic ECGs: Physicians vs. AI (Queen of Hearts by PMcardio) (Shroyer et al., 2025) (18:00) Guidelines for EM - ESC Atrial Fibrillation (Part Two) ESC - 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) (ESC, 2024) (39:03) New in EM - Management of acute asthma exacerbations As-Needed Albuterol–Budesonide in Mild Asthma (LaForce et al., 2025) Combination fixed‐dose beta agonist and steroid inhaler as required for adults or children with mild asthma (Cochrane Library, 2021) (54:00) New Online – new articles on RCEMLearning for your CPD Understanding Medical Cannabis: Mechanisms, Indications and Clinical Integration - David Tang Safe Sedation Procedures in Adults - Duncan Russell and Shobhan B Thakore Unusual Agitation in Final Year Student - Cathy Wield and Mark Horowitz

King and I | S6 E3 | Should EKG be the Discriminator for STEMI

The JournalFeed podcast for the week of Sept 1-5, 2025.These are summaries from just 2 of the 5 articles we cover every week! For access to more, please visit JournalFeed.org for details about becoming a member.Tuesday Spoon Feed:The Queen of Hearts AI (QoH AI) model beat both emergency physicians (EPs) and cardiologists at deciding who needs immediate catheterization for certain STEMI-equivalents and STEMI-mimics—88.9% accuracy vs. ~66%—promising fewer missed occlusion myocardial infarctions (OMIs) and fewer unnecessary activations.Wednesday Spoon Feed:Reliance on STEMI criteria alone misses a substantial proportion of LAD occlusions, while expert and AI ECG interpretation achieved earlier and more accurate detection, with 100% sensitivity for LAD occlusion MI in this study.

We talk about stat vs routine EKG orders as well as metrics that they are always working to hit on timeWhen EKG's are not done on time the source of the problem needs to be found, sometimes it is the providers' fault for not realizing the EKG order had not been placed We talk about how we should communicate between provider and EKG tech and how much info we like to get as providersI talk about how providers need to become good at task switching frequently and this includes signing EKG'sWe talk about the responsibility of the PA or NP to sign EKG's (calling STEMI's or deciding not a STEMI) and how this responsibility is currently in the hands of the physicians onlySean talks about how important EKG's can still fall through the cracks at times and people will still point the blame all the way back to the EKG techIt's important to make sure you do your job well and then realize some things are out of your handsCheyenne talks about an experience she had with an end-of-life patient she cared forEven being just peripherally involved in a patient's care can really affect you emotionallyAvoiding burnout:Cheyenne likes to go to the gym or hang out at home with her dogsSean talks about how he avoids burnout doing a job that can sometimes be repetitiveSean also talks about the importance of calmness in front of patients, even when an EKG might be alarmingDon't sweat the small things, especially in the ED, everyone is under a lot of stress, and you can't allow a small comment from a stressed-out coworker to get under your skin and make you spiral Sean talks about some methods to reassure patients despite not being able to diagnose their EKG We talk about the importance of stress management in the ED so that you can think clearly about the next patientIt is not your emergency, we must be the calm in the stormSupport the showFull show notes can be found here: Episodes - Practical EMS - Content for EMTs, PAs, ParamedicsMost efficient online EKG course here: Practical EKG Interpretation - Practical EMS earn 4 CME and learn the fundamentals through advanced EKG interpretation in under 4 hours. If you want to work on your nutrition, increase your energy, improve your physical and mental health, I highly recommend 1st Phorm. Check them out here so they know I sent you. 1st Phorm | The Foundation of High Performance Nutrition Everything you hear today from myself and my guests is opinion only and doesn't represent any organizations or companies that any of us are affiliated with. The stories you hear have been modified to protect patient privacy and any resemblance to real individuals is coincidental. This is for educational and entertainment purposes only and should not be taken as medical advice nor used to diagnose any medical or healthcare conditions.

The chain of survival for ACLS is the same as was learned in your BLS class.The beginning steps of the Cardiac Emergency and Stroke chain of survival.ACLS's timed goals for first medical contact to PCI for STEMI and door-to-needle for ischemic stroke.Characteristics of areas that have significantly better stroke and out-of-hospital cardiac arrest outcomes.**American Cancer Society (ACS) Fundraiser This is the seventh year that I'm participating in Men Wear Pink to increase breast cancer awareness and raise money for the American Cancer Society's life-saving mission.I hope you'll consider contributing.Every donation makes a difference in the fight against breast cancer! Paul Taylor's ACS Fundraiser Page: http://main.acsevents.org/goto/paultaylorTHANK YOU for your support! Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Free Prescription Discount Card - Get your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vip/savePass ACLS Web Site - Other ACLS-related resources: https://passacls.com@Pass-ACLS-Podcast on LinkedIn

One unstable patient, three departments, and every nurse on alert... Let's break down what really happens during a high-risk STEMI. This episode follows the case of a 62-year old patient from ER to the Cath Lab to the ICU. Nurses Sarah Vance and Caitlyn Nichols help us explore the role of nurses in each stage of care, from stabilizing the patient to placing an Impella device.We cover everything from IV placement and medications to monitoring patients through each phase of care. Learn how to prepare patients for the Cath Lab, manage complications like V-fib and bleeding post-PCI, and support the next team during handoffs. This is a must-listen for nurses involved in cardiac care!Topics discussed in this episode:Case presentation of a 62-year old patientER nurse priorities for STEMI patientsInitial treatment and stabilizationWhy “M.O.N.A.” is an outdated practicePreparing the patient for the Cath Lab teamCath Lab nurse responsibilities and role during PCIHigh-risk PCI vs. standard PCIManaging common complicationsTransitioning from Cath Lab to ICUICU nurse priorities for post-PCI patientsImpella placement and monitoringManaging reperfusion arrhythmiasLong-term care and getting patients off the ImpellaPatient and family educationConnect with Sarah Vance:https://www.instagram.com/iseeu_nurse/Connect with Caitlyn Nichols:https://www.instagram.com/icunursingnotesbycaitlyn/Mentioned in this episode:CONNECT

The chain of survival for a cardiac emergency and stroke start the same:1. preparedness & recognition of an emergency;2. activation of EMS;3. delivery of Advanced Life Support; and4. transporting to the most appropriate facility.ALS ambulances are staffed with paramedics who have training in ACLS skills.Why EMS "Destination Protocols" for suspected stroke and STEMI make a difference.ACLS's timed benchmarks for:point of first medical contact to PCI for ST elevation MI;door to tPA for ischemic stroke; andonset of symptoms to EVT for LVO strokes.Why EMS should bypass a close hospital to transport a STEMI or suspected stroke patient to a hospital capable of 24/7 PCI or a certified stroke center.Good luck with your ACLS class!Links: Buy Me a Coffee at https://buymeacoffee.com/paultaylor Practice ECG rhythms at Dialed Medics - https://dialedmedics.com/Free Prescription Discount Card - Download your free drug discount card to save money on prescription medications for you and your pets: https://safemeds.vipPass ACLS Web Site - Episode archives & other ACLS-related podcasts: https://passacls.com@Pass-ACLS-Podcast on LinkedIn Check out the Pod Resource page at passacls.com for links to the "EMS On Air" podcast for links to episodes that look at EMS's role in stroke outcomes in the rural vs urban area.

In this JACC Deep Dive, Harlan M. Krumholz, MD, SM, FACC reviews a study by Covani, et al that uses OCT imaging in over 1,500 ACS patients to show how increasing cardiovascular risk factor burden—like smoking, diabetes, and hypertension—is strongly associated with vulnerable plaque features such as thin caps, inflammation, and rupture. The findings were most pronounced in STEMI patients and reinforce the biological impact of cumulative risk. Reviewers found the core results intuitive but pushed for deeper mechanistic insights, leading to a stronger final paper with improved clarity, additional analyses, and a more nuanced understanding of how traditional risk factors shape plaque instability.

Hosts Mitsuaki Sawano, MD, Kentaro Ejiri, MD, and Nobuhiro Ikemura, MD, welcome Yuki Obayashi, MD, of Leiden University Medical Center, to discuss findings from the STOPDAPT-3 trial. Dr. Obayashi highlights that, among ACS patients—including those with HBR or STEMI—aspirin and clopidogrel monotherapy after 1 month of DAPT resulted in similar rates of ischemic and bleeding events. These results support flexible, patient-centered antiplatelet strategies beyond the acute phase.

In this webinar, the CardioNerds collaborated with the Cardiogenic Shock Working Group (CSWG) to discuss LV unloading and the updated AMI guidelines, which upgraded transvalvular flow pumps to a Class 2A recommendation in AMI shock. Dr. Rachel Goodman and Dr. Gurleen Kaur from CardioNerds were joined by Dr. Navin Kapur (Tufts Medical Center), Dr. Shashank Sinha (INOVA Fairfax Hospital), and Dr. Rachna Kataria (Brown University) from the CSWG. Together, they explore a case of an older woman who presented with inferior STEMI and was found to have complete occlusion of an anomalous single coronary artery originating from the right coronary cusp and supplying the entire left ventricle. She was treated with DES to the anomalous RCA. Her course was complicated by AMI shock with re-occlusion of the DES, which was treated with thrombectomy and balloon angioplasty. An IABP was placed. After transfer to a tertiary care center, a pulmonary artery catheter revealed a CI of 0.96. With worsening shock, rising lactate, and end organ dysfunction, the team proceeded with VA-ECMO and Impella CP for LV unloading. Her lactate subsequently normalized. Produced by CardioNerds in collaboration with the Cardiogenic Shock Working Group. CardioNerds Cardiac Critical Care PageCardioNerds Episode PageCardioNerds AcademyCardionerds Healy Honor Roll CardioNerds Journal ClubSubscribe to The Heartbeat Newsletter!Check out CardioNerds SWAG!Become a CardioNerds Patron!

Chest pain? Check. Sus ECG? Check. STEMI? Not check. A very tired Chris and a nerded out Spencer (12-leads... go figure) give MAXIMUM effort in today's call with a curious conclusion.

Blanking period after AF ablation, periprocedural MI after PCI in non-STEMI, predicting AF after ischemic stroke, and the proper standards for mitral valve repair in primary mitral regurgitation are the topics John Mandrola, MD, discusses in today's podcast. This podcast is intended for healthcare professionals only. To read a partial transcript or to comment, visit: https://www.medscape.com/twic I AF blanking period CIRCA DOSE Research letter https://www.ahajournals.org/doi/10.1161/CIRCEP.124.013232 Circa-Dose https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.119.042622 COMPARE CRYO  https://doi.org/10.1016/j.jacep.2024.03.021 Mohanty et al  10.1016/j.hrthm.2024.08.011 Ruzieh, Foy, Mandrola Patients' Lives Don't Pause for Blanking Periods https://doi.org/10.1016/j.ahjo.2024.100497 II Periprocedural MI and Future events Circulation paper https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.124.070729 III AI to detect AF related stroke eClinical Medicine Paper  https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00050-1/fulltext IV Mitral Valve Repair JACC paper -- https://doi.org/10.1016/j.jacc.2024.10.108 You may also like: The Bob Harrington Show with the Stephen and Suzanne Weiss Dean of Weill Cornell Medicine, Robert A. Harrington, MD. https://www.medscape.com/author/bob-harrington Questions or feedback, please contact news@medscape.net