Another round of guidelines are now on the table. For practitioners across Canada this may lead to a possible change in practice. Fortunately it seems, that the changes will not be drastic.

Some interesting things to note:

• In the absence of contraindications, it may be reasonable to administer morphine sulfate intravenously to patients with NSTE-ACS if there is continued ischemic chest pain despite treatment with maximally tolerated anti-ischemic medications (Class IIb LOE B)
• Measure serial cardiac troponin I or T at presentation and 3-6 hours after symptom onset in all patients with ACS symptoms. Additional troponin levels should be obtained beyond 6 hours in patients with normal troponin levels on serial examination when ECG changes clinical presentation confer an intermediate or high suspicion for ACS. (Class I LOE A)
• If the time of symptom onset is ambiguous, the time of presentation should be considered the time of onset for assessing troponin values (Class I LOE A).
  • Further reinforcing the need for a good history while on scene.
• With contemporary troponin assays, CK-MB and myoglobin are not useful for diagnosis of ACS. (Class III LOE A)
• A 12-lead ECG should be performed and interpreted within 10 minutes of the patient’s arrival at an emergency facility to assess for cardiac ischemia or injury
  • This protocol used to indicate an experienced physician to interpret the ECG. However that has been removed. This further reinforces the need for all practitioners to know their ECG’s!

Reference: Amsterdam A, et al. 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes Circulation, epub September 23, 2014.

You get a call to a home for a 25 yr old female, syncopol episode. upon arrival, youre greeted by her boyfriend, he tells you that they had a disagreement, and had one of her so called panic attacks again, because she said she felt her heart jumping around in her chest.. she decided to go on the treadmill, and callapsed shortly after. Pt is on the couch, and says she feels ok now. you decide to do a 12 lead, and this is what you find.. what do ya think it is.. no hx no meds..not dx with anxiety, bf just says she has it

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This is a challenging one! Take your time and try to determine as much about it as you can.

I am going to try to get some regular ECG’s back up for you guys but bare with me! The format has changed. Now rather than waiting for the following weeks ECG to show up for the answer, it will just be in the post. You will have to click “continue reading” though just to force you to spend some time thinking about it before you decide on what it is.

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