Monday, April 30, 2018

Stress Tests, PoCUS & ECG

R.E.B.E.L.EM - April 30, 2018 - Expert Peer Review Stephen W. Smith,
"I was working a busy shift in the ED, like many of us do, and the next patient I was going to see was a 57 year old male with no real medical problems complaining of chest pain. I remember thinking as I walked into the room this guy looks ashen and diaphoretic….he doesn’t look well. He is a paramedic telling me how he has been having off and on chest pain for the past several months. He just had a stress test two months ago that was “negative”. Today he was working on his pool and developed the same chest discomfort as he had been having off and on the past several months, but today, the pain would just not go away. In his mind, he thought this might be an ulcer and just needed some Pepcid to help. He got put on the monitor and an ECG was run…
Clinical Bottom Line & Things I Learned from the Case:
  1. A prior “negative” stress test, even if recently done, should not be used to determine the disposition of your patients. If you think they are having ACS, then disposition them appropriately regardless of the prior “negative” stress test.
  2. In patients having chest pain, use POCUS liberally, as this will save patients’ lives
  3. If you are having difficulty differentiating between benign early repolarization vs “subtle” anterior STEMI don’t forget about the Steve Smith equation to help differentiate between the two in the correct clinical setting"