Mark Ramzy @MRamzyDO
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Critical Care and Emergency Medicine Doc, Paramedic, REBEL EM and EPMonthly Author, emDOCs Editor, interested in all things FOAMed! Passionate about baking cheesecakes, changing how we educate and presentation design. Follow me on Twitter: https://twitter.com/MRamzyDO
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GRACE-1 Guidelines for Adult Patients with Recurrent Low-Risk Chest Pain

1) Pain > 3 hours - A
GRACE-1 Guidelines for Adult Patients with Recurrent Low-Risk Chest Pain 1) Pain > 3 hours - A single, high sensitivity troponin to reasonably exclude ACS within 30 days 2) Normal stress test within the past 12 months - Repeat stress testing to decrease 30-day MACE NOT recommended 3) For all adult patients with recurrent, low-risk chest pain - Hospitalization (neither inpatient or observation stay) NOT recommended 4) With non-obstructive (<50%) CAD on prior angiography in past 5 years - Referral for expedited outpatient testing rather than inpatient admission 5) With no occlusive CAD (0% stenosis) on prior angiography in the past 5 years - Referral for expedited outpatient testing rather than inpatient admission 6) With no coronary stenosis on CCTA within past 2 years - No further diagnostic testing other than a single high-sensitivity troponin to exclude ACS within those 2 years 7) For all adult patients with recurrent, low-risk chest pain - Depression and anxiety screening tools are recommended to evaluate healthcare use and return 8) For all adult patients with recurrent, low-risk chest pain - Referral for anxiety and depression management are recommended #ChestPain #LowRisk #GRACE #Guidelines #cardiology #management
MIRACLE2 Risk Score for Neuro-prognostication in Post Cardiac Arrest Patients
Missed (Unwitnessed Arrest) 1
Initial Rhythm (Non-Shockable) 1
Reactivity
MIRACLE2 Risk Score for Neuro-prognostication in Post Cardiac Arrest Patients Missed (Unwitnessed Arrest) 1 Initial Rhythm (Non-Shockable) 1 Reactivity of Pupils (none at ROSC) 1 Age 0-60 years old - 0 60 - 80 years old - 1 > 80 years old - 3 Changing Rhythm (Any 2 VF/PEA/Asystole) - 1 Low pH (< 7.20) - 1 Epinephrine Given - 2 Risk (Total Points 10): 0-2 = Low Risk 3-4 = Medium Risk >5 = High Risk #MIRACLE2 #Risk #Score #Neuroprognostication #CardiacArrest #stratification #neurology #diagnosis
Tranexamic Acid - Indications and Pharmacology
Pharmacokinetics:
 • MOA: Inhibits plasminogen activation to plasmin & inhibits fibrinolysis
Tranexamic Acid - Indications and Pharmacology Pharmacokinetics: • MOA: Inhibits plasminogen activation to plasmin & inhibits fibrinolysis (reduces complement activation → decreasing swelling in w/ hereditary angioedema) • Metabolism: Unknown, small amount of hepatic metabolism • Time to Onset: 5 - 15 minutes • Duration of Action: ~ 2-3 hours • Method of Excretion: Urine Common Uses: Trauma, Epistaxis, Post-partum, ICH/TBI, Hemoptysis, GI Bleeding Side Effects: Hypotension with rapid injection; Nausea, vomiting, diarrhea & abdominal pain; Dizziness, headache & fatigue; Increases risk of seizures; Hypersensitivity & anaphylaxis; Potentially increases venous & arterial thrombotic events; Impaired color vision & visual disturbances #TXA #Tranexamic #Acid #Indications #Pharmacology #hematology
Tachycardia - Differential Diagnosis Framework
Narrow-Complex:
 • Regular: Sinus Tachycardia, Junctional Tachycardia, Atrial Tachycardia, Atrial Flutter, AVRT
Tachycardia - Differential Diagnosis Framework Narrow-Complex: • Regular: Sinus Tachycardia, Junctional Tachycardia, Atrial Tachycardia, Atrial Flutter, AVRT (ie. WPW), AVnRT (ie SVT) • Irregular: Atrial Fibrillation, Multifocal Atrial Tachycardia (MAT), Atrial Flutter (w/ variable block) Regular-Complex: • Ventricular Tachycardia, Antidromic AVRT, SVT w/aberrancy • Irregular: Polymorphic VT (ie Torsades, VF), Any irregular SVT w/ aberrancy - Mark Ramzy, DO, EMT-P @MRamzyDO #Tachycardia #Differential #Diagnosis #cardiology #wide #narrow #irregular #regular
Radiographical Findings in Spontaneous Pneumothorax - #FOAMed #radiology #pulmonary #cxr #clinical #Pneumothorax #CriticalCare #EmergencyDepartment
Radiographical Findings in Spontaneous Pneumothorax - #FOAMed #radiology #pulmonary #cxr #clinical #Pneumothorax #CriticalCare #EmergencyDepartment
Slit Lamp Made Simple 

#Ophtho #Eye #Ophthalmology #SlitLamp #Slit #Lamp #instructions #manual
Slit Lamp Made Simple #Ophtho #Eye #Ophthalmology #SlitLamp #Slit #Lamp #instructions #manual
Therapy Options in Acute Respiratory Distress Syndrome - Proning  #CriticalCare #ARDS #Pulmnology #clinical #ICU #Lung
Therapy Options in Acute Respiratory Distress Syndrome - Proning #CriticalCare #ARDS #Pulmnology #clinical #ICU #Lung #FOAMed
Therapy Options in Acute Respiratory Distress Syndrome - Paralytic  #CriticalCare #ARDS #Pulmnology #clinical #ICU #Lung
Therapy Options in Acute Respiratory Distress Syndrome - Paralytic #CriticalCare #ARDS #Pulmnology #clinical #ICU #Lung #FOAMed
Therapy Options in Acute Respiratory Distress Syndrome - Lung Protection  #CriticalCare #ARDS #Pulmnology #clinical #ICU
Therapy Options in Acute Respiratory Distress Syndrome - Lung Protection #CriticalCare #ARDS #Pulmnology #clinical #ICU #Lung #FOAMed
Therapy Options in Acute Respiratory Distress Syndrome #CriticalCare #ARDS #Pulmnology #clinical #ICU
Therapy Options in Acute Respiratory Distress Syndrome #CriticalCare #ARDS #Pulmnology #clinical #ICU