Dr. Smith’s ECG Blog has an excellent discussion on the clinical significance of augmented vector right (aVR) elevation:⁶

“Ischemic ST elevation in aVR occurs in two broad categories: 1) in patients with recognized STEMI (due to coronary occlusion, usually of the LAD) and is associated with higher mortality than in patients without STE in aVR and 2) in patients without ischemic ST elevation, in which case there is always diffuse ST depression of subendocardial ischemia (which can be due to supply-demand mismatch or due to ACS). If due to ACS, this STE in aVR is associated not only with acute LM insufficiency, but alternatively with 3 vessel disease, or with LAD insufficiency.”

EM Docs continue to use crowdsourcing to improve patient care in real time as well as to prevent burnout by supporting one another with camaraderie. Emergency physicians can’t always share their challenges with their non-physician family members. EM Docs allows for true understanding of the bedside challenges that are unique to our profession.

Dr. Moody, founder of the EM Docs Facebook group, is president of the Tennessee College of Emergency Physicians and former emergency department chair for Mountain States Health Alliance.

References

1. Mohammadkarimi N, Jafari M, Mellat A, et al. Evaluation of efficacy of intra-nasal lidocaine for headache relief in patients refer to emergency department. J Res Med Sci. 2014;19(4):331-335.
2. Maizels M, Scott B, Cohen W, et al. Intranasal lidocaine for treatment of migraine: a randomized, double-blind, controlled trial. JAMA. 1996;276(4):319-321.
3. Fu J, Watts M, Coralic Z. Trick of the trade: paraphimosis–pour some sugar on me. Academic Life in Emergency Medicine website. Accessed Oct. 24, 2016.
4. Brooks NA, Brown JA. Paraphimosis treatment & management. Medscape website. Accessed Oct. 24, 2016.
5. Hickey JL, Witsil JC, Mycyk MB. Haloperidol for treatment of cannabinoid hyperemesis syndrome. Am J Emerg Med. 2013;31(6):1003.e5-6.
6. Smith SW. ST Elevation in lead aVR, with diffuse ST depression, does not represent left main occlusion. Dr. Smith’s ECG Blog website. Accessed Oct. 24, 2016.