I'm Anton Hellman.

I'm Justin Morganstern.

And I'm Rory Spiegel.

And this is the journal jam podcast.

Where I work when a six-year-old guy rolls in with crushing chest pain and diapheresis and I get handed to the EMS ECG showing an obvious anterior stemmy.

It's kind of a no-brainer.

Call the code stemmy and tick off a bunch of boxes so that the nurses can go ahead and give a bunch of meds before the patient's whisked off to the cath lab.

Now on that tick box list is ASA with a number needed to treat of 42 to prevent death.

Pretty good.

There's ticagrelor, and the figure quoted on that one for a number needed to treat is 72.

Not too bad, if you believe the data.

And then next on the list is heparin.

Now, I've been taking that box for just about every patient with a stem E.

But now that I've reviewed the literature, I'm not so sure that I should always be ticking that box,

especially in the patient with more than a zero has-blood score.

Now, I'm not going to give you a number needed to treat for heparin and stemmy,

because that data isn't nearly as definitive as it is with ASA, and any benefit in stemmy

patient, as you'll see in this deep dive journal jam, is, well, small. Now, what about non-stemmy

or unstable angina patients? Does heparin, low molecular weight heparin or unfractionated

heparin, benefit the patient with, say, a pretty good story for angina with a little bump in

their troponin and some ST depression in the lateral leads? I mean, I think we're expected to routinely

give heparin for pretty much all these n-stemmy

...