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Almost all seizures in the ICU setting are nonconvulsive andnot detectable unless EEG monitoring is employed. The Platelet Receptor Inhibition in Ischemic SyndromeManagement (PRISM) trial suggested that tirofiban was superiorto heparin for the conservative management of patients withACS.177 Subsequent investigation, however, contradicted thisclaim.The PRISM-PLUS (Patients Limited by Unstable Signs andSymptoms) study randomized 1,915 patients with non-STEMIto tirofiban alone, heparin alone, or tirofiban with heparin.Coronary angiography was performed in the vast majority ofthese patients (90%) but percutaneous coronary interventionwas performed in a minority (30.5%)

The Platelet Receptor Inhibition in Ischemic SyndromeManagement (PRISM) trial suggested that tirofiban was superiorto heparin for the conservative management of patients withACS.177 Subsequent investigation, however, contradicted thisclaim.The PRISM-PLUS (Patients Limited by Unstable Signs andSymptoms) study randomized 1,915 patients with non-STEMIto tirofiban alone, heparin alone, or tirofiban with heparin.Coronary angiography was performed in the vast majority ofthese patients (90%) but percutaneous coronary interventionwas performed in a minority (30.5%). Aprimary peristaltic contraction travels down the esophagus at a rate of 2–4cm/second andreaches the LES in about 9 seconds after the initiation of the swallow. The electrodes either areintegrated in an electrode band or are individu-ally attached on the thorax wall

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