Dr. Smith's ECG Blog

MAY 30, 2023

We recorded an ECG in which V1-V3 were put in the position of V4R-V6R, and V4-6 were placed in V7-9 to (academically) confirm posterior OMI. 1 mg of Atropine was given and the heart rate increased transiently to 60. Atropine usually works in junctional rhythm with a narrow complex 9. What to do? RVMI explains part of the shock.

E-9-1-1 82

E-9-1-1 STEMI Coronary OR 82

REBEL EM

SEPTEMBER 26, 2022

2020;71(1):235-246. What They Did Single-center randomized controlled study design performed by the Department of Hepatology & Liver transplantation in New Delhi Study participants, investigator clinicians, data collectors, and data analysts were blinded Investigators recruited participants from February 27, 2016 – March 3, 2018.

FFP 52

FFP E-9-1-1 ICU ALS 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

He was taken emergently to the cardiac catheterization lab and found to have multi-vessel coronary artery disease with a near-occlusive culprit lesion in the RCA, possibly reperfused. Slow TIMI 2 initially with brisk flow status post percutaneous coronary intervention with 18mm drug-eluting stent.

E-9-1-1 52

E-9-1-1 Coronary STEMI Emergency Department 52

Dr. Smith's ECG Blog

FEBRUARY 28, 2020

4 important features that indicate acute right hear strain: 1. In this study, (quote) "negative T waves in leads III and V 1 were observed in only 1% of patients with ACS compared with 88% of patients with APE (p less than 0.001). They found that only 11% of PE had 1 mm T-wave inversions in both lead III and lead V1, vs. 4.6%

E-9-1-1 52

E-9-1-1 ACS ALS OR 52

Dr. Smith's ECG Blog

AUGUST 9, 2018

The coronaries were clean (this is not the gold standard, however, as some patients with ischemic ST elevation may have clean coronaries). ACTUAL CORONARY ANATOMY: Dominance: Right LM: A 5 mm vessel which bifurcates into the LAD and LCx coronary artery. QRSV2 = 16 RAV4 = 14 Value = 20.24 (The cutoff of 18.2

E-9-1-1 52

E-9-1-1 STEMI Coronary Ambulance 52

Dr. Smith's ECG Blog

OCTOBER 24, 2018

A 40-something male presented with dyspnea and left arm numbness, and perhaps some chest tightness, for 1 1/2 hours. My Comment , by K EN G RAUER, MD ( 10/24/2018 ): = Important teaching points are made in this post by Dr. JACC 2016;67:1531. Here is his triage ECG: There is massive STE in V3-V6, and also STE in II, III, aVF.

E-9-1-1 52

E-9-1-1 STEMI ACS Coronary 52

AAEM RSA

AUGUST 27, 2020

1 The primary goal of cardiopulmonary resuscitation (CPR) is to optimize coronary perfusion pressure and maintain systemic perfusion in order to prevent neurologic and other end-organ damage while working to achieve ROSC. Kirkegaard H, Soreide E, de Haas, I et al. De Fazio C, Skrifvars MB, Soreide E et al. 2019;23(1):1–9.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

Dr. Smith's ECG Blog

SEPTEMBER 7, 2020

The Differential Diagnosis is: SVT with aberrancy(#) [AVNRT vs. WPW (also called AVRT*)] Atrial flutter with 1:1 conduction, with aberrancy VT coming from the anterior fascicle ( fascicular VT )@ *AVRT = AV Reciprocating Tachycardia (Tachycardic loop that uses both the AV node and an accessory pathway. See Learning point 1 below.

E-9-1-1 52

E-9-1-1 ALS OR Coronary 52

EMDocs

JANUARY 20, 2024

She describes the pain as left-sided, non-radiating, and 9/10 in severity. The catheterization lab is activated, but catheterization shows no coronary artery occlusion. A 67-year-old female with past medical history of hypertension presents with acute onset of chest pain without associated symptoms. What is the diagnosis?

E-9-1-1 74

E-9-1-1 EMS Coronary ACS 74

EMDocs

JANUARY 6, 2024

1 Indications for transplant include: Non-ischemic cardiomyopathy (49%) Ischemic cardiomyopathy (35%) Restrictive cardiomyopathy (4%) Retransplantation following failed prior transplant (3%) Hypertrophic cardiomyopathy (3%) Congenital heart disease (3%) Valvular cardiomyopathy (3%) The median survival after heart transplant is over 12 years.

EMS 63

EMS E-9-1-1 ACS Coronary 63

EMDocs

NOVEMBER 4, 2024

1 The ED is a fast-paced environment where patient stability and life-and-limb-threatening conditions are prioritized. The pain began abruptly 1 hour ago, described as a stabbing sensation, and has occurred daily at the same time for the past week, each episode lasting about 45 minutes. Pain can be improved or exacerbated with meals.

ED 98

ED E-9-1-1 Emergency Department ALS 98

EMDocs

NOVEMBER 13, 2023

1 One study found that CTA head and neck was ordered for 2.5% 8 The VAN (vision, aphasia, neglect) score ( Figure 1 ), first proposed by Teleb et al. 9 A later assessment of the VAN score in Beume et al. 8 The VAN (vision, aphasia, neglect) score ( Figure 1 ), first proposed by Teleb et al.

E-9-1-1 86

E-9-1-1 ALS Emergency Department ED 86