Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. If this is ACS with Aslanger's pattern , the ST depression vector of subendocardial ischemia (due to simultaneous 3 vessel or left main ACS) is directed toward lead II (inferior and lateral). It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation.

ACS 52

ACS CPR CAD Heart Attack 52

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. PMID: 23102885 Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. Clin Exp Emerg Med 2023. JACC Cardiovasc Interv 2018.

ALS 137

ALS ACS OR CPR 137

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He underwent CPR and then was shocked out of VF. ST depression maximal in V1-V4, in the context of ACS symptoms and unexplained by QRS abnormality or tachydysrhythmia, should be considered posterior OMI until proven otherwise. Today's patient is high-risk ( ie, in a high "prevalence" group for having an acute coronary event ).

Coronary 52

Coronary Heart Attack ED CPR 52

Dr. Smith's ECG Blog

OCTOBER 24, 2013

He underwent immediate CPR, was found to be in ventricular fibrillation, and was successfully resuscitated. He underwent coronary stenting (uncertain which artery). See explanation below. The patient went home and, in front of his wife, he collapsed. I do not have the post-resuscitation ECG. Did the ECG offer unseen hints?

CPR 52

CPR ACS Coronary OR 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts. Coronary spasm causing massive current of injury with shark fin ECG. I would not expect ST-E to vanish in four beats with dissolving thrombus (also we know that the coronaries were clean). I suspect LAD or LM.

Coronary 52

Coronary Defibrillator ACS CAD 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was It is highly associated with proximal LAD occlusion or severe left main ACS and with bad outcomes. Here is a parasternal long axis without speckle tracking: There is very good function, but the lateral wall is not in this view.

STEMI 52

STEMI CPR CAD Coronary 52

EMDocs

JANUARY 11, 2024

Data that do not establish neurological risk stratification in the first 6 hours after CA include the patient’s age, duration of CPR, seizure activity, serum lactate level or pH, Glasgow motor subscore in patients who received NMB or sedation, pupillary function in patients who received atropine, and optic nerve sheath diameter (95.3%, 20/21).

Critical Care 75

Critical Care E-9-1-1 OR ICU 75

Dr. Smith's ECG Blog

MARCH 9, 2017

CPR was initiated and she subsequently entered into V-Fib storm. ACS can be a very dynamic process. For example, a coronary plaque ruptures: the vessel can undergo occlusion, spontaneous reperfusion, maybe reocclusion, again reperfusion, etc. Shortly after this ECG she suddenly went unresponsive and into V-Fib.

CPR 52

CPR ACS Coronary ED 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. And so it is wise to look at the coronary arteries. This ECG certainly looks like myocarditis, and was due to myocarditis, but missing acute coronary occlusion is not acceptable.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52