Dr. Smith's ECG Blog

JUNE 23, 2024

His daughter immediately started CPR and another family member called EMS. The patient was treated as possible NSTEMI and underwent coronary angiography about 4 hours after presentation. TIMI 3 means the rate of passage of dye through the coronary artery is normal by angiography.) Initial hsTnI was 384 ng/L.

Coronary 118

Coronary CAD CPR Critical Care 118

Dr. Smith's ECG Blog

MAY 19, 2020

ECMO Flow was achieved after approximately 1 hour of high quality CPR. Angiography showed normal coronaries. MINOCA: Myocardial Infarction in the Absence of Obstructive Coronary Artery Disease). Here is my comment on MINOCA: "Non-obstructive coronary disease" does not necessarily imply "no plaque rupture with thrombus."

Defibrillator 52

Defibrillator CPR Coronary CAD 52

Dr. Smith's ECG Blog

APRIL 2, 2024

There was no bystander CPR. For this reason we did not believe this was an acute coronary event and did not activate the cath lab. Here is the troponin profile overnight: This is consistent with cardiac arrest without acute coronary occlusion. So a dual chamber pacer is placed with one lead through the coronary sinus to the LV.

Defibrillator 133

Defibrillator Coronary Epinephrine CPR 133

K.S. Chew

APRIL 22, 2015

There are two types of CPR devices: 1. Load-distributing band CPR devices (LDB) Provide circumferential thoracic compression 2. Piston-driven CPR device (PD) Provide sternal compressions In preclinical settings, CPR devices improve coronary perfusion, cardiac output, ROSC. What’s the evidence so far?

CPR 40

CPR Coronary 40

REBEL EM

SEPTEMBER 28, 2023

STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. Based on this, the authors did a literature review and found that there is an increasing rate of ICH and major non-intracranial bleeding starting at ≈60 years of age.

STEMI 138

STEMI Allergic Reaction Coronary Ambulance 138

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. 3-vessel disease can make resuscitation very difficult, since CPR does not perfuse diseased vessels as well as one would like. He reports feeling nauseated with emesis.

Defibrillator 135

Defibrillator Coronary STEMI CPR 135

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" Furthermore, among 35 patients with acute left main coronary artery occlusion, 9 presented with RBBB (mostly with LAFB) on the admission ECG.

Coronary 52

Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

E-9-1-1 98

E-9-1-1 Defibrillator CPR STEMI 98

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

Furthermore, among 35 patients with acute left main coronary artery occlusion, 9 presented with RBBB (mostly with LAH) on the admission ECG. See this paper by Widimsky et al, which shows the high association of RBBB, especially with LAFB, with LAD occlusion.

CPR 52

CPR STEMI Coronary ALS 52

EMDocs

NOVEMBER 6, 2023

It is reasonable to administer vasodilators (eg, nitrates, phentolamine, calcium channel blockers) for patients with cocaine-induced coronary vasospasm or hypertensive emergencies. Vasodilators, such as phentolamine and/or nitrates, are reasonable for coronary vasospasm from sympathomimetic poisoning. COR 2a, LOE C-LD. COR 1, LOE C-EO.

Naloxone 115

Naloxone OR BLS Overdose 115

REBEL EM

MARCH 30, 2023

Clinical Question : In patients who suffer an OHCA without ST-segment elevation on the post-resuscitation ECG, will early coronary angiogram (CAG) vs. delayed CAG improve outcomes? Emergency vs Delayed Coronary Angiogram in Survivors of Out-of-Hospital Cardiac Arrest: Results of the Randomized, Multicentric EMERGE Trial. Janssens, G.

Coronary 66

Coronary CPR OR ICU 66

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.

CPR 52

CPR ACS Coronary OR 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

It was witnessed, and CPR was performed by trained individuals. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. Updates on the Electrocardiogram in Acute Coronary Syndromes. Electrocardiogram patterns in acute left main coronary artery occlusion. References : 1. Nikus KC, Eskola MJ.

Defibrillator 52

Defibrillator ACS CPR STEMI 52

REBEL EM

JANUARY 29, 2024

What They Did: Single-center, pilot prospective observational cohort trial in Turkey Thrombolysis 25mg of alteplase without a bolus was administered over 6 hours by peripheral IV infusion If hemodynamic instability persisted despite first dose of thrombolysis, a second 6hr infusion of 25mg alteplase without bolus was administered (No patients in the (..)

ALS 136

ALS ACS OR CPR 136

Dr. Smith's ECG Blog

OCTOBER 3, 2017

The assay at my institution, for example, is frequently negative until 4-6 hours after acute coronary occlusion. This rhythm reportedly produced no palpable pulse, and CPR was continued. 30 seconds later, however, the patient began spontaneously moving and CPR was discontinued.

CPR 52

CPR Defibrillator STEMI ED 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. Rather it is due to coronary insufficiency due to a tight left main or 3-vessel disease with inadequate coronary flow. A middle-age woman with h/o hypertension was found down by her husband.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He underwent CPR and then was shocked out of VF. At times — the initial subtle findings simply represent a phase of "pseudo-normalization" that may occur soon after spontaneous reopening of an acutely occluded coronary artery. 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

Don't Forget the Bubbles

OCTOBER 7, 2024

However, vertical flow can result in myocardial injury secondary to coronary artery spasm. Prolonged CPR should be considered as outcomes are generally good, even if asystole is the presenting rhythm. Household supply in the UK and Australia is typically capped at 230v, so children get low-voltage injuries.

ACS 80

ACS Life Support OR CPR 80

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was Furthermore, among 35 patients with acute left main coronary artery occlusion, 9 presented with RBBB (mostly with LAFB) on the admission ECG. 30 minutes later, this ECG was recorded: There is less high lateral ST elevation And another 3.5

STEMI 40

STEMI CPR CAD Coronary 40

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 98

Critical Care E-9-1-1 OR ICU 98

Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. As in all ischemia interpretations with OMI findings, the findings can be due to type 1 AMI (example: acute coronary plaque rupture and thrombosis) or type 2 AMI (with or without fixed CAD, with severe regional supply/demand mismatch essentially equaling zero blood flow).

ACS 52

ACS CPR CAD Heart Attack 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. There was no significant difference in cooling method between original cohorts.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 52

Dr. Smith's ECG Blog

MARCH 9, 2017

CPR was initiated and she subsequently entered into V-Fib storm. For example, a coronary plaque ruptures: the vessel can undergo occlusion, spontaneous reperfusion, maybe reocclusion, again reperfusion, etc. Another ECG is obtained: She suddenly occluded her LAD with a very large territory of viable myocardium at risk!

CPR 52

CPR ACS Coronary ED 52

Dr. Smith's ECG Blog

JUNE 11, 2021

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. This ALONE is very strong evidence of acute coronary occlusion. Any indications for cath lab activation?

EMR 52

EMR STEMI CPR 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

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 40

Coronary Defibrillator ACS CAD 40

Dr. Smith's ECG Blog

APRIL 29, 2020

CPR was started immediately. Angiogram --Minimal coronary atherosclerosis --No obstructive epicardial coronary artery disease or evidence of plaque rupture noted to explain prolonged QT or ventricular fibrillation cardiacarrest, suspect nonischemic mechanism Echo The estimated left ventricular ejection fraction is 45 %.

Defibrillator 52

Defibrillator Epinephrine Coronary Overdose 52

REBEL EM

SEPTEMBER 5, 2022

Liberal O2 (PaO2 13 to 14kPa (98 to 105mmHg) Initial FiO2 set at 0.6 Liberal O2: 33.9% HR 0.95; 95% CI 0.75 to 1.21; p = 0.69 Results were consistent in all prespecified subgroups Death at 90d Restrictive O2: 28.7% Liberal O2: 31.1% HR 0.93; 95% CI 0.72 Higher MAP: 34.0% HR 1.08; 95% CI 0.84 to 1.37; p = 0.56

ICU 52

ICU ALS OR CPR 52

Dr. Smith's ECG Blog

MARCH 11, 2016

Patients who received CPR or experienced reinfarction or very small infarcts due to thrombolysis also displayed Type II T-wave evolution. Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries. Specificity of Type II for PIRP was 77%. GUSTO-I Investigators. JAMA 1998; 279:387-381. Methods: Hathaway et al.

ALS 52

ALS STEMI OR CPR 52

Dr. Smith's ECG Blog

APRIL 8, 2016

We could not resuscitate her, but we did have excellent perfusion with LUCAS CPR, such that pulse oximetry had excellent waveform and 100% saturations, end tidal CO2 was 35, and cerebral perfusion monitoring was near normal throughout the attempted resuscitation. Armstrong, MD Arch Intern Med. 1987;147(3):465-469. doi:10.1001/archinte.1987.00370030069014.

STEMI 52

STEMI Plasma Defibrillator OR 52

Don't Forget the Bubbles

DECEMBER 5, 2023

Reviewed by: Vicki Currie Article 5: Does occluding the femoral artery during neonatal CPR increase the likelihood of ROSC? (In The goal of chest compressions during neonatal resuscitation is to increase cerebral and coronary blood flow with the intention to achieve a return of spontaneous circulation (ROSC).

Coronary 111

Coronary Epinephrine CPR Emergency Department 111

Dr. Smith's ECG Blog

MARCH 8, 2025

The arterial pressure waveform is transduced using the coronary catheter. Normally, the diameter of the coronary artery ostium is much greater than the diameter of the catheter so that catheter engagement does not significantly impair antegrade coronary perfusion. Here is the ECG and arterial waveform during RCA angiography.

E-9-1-1 75

E-9-1-1 OR Defibrillator Coronary 75