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What Lies Beneath

EMS 12-Lead

A 65 y/o Female was admitted to the ICU for septic shock. Question 1: What is the rhythm? Beat 1 : Sinus, narrow QRS complex. The assumption is that a premature complex discharged prior to Beat 1, which prolonged its respective refractory period in the same manner as Beat 5.

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Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. C Examination notable for diaphoresis, 1+ bilateral lower extremity edema, regular heart rate and rhythm, and no signs of respiratory distress with normal breath sounds. The patient was upgraded to the ICU for closer monitoring.

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EM@3AM: Retroperitoneal Hematoma

EMDocs

A 70-year-old female with a past medical history of hypertension, coronary artery disease s/p 2x drug eluting stent placement one month ago, atrial fibrillation on apixaban presents to the ED with weakness and lightheadedness. 1 Risk Factors: 1-4 Spontaneous Anticoagulants (Apixaban, Rivaroxaban, etc.)

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TEG-Guided Resuscitation of Patients with Cirrhosis and Non-Variceal Bleeding

REBEL EM

2020;71(1):235-246. Article: Kumar M et al. Thromboelastography-Guided Blood Component Use in Patients With Cirrhosis With Nonvariceal Bleeding: A Randomized Controlled Trial. Hepatology. Significant coagulopathy: INR > 1.8 Significant coagulopathy: INR > 1.8 Significant coagulopathy: INR > 1.8

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20-something with huge verapamil overdose and cardiogenic shock

Dr. Smith's ECG Blog

He was admitted to the ICU and was unstable, in shock, overnight. Learning Points: 1. If the situation is not right for acute coronary occlusion, then the ECG findings probably do not represent acute coronary occlusion. For clarity in Figure-1 — I've reproduced and put these first 2 ECGs together.

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"Pericarditis" strikes again

Dr. Smith's ECG Blog

On review of systems the patient reported back pain for approximately 1 week which he was treating with NSAIDs with minimal relief. in the ICU but survived with excellent function. 15-9/6/2017 ). Figure-1: Excerpt from ESC review on acute pericarditis ( See text ).

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Inotropes and Vasopressors: Doses, indications, contraindications and effects

ECG & Echo Learning

Most agents exhibit both vasopressor and inotropic effects (Figure 1). Below follows a drug manual for use in the CCU (coronary care unit), ICU (intensive care unit) or ER (emergency room). μg/kg/min + + + ++ Low dose dopamine stimulates D1 receptors and induces vasodilation in coronary, renal, cerebral and mesenteric vessels.

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