Dr. Smith's ECG Blog

FEBRUARY 8, 2015

Potentiation of cocaine-induced coronary vasoconstriction by beta-adrenergic blockade Ann Int Med 897-903 112 12 1990 December 15 816 2 style='mso-element:field-end'> Indeed, major articles advising against the use of beta blockers in cocaine toxicity reference only this article and do not discuss cardioselectivity. Cigarroa, R.G. McBride, W.

E-9-1-1 52

E-9-1-1 Coronary Epinephrine Overdose 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

With ventilations and epinephrine, she regained a pulse. She was hypotensive in the ED and her bedside echo showed a normal RV and LV. Two prehospital 12-lead ECGs looked similar to this ED ECG: This shows diffuse ST depression (I, II, III, aVL, aVF, V3-V6) with reciprocal ST elevation in lead aVR. BP gradually rose.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. Updates on the Electrocardiogram in Acute Coronary Syndromes. The patient was discharged neurologically intact.

Defibrillator 52

Defibrillator ACS CPR STEMI 52

Dr. Smith's ECG Blog

APRIL 29, 2020

She was given 3 mg IV epinephrine and multiple rounds of ACLS over approximately 20 minutes. I was texted this ECG in real time, but it turns out to actually be the 2nd one recorded in the ED. ECG #4 — This is the 3rd ECG that was done in this case ( obtained ~1 hour after arrival in the ED ). She was never defibrillated.

Defibrillator 52

Defibrillator Epinephrine Coronary Overdose 52

Dr. Smith's ECG Blog

JULY 24, 2018

They stated that the patient was coded for 20 minutes, including multiple doses of epinephrine, and they also gave glucose, calcium, and bicarb. As stated above, resuscitation included epinephrine, calcium, and bicarb. Acute coronary syndrome is unlikely to be one of those entities. After ROSC achieved: Sinus rhythm.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED. The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. In the cath lab, the patient’s blood pressure remained low.

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

This is a 30-something healthy patient presented with COVID pneumonia who presented to the ED. 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. He was moderately hypoxic.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

He reportedly told his family "I think I'm having a heart attack", then they immediately drove him to the ED, and he was able to ambulate into the triage area before he collapsed and became unresponsive. On epinephrine and norepinephrine drips." CPR was initiated immediately. CT angiogram showed extensive saddle pulmonary embolism.

ACS 52

ACS CPR CAD Heart Attack 52

Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. Over a 13-month period, serum potassium and magnesium levels were measured in 590 patients admitted to a coronary care unit. Medics stated that he had not been taking his clopidogrel for 2 weeks. He appeared to be in shock. What are you worried about in addition to his STEMI?

STEMI 52

STEMI Plasma Defibrillator OR 52

EMDocs

JANUARY 20, 2024

The catheterization lab is activated, but catheterization shows no coronary artery occlusion. ECG shows ST-segment elevation in V3-V6 only with depression in aVR. Initial troponin is mildly elevated. On further questioning, the patient denies recent illness but does mention that her daughter passed away in a car accident yesterday.

E-9-1-1 102

E-9-1-1 EMS Coronary ACS 102

Don't Forget the Bubbles

DECEMBER 5, 2023

Sex ed” sucks. They believe that Sex Ed programs are irrelevant to real-life experience and contain inadequate discussion of important issues, including consent or positive sexual relationships. Both were partly delivered via caesarian section, flow probes inserted into carotid, pulmonary and left circumflex coronary arteries.

Coronary 111

Coronary Epinephrine CPR Emergency Department 111

Critical Care Scenarios

JANUARY 8, 2025

We talk about the nitty-gritty details of a well-run cardiac arrest, with Scott Weingart of Emcrit (@emcrit), ED intensivist. Takeaway lessons Resources We talk about the nitty-gritty details of a well-run cardiac arrest, with Scott Weingart of Emcrit ( @emcrit ), ED intensivist. Learn more at the Intensive Care Academy!

Epinephrine 212

Epinephrine Defibrillator Coronary ED 212

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

This is what the providers in the ED understood on patient arrival: Patient called 911 for syncope, then had witnessed PEA arrest after medics arrived. Resuscitated with chest compressions, epinephrine. including epinephrine, and there was ROSC. Moreover, it does not follow a coronary distribution very well.

STEMI 89

STEMI Paramedic E-9-1-1 Epinephrine 89

Dr. Smith's ECG Blog

APRIL 6, 2025

On arrival to the ED, he was breathing spontaneously, had faint pulses, and was cool to the touch. He was given 50 mcg epinephrine with good response in both heart rate and blood pressure. His heart rate had improved to the 80s after epinephrine administration. Epinephrine drip was started and norepinephrine was discontinued.

OR 93

OR Epinephrine CPR ED 93

EMDocs

OCTOBER 29, 2024

A 43-year-old male with a history of mitral valve regurgitation s/p valvular replacement, hypertension, hyperlipidemia was evaluated in the ED for septic shock secondary to a pyelonephritis with a renal abscess. EPINEPHRINE-INUDCED SHOCK: LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION ON VASOPRESSORS. Clin Cardiol. 2009;32(7):397-402.

E-9-1-1 98

E-9-1-1 ICU Epinephrine EMS 98