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 28, 2013

Fine ventricular fibrillation She received 2 mg epinephrine, 150 mg amiodarone and underwent chest compressions with the LUCAS device. Updates on the Electrocardiogram in Acute Coronary Syndromes. Electrocardiogram patterns in acute left main coronary artery occlusion. 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. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. A 60-something woman presented after a witnessed cardiac arrest. CPR was started immediately.

Defibrillator 52

Defibrillator Epinephrine Coronary Overdose 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

The diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Author continued : STE in aVR is often due to left main coronary artery obstruction (OR 4.72), and is associated with in-hospital cardiovascular mortality (OR 5.58).

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The ST segment changes are compatible with severe subendocardial ischemia which can be caused by type I MI from ACS or potentially from type II MI (non-obstructive coronary artery disease with supply/demand mismatch). This patient is actively dying from a left main coronary artery OMI and cardiac arrest from VT/VF or PEA is imminent!

Coronary 128

Coronary ACS Emergency Department Defibrillator 128

Dr. Smith's ECG Blog

JULY 21, 2024

It shows a proximal LAD occlusion, in conjunction with a subtotally occluded LMCA ( Left Main Coronary Artery ). Epinephrine infusion was begun. Upon contrast injection of the LMCA, the patient deteriorated, as the LMCA was severely diseased and flow to all coronary arteries ( LAD, LCx and RCA ) was compromised.

Defibrillator 131

Defibrillator Coronary ALS STEMI 131

ECG & Echo Learning

OCTOBER 2, 2022

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. Increases coronary blood flow. Coronary flow enhanced.

E-9-1-1 52

E-9-1-1 ALS Coronary Epinephrine 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

JUNE 19, 2023

The patient has also developed sinus bradycardia, which may result from right coronary artery ischemia to the SA node. The patient is started on epinephrine infusion for cardiogenic shock and cardiology took the patient to the cath lab. The Queen of Hearts sees it of course: Still none of these three ECGs meet STEMI criteria.

STEMI 52

STEMI ACS Coronary Defibrillator 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

OCTOBER 20, 2013

With ventilations and epinephrine, she regained a pulse. 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. She was never seen to be in ventricular fibrillation and was never defibrillated.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

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). On epinephrine and norepinephrine drips."

ACS 52

ACS CPR CAD Heart Attack 52

REBEL EM

SEPTEMBER 26, 2022

Limitations Single center study in India A very specific subset of patients with advanced liver cirrhosis and non-variceal upper GI bleeding (gastritis, portal hypertensive gastropathy, ulcers) Investigators also excluded patients on antiplatelet and anticoagulant therapy, likely eliminating many patients with diabetes and coronary artery disease.

FFP 52

FFP E-9-1-1 ICU ALS 52

ECG & Echo Learning

JANUARY 18, 2023

This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST-segment elevations (i.e III A Primary percutaneous coronary intervention strategy Management Recommendation Level of evidence Primary PCI of the infarct related artery (IRA) is indicated.

STEMI 40

STEMI Coronary OR Defibrillator 40

Dr. Smith's ECG Blog

APRIL 8, 2016

Over a 13-month period, serum potassium and magnesium levels were measured in 590 patients admitted to a coronary care unit. Hypokalemia after cardiac arrest was independent of arterial pH, epinephrine or bicarbonate therapy during resuscitation, or prior therapy with diuretic drugs, digoxin or propranolol. 1987;147(3):465-469.

STEMI 52

STEMI Plasma Defibrillator OR 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. Interventions during the acute phase of treatment post return of spontaneous circulation (ROSC) are therefore critical.

E-9-1-1 52

E-9-1-1 CPR ICU ALS 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

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). 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

It eliminates the “pulse check,” allowing instant confirmation of pulsatility, while also allowing a very sophisticated assessment of coronary perfusion. * A diastolic BP above 3540 mmHg, measured from the arterial line during cardiac arrest, suggests adequate coronary perfusion.

Epinephrine 212

Epinephrine Defibrillator Coronary ED 212

Dr. Smith's ECG Blog

APRIL 6, 2025

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. He was persistently bradycardic, requiring 2 x 50 mcg epinephrine to maintain HR >60. Epinephrine drip was started and norepinephrine was discontinued.

OR 111

OR Epinephrine CPR ED 111

FOAMfrat

DECEMBER 4, 2024

The ultimate goal is to optimize coronary perfusion pressure (CPP)—in other words, the amount of blood flow into the coronary arteries. When the heart is full, it puts pressure on the myocardium, compressing the coronary microvasculature. When it gets too high, it can impair blood flow into the coronaries. mcg/kg/min.

Coronary 65

Coronary STEMI Epinephrine Critical Care 65

EMDocs

OCTOBER 29, 2024

EPINEPHRINE-INUDCED SHOCK: LEFT VENTRICULAR OUTFLOW TRACT OBSTRUCTION ON VASOPRESSORS. m/s)—problematic and elevated > 50 mm Hg (2.5 Left ventricular outflow tract gradient variability in hypertrophic cardiomyopathy. Clin Cardiol. 2009;32(7):397-402. doi:10.1002/CLC.20594 20594 MOZELL D, SHAH N, CASTILLON JJR, GONUGUNTLA VT, AWERBUCH E.

E-9-1-1 98

E-9-1-1 ICU Epinephrine EMS 98

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Resuscitated with chest compressions, epinephrine. including epinephrine, and there was ROSC. Moreover, it does not follow a coronary distribution very well. The coronaries were clean. Not a shockable rhythm. They laid her on the floor and called 911. Shortly thereafter, pulses were lost. This is unusual in acute OMI.

STEMI 88

STEMI Paramedic E-9-1-1 Epinephrine 88

Dr. Smith's ECG Blog

APRIL 18, 2025

Angiography was performed at 10:31, just under 13 hours after the patients ED presentation: The red arrow shows a 50% distal stenosis of the left main coronary artery involving the ostium of the LAD. He suffered another cardiac arrest in the ICU with ROSC after another dose of epinephrine and one round of CPR. PCI was not performed.

ED 81

ED ACS ICU OR 81