Dr. Smith's ECG Blog

JANUARY 9, 2024

The pacing rate was increased without clinical improvement and the patient was transferred to the ICU for closer monitoring/treatment. The patient is an older woman with known coronary disease and an ICD-Pacemaker implanted because of a history of VT ( V entricular T achycardia ). Is this: 1. small squares in width (260ms).

Coronary 119

Coronary ACS ED OR 119

EMS 12-Lead

MAY 8, 2022

Cardiology was consulted, who advised to surveil a metabolic process as this did not strike them as acute coronary syndrome. Thankfully, the patient experienced an uncomplicated ICU stay and subsequently made a full recovery. 2] But there is also Sinus Tachycardia! Such a finding is most dramatic in Lead I, reproduced here.

STEMI 130

STEMI ED EMS Firefighter 130

EMDocs

JANUARY 11, 2024

In ICUs where advanced cerebral monitoring is not in routine use, target an MAP >80 mm Hg unless there are clinical concerns or evidence of adverse consequences (82.6%, 19/23). In ICUs where noninvasive monitoring of cerebral autoregulation is in routine use, maintain MAP at or near the predicted MAPOPT (88.2%, 15/17).

Critical Care 97

Critical Care E-9-1-1 OR ICU 97

EMDocs

SEPTEMBER 7, 2024

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. We’ll keep it short, while you keep that EM brain sharp. Vital signs include BP 90/48, HR 122, T 98.3

EMS 97

EMS E-9-1-1 Operating Room OR 97

Dr. Smith's ECG Blog

OCTOBER 25, 2023

The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. Instead — it commonly reflects ischemia from severe underlying coronary disease. QTc/QUc is in the range of 630 msec. See these other relevant cases: What are these bizarre bigeminal PVCs??

Overdose 124

Overdose ACS OR ICU 124

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.

Coronary 66

Coronary CPR OR ICU 66

Dr. Smith's ECG Blog

MAY 26, 2023

He was admitted to the ICU and was unstable, in shock, overnight. If the situation is not right for acute coronary occlusion, then the ECG findings probably do not represent acute coronary occlusion. Despite the eye-catching ST-T wave changes that came-and-went a number of times — there was no acute coronary occlusion.

Overdose 98

Overdose E-9-1-1 Coronary ICU 98

REBEL EM

SEPTEMBER 26, 2022

The TEG group had a shorter ICU length of stay in the first admission. Patients exclusively managed in the ICU which decreases applicability for patients in other locations Very small sample size of 96 patients No definition was provided for exclusion criteria of significant cardiopulmonary disease.

FFP 52

FFP E-9-1-1 ICU ALS 52

Dr. Smith's ECG Blog

JULY 22, 2012

Course : A CT of the head, neck, chest, abdomen and pelvis showed no other unanticipated injuries and she was admitted to the ICU. More commonly, however, ECG and/or echo wall motion abnormalities are due to pre-existing disease, especially coronary disease complicating trauma. She was intubated.

Coronary 52

Coronary ICU OR ED 52

Dr. Smith's ECG Blog

OCTOBER 28, 2022

Electrocardiographic diagnosis of acute coronary Occlusion Myocardial Infarction in ventricular paced rhythm using the modified Sgarbossa criteria. There is no doubt about these 2 EKGs: they are due to acute coronary occlusion. He went into cardiogenic shock and is intubated in the cardiac ICU. Annals of Emergency Medicine 2021.

Coronary 52

Coronary Paramedic ICU EMS 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 Liberal O2: 33.9% HR 0.95; 95% CI 0.75

ICU 52

ICU ALS OR CPR 52

EMDocs

OCTOBER 21, 2023

A 68-year-old male with a past medical history of hypertension, diabetes mellitus, and coronary artery disease with a drug eluting stent placed 2 months ago presents with dizziness and vomiting that began 3 hours ago. We’ll keep it short, while you keep that EM brain sharp. Symptoms may range from days to months prior to stroke onset.

EMS 97

EMS ALS OR ACS 97

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

Emergency Medicine Ireland

MAY 31, 2021

When it’s too low the oveerall CO is too low, at some point it’s too fast, impairing cardiac and coronary filling and hence impairing stroke volume. Pretty much all vasoactive medications have the same end point – that is the release, utilisation or sequestration of intracellular calcium.

Critical Care 52

Critical Care ICU Coronary OR 52

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

JANUARY 6, 2023

Immediate and early percutaneous coronary intervention in very high-risk and high-risk Non-STEMI patients. The facility was not pressed to activate emergent transfer for PCI since the pain was improving and suggested we optimize pain control and admit to the Cardiac ICU. No history of GIB, dysuria, or GU symptoms. mg/dL, K 3.5

ACS 52

ACS Coronary ICU STEMI 52

Dr. Smith's ECG Blog

MARCH 12, 2018

Wellens pattern is a term which refers to coronary reperfusion morphology in the anterior leads) The best answer is because the entire gestalt of the ECG shows acute right heart strain instead, and just does not look like Wellens after you've seen Wellens hundreds of times. Why is it not Wellens??? She was discharged and did well.

ACS 40

ACS Coronary ALS ICU 40

Dr. Smith's ECG Blog

APRIL 20, 2018

If she had no risk factors, it is doubtful that she would have developed such extensive coronary artery disease as we see on the angiogram. I took part in her ICU care and she was extubated and stable to transfer to a stepdown unit after a few days. These look like ischemic ST segments and T-waves.

Coronary 40

Coronary STEMI EMS ACS 40

Emergency Medicine Ireland

OCTOBER 30, 2023

This vasoconstriction affects pretty much all the vasculature including things like the coronaries (not so good) but does seem to spare the pulmonary arteries meaning it may be good in those with pulmonary hypertension. How does it work? Well this is where the fun beings. What other receptors is it worth knowing about? How does it work?

Critical Care 52

Critical Care ALS Coronary ICU 52

Dr. Smith's ECG Blog

DECEMBER 13, 2019

in the ICU but survived with excellent function. Several hours prior to presentation, while driving his truck, he started experiencing new central chest pain, without radiation, aggravating/alleviating factors, or other associated symptoms. You diagnose pericarditis at your peril! Acute MI is frequently misdiagnosed as pericarditis.

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 52

Dr. Smith's ECG Blog

MARCH 6, 2019

If for some reason the angiogram is delayed, they should receive maximal medical therapy in an ICU setting with continuous 12-lead ST segment monitoring under the close attention of a practitioner with advanced ECG interpretation training. The patient did well. Patel et al., Krucoff et al.) Patel et al. American Journal of Cardiology 1990.

STEMI 52

STEMI ALS ACS ICU 52

Dr. Smith's ECG Blog

JULY 24, 2018

Upon arrival in the ICU, before getting Continuous Veno-Venous Hemodialysis (CVVHD), his potassium had risen again to 7.8 Acute coronary syndrome is unlikely to be one of those entities. Written by Pendell Meyers We received a call from an outside hospital asking to transfer a "traumatic post arrest" patient.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

Fortunately, he was extubated several days later in the ICU with intact baseline mental status and was discharged shortly thereafter to subacute rehab. His troponin I peaked at 97 ng/mL (very large MI!). His follow up ECHO the next day revealed an EF of 24% and a posterior wall motion abnormality. Herzog et al. What can we learn?

CAD 52

CAD OR ED ALS 52

Dr. Smith's ECG Blog

JULY 12, 2020

A CT was obtained later and showed appropriate positioning of the catheter: She was admitted to the ICU and the catheter was used several times to withdraw more fluid. There are too-numerous-to-count cases on Dr. Smiths ECG Blog in which emergency providers diagnosed acute pericarditis that was really acute coronary syndrome.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40

EMDocs

JANUARY 6, 2024

3,10 Coronary Allograft Vasculopathy Nicknamed “The Achilles Heel of Heart Transplantation,” this accounts for the majority of patient mortality in the 5-10 year range. 10 It affects the whole length of the vessel and all layers of the coronary vasculature rather than just the intima, which is seen in non-transplant atherosclerosis.

EMS 89

EMS E-9-1-1 ACS Coronary 89

ACEP Now

JUNE 14, 2024

Some of the critical differentials include pulmonary embolism, acute decompensated heart failure, pneumonia, pneumothorax, and acute coronary syndrome. Anginal chest pain, chest heaviness, or evidence of fluid overload suggest acute coronary syndrome or acute decompensated heart failure. Signs and symptoms of systemic infection (e.g.,

ALS 52

ALS Coronary OR ED 52

Dr. Smith's ECG Blog

MARCH 6, 2025

Fifth , potential management actions are in your hands; you do not need to request a coronary interventionalist or cath lab team. She was critically ill and required noninvasive positive pressure ventilation and ICU admission for suspected infectious respiratory illness. Sinus tach is often misinterpreted as a dysrhythmia.

Coronary 96

Coronary ICU OR Defibrillator 96

EMDocs

OCTOBER 29, 2024

He was started appropriately on vancomycin and cefepime and accepted for ICU admission but remains in the ED due to boarding and bed lock. Left ventricular outflow tract obstruction in ICU patients. He has clinically deteriorated and required intubation. m/s)—problematic and elevated > 50 mm Hg (2.5 Curr Opin Crit Care.

E-9-1-1 98

E-9-1-1 ICU Epinephrine EMS 98

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. LVEDP (measured in the ICU using a Swan-Ganz or pulmonary artery catheter) is the pressure inside the left ventricle at the end of diastole, when the LV is at its fullest. So how do we treat it?

Coronary 64

Coronary STEMI Epinephrine Critical Care 64

Don't Forget the Bubbles

MARCH 24, 2025

This is likely because Dexmed helps dampen the sympathetic response to perioperative stress, improving coronary artery perfusion. Dexmedetomidine is currently licensed only for adult sedation in an ICU setting, but guidelines exist to support its off-licence use in paediatric intensive care (PICU).

E-9-1-1 59

E-9-1-1 Emergency Department ALS Critical Care 59