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Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Dr. Smith's ECG Blog

Among patients with left bundle branch block, T-wave peak to T-wave end time is prolonged in the presence of acute coronary occlusion. CASE CONTINUED She was admitted to the ICU. Finally, do a coronary angiogram Possible alternative to pacing is to give a beta-1 agonist to increase heart rate. but potassium returned normal.

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How terrible can it be to fail to recognize OMI? To whom is OMI Obvious or Not Obvious?

Dr. Smith's ECG Blog

A temporary pacemaker was implanted, and she was admitted to the ICU with cardiogenic shock. In the context of this woman in her 60s who has known coronary disease ( and who is now presenting with acute chest discomfort ) — I interpreted neighboring leads V1 and V2 as part of the same acute process suggested by the QRST in lead V3.

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What Lies Beneath

EMS 12-Lead

A 65 y/o Female was admitted to the ICU for septic shock. The combination of prolonged QT and deep T wave inversion throughout the precordium is typical of Takotsubo syndrome, or Stress Cardiomyopathy – which can occur in the context of a physiologically distressed ICU patient, further compromising their hemodynamics.

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emDOCs Podcast – Episode 86 Tricky Cases Part 2

EMDocs

Propofol utilized for sedation; patient admitted to ICU for EEG monitoring. NSTEMI dichotomy is not sensitive for true occlusion MI or acute coronary occlusion. “The application of STEMI ECG criteria on a standard 12-lead ECG alone will miss a significant miry of patients who have acute coronary occlusion.”

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A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

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).

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AHA/NCS Statement on Critical Care Management of Post ROSC Patients

EMDocs

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).

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

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