Remove E-9-1-1 Remove Epinephrine Remove STEMI
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emDOCs Revamp: Left Ventricular Outflow Tract Obstruction

EMDocs

Chu CK, Delia E, Mograder A, Dwyer EM. 2017;45(1):12-20. 2015;7(9):E365-E369. General: Intubated sedated CV: Tachycardic, regular rhythm, systolic murmur Pulm: Clear to auscultation bilaterally Skin: Mottled and cool Neuro: GCS 3T What is the underlying this patient’s vasopressor and inotrope refractory shock?

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Anaphylaxis, chest pain, and ST elevation in aVR

Dr. Smith's ECG Blog

In the ED he received methylprednisolone, diphenhydramine, and epinephrine for possible anaphylaxis. Shortly after receiving epinephrine, the patient developed new leg cramps and chest pain. A "STEMI alert" was called and soon cancelled. ST depression will not always be present in 9/12 leads — as is seen in Figure-1.

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A woman in her 70s with bradycardia and hypotension

Dr. Smith's ECG Blog

There is STE in III and aVF which does not meet STEMI criteria due to insufficient STE in lead aVF. The interventionalists insisted that the ECGs did not meet STEMI criteria and cancelled the activation, stating that they would consider urgent cath after further stabilization. This is an obvious inferoposterior OMI. mm STE with 9.5

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Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Here they are: Learning Points: 1. In a series of 18 patients with COVID and ST elevation, 8 were diagnosed with STEMI, 6 of whom had an angiogram and it showed obstructive coronary disease.

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