Chest pain, ST Elevation, and tachycardia in a 40-something woman
A prehospital cath lab activation for STEMI came through with the information that the 40-something woman had chest pain and a pulse of140.We were immediately skeptical that the patient had a STEMI because of the high heart rate. She would have to be in cardiogenic shock with a massive STEMI for that. Certainly possible, but when the heart rate is so high, be skeptical.The patient arrived with this ECG:Here the heart rate is obviously no longer 140What do you think?ECG: it certainly appears to be an anterior STEMI, but it is important to realize that right ventricular ischemia from either inferior and RV STEMI ...
Source: Dr. Smith's ECG Blog - January 30, 2021 Category: Cardiology Authors: Steve Smith Source Type: blogs
Repost: 63 minutes of ventricular fibrillation, followed by shock. What is going on?
In this study, 5% of VF arrest was due to PE: V fib is initial rhythm in PE in 3 of 60 cases. On the other hand, if the presenting rhythm is PEA, then pulmonary embolism is likely. When there is VF in PE, it is not the initial rhythm, but occurs after prolonged PEA renders the myocardium ischemic.--Another study by Courtney and Kline found that, of cases of arrest that had autopsy and found that a presenting rhythm of VF/VT had an odds ratio of 0.02 for massive pulmonary embolism as the etiology, vs 41.9 for PEA. ===================================MY Comment by KEN ...
Source: Dr. Smith's ECG Blog - June 27, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
1 hour of CPR, then ECMO circulation, then successful defibrillation....
An elderly woman had sudden ventricular fibrillation.She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). ECMO Flow was achieved after approximately 1 hour of high quality CPR.After good ECMO flow was established, she was successfully defibrillated.Here is her monitor rhythm:Notice the " Shark Fin " morphology in lead I monitor rhythm.Also notice that the arterial line mean arterial pressure is 63 mmHg, but there is no waveform (and SpO2 says " no pulse " ), as the flow is continuous on ECMO and the LV function at this point was ext...
Source: Dr. Smith's ECG Blog - May 18, 2020 Category: Cardiology Authors: Steve Smith Source Type: blogs
ViTrack for Direct, Continuous, Non-Invasive Blood Pressure Monitoring: Interview with CEO of Dynocardia, Dr. Mohan Thanikachalam
Most modern blood pressure cuffs use the oscillometric technique, in which the cuff measures one value (mean arterial pressure) and an algorithm calculates systolic and diastolic blood pressure readings. However, this indirect method can produce inaccuracies, and single-point measurements lead to an inaccurate hypertension diagnosis in 30% of patients. While intraarterial lines can be used for direct and continuous blood pressure readings, they are highly invasive and reserved for inpatient use.
ViTrack is different:
it is a direct, continuous, yet non-invasive way of measuring systolic and
diastolic blood pressures.
...
Source: Medgadget - March 23, 2020 Category: Medical Devices Authors: Cici Zhou Tags: Anesthesiology Cardiology Critical Care Diagnostics Emergency Medicine Exclusive Pediatrics Source Type: blogs
He couldn ’t let his wife go peacefully. Even after death.
No break for 12 hours. We beg to go to the bathroom just for a nano-second. You know, in between not skipping a beat to hang life-saving IV drips, assisting with central line insertions and arterial lines and intubations of the sickest. We pretty much just go door to door literally saving lives. Code blues, […]Find jobs at Careers by KevinMD.com. Search thousands of physician, PA, NP, and CRNA jobs now. Learn more. (Source: Kevin, M.D. - Medical Weblog)
Source: Kevin, M.D. - Medical Weblog - March 17, 2020 Category: General Medicine Authors: < span itemprop="author" > < a href="https://www.kevinmd.com/blog/post-author/debbie-moore-black" rel="tag" > Debbie Moore-Black, RN < /a > < /span > Tags: Conditions Critical Care Source Type: blogs
Shark Fin morphology recognized only by EM physician
Case submitted by Alex Bracey, Written by Alex Bracey and Pendell MeyersA man in his 70s complained of acute chest pain followed by witnessed cardiac arrest. He received immediate bystander CPR prior to EMS arrival. EMS found him in VF and administered 4 shocks, multiple doses of epinephrine, and amiodarone with intermittent ROSC, however he was in arrest on arrival to the ED with ongoing CPR via LUCAS device. Overall down time was 35 minutes from the time of arrest to arrival at the ED.First rhythm check in the ED showed PEA with a wide complex at a rate of approximately 30 bpm. Calcium and epinephine were given at CPR wa...
Source: Dr. Smith's ECG Blog - October 3, 2019 Category: Cardiology Authors: Pendell Source Type: blogs
ROSC: does the ECG rule out OMI? And why does a heart just stop beating? And what rhythm is this?
This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram. It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab. So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram. This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI.What percent of shockable arrests without STE have an OMI? This large registry in Circulatio...
Source: Dr. Smith's ECG Blog - June 17, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
ROSC: does the ECG to rule out OMI? And why does a heart just stop beating? And what rhythm is this?
This study had afatal flaw: they did not keep track of all the Non-STEMI patients who were NOT enrolled, but instead were sent for immediate angiogram. It was done in Europe, where the guidelines suggest taking all shockable arrests emergently to the cath lab. So it is highly likely that physicians were very reluctant to enroll patients; they did not want them to be randomized to no angiogram. This strong suspicion is supported by their data:only 22 of 437 (5.0%) patients in this study had OMI. What percent of shockable arrests without STE have an OMI? This large registry in Circ...
Source: Dr. Smith's ECG Blog - June 17, 2019 Category: Cardiology Authors: Steve Smith Source Type: blogs
An experimental study of pharmaceutical cannabis in fibromyalgia
This study is one of the growing number of studies beginning to examine the effects of cannabinoids on pain, and offers a tiny window into what might be happening. Note: the study was performed in collaboration with the cannabis producer, and one of the authors is an employee of this company. Although his role was only to comment on the protocol and final version of the paper, it’s worth noting this relationship.
The study question
In this study, the researchers were looking to understand the analgesic effect of inhaled pharmaceutical-grade cannabis as a plant rather than an extract, using four different variet...
Source: HealthSkills Weblog - May 5, 2019 Category: Anesthesiology Authors: BronnieLennoxThompson Tags: Chronic pain Coping strategies News Pain conditions Research cannabis experiment fibromyalgia Source Type: blogs
Aktiia ’s Cuffless Blood Pressure Monitor is Accurate for Months
It doesn’t need recalibrating often.
The Aktiia optical blood pressure monitor was tested in six healthy volunteers and agreed with a traditional inflating-cuff blood pressure monitor (Omron M6) two months after the initial calibration. The Blood Pressure Monitor was accurate to within 1 ± 7 mmHg, which satisfied the 5±8 mmHg guidelines set by the AAMI (Association for the Advancement of Medical Instrumentation). Aktiia will reveal the full results of their study at the 41st IEEE International Engineering in Medicine and Biology Conference in Berlin, Germany at the end of July. They have now initiated a clinical t...
Source: Medgadget - March 29, 2019 Category: Medical Devices Authors: Ben Ouyang Tags: Cardiology Exclusive Source Type: blogs
LITFL Review 344
LITFL • Life in the Fast Lane Medical Blog LITFL • Life in the Fast Lane Medical Blog - Emergency medicine and critical care medical education blog
Welcome to the 344th LITFL Review! Your regular and reliable source for the highest highlights, sneakiest sneak peeks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the blogosphere’s best and brightest and deliver a bite-sized chunk of FOAM.
The Most Fair Dinkum Ripper Beauts of the Week
Catch up with the Curbsiders and hear Renee Dversdal talk about her passion for IMPOCUS...
Source: Life in the Fast Lane - August 20, 2018 Category: Emergency Medicine Authors: Marjorie Lazoff, MD Tags: LITFL review LITFL R/V Source Type: blogs
The EBM Wars: Manufacturing Equipoise (Part 1)
By ANISH KOKA
The phone rings. It’s not supposed to be ringing. It’s 2 am. The voice on the other line is from an apologetic surgery resident.
Resident: There is this patient..
Me: Yes, go ahead. Please.
Resident: He’s tachycardic.
Me: How fast?
Resident: 160 ?
Me: What’s the blood pressure?
Resident: 130/90
Me: Rhythm?
Resident: An SVT I think.. I gave adenosine. Nothing happened
Me: Audibly groaning. I’ll be in..
Forty five minutes later I’m at the bedside of a decidedly ill appearing man.
I want to be triumphant that his heart rate is only 145, and a quick glance at the ...
Source: The Health Care Blog - June 16, 2018 Category: Consumer Health News Authors: anish_koka Tags: Uncategorized Source Type: blogs
" Shark Fin " : A Deadly ECG Sign that you Must Know!
Conclusions:Shark Fin is an electrocardiographic sign of acute coronary occlusion. It is a unique ECG phenomenon consisting of complexes formed by the blurring together of QRS and T-wave as a result of extreme ST-Deviation. These complexes manifest in contiguous ECG leads corresponding with coronary anatomy, and represent transmural ischemia. Shark Fin Sign should be recognized based on its characteristic morphology, and confirmed by delineating the J-point using the technique described above. While there is a paucity of literature on the topic, the presence of this sign appears to be associated with a significant mortalit...
Source: Dr. Smith's ECG Blog - June 11, 2018 Category: Cardiology Authors: Steve Smith Source Type: blogs
A middle aged man with unwitnessed cardiac arrest
Written by Pendell Meyers, with edits by Steve SmithThanks to my attending Nic Thompson who superbly led this resuscitationWe received a call that a middle aged male in cardiac arrest was 5 minutes out. He was estimated to be in his 50s, with no known PMHx. He arrived with chest compressions ongoing, intubated, and being bagged. EMS report was that the patient had unknown down time with unwitnessed arrest, found initially in VFib arrest, defibrillated x1 followed by PEA arrest alternating with asystolic arrest during transport.He arrived in PEA arrest with a slow and wide cardiac waveform during initial rhythm check, with ...
Source: Dr. Smith's ECG Blog - April 6, 2018 Category: Cardiology Authors: Pendell Source Type: blogs
