Cardiac Arrest: To the cath lab with ongoing chest compressions
CONCLUSION Beta-blockade should be considered in all patients with RVF in the ED prior to cessation of resuscitative efforts. (Source: Dr. Smith's ECG Blog)
Source: Dr. Smith's ECG Blog - February 28, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Dyspnea on Exertion and a Positive Troponin
In conclusion, the presence of negative T waves in both leads III and V1 allows PE to be differentiated simply but accurately from ACS in patients with negative T waves in the precordial leads."Witting et al. looked at consecutive patients with PE, ACS, or neither. They found that only 11% of PE had 1 mm T-wave inversions in both lead III and lead V1, vs. 4.6% of controls. This does not contradict the conclusions of Kosuge et al. that when T-wave inversions in the right precordial leads and in lead III are indeed present, then PE may indeed by more common. In my expe...
Source: Dr. Smith's ECG Blog - February 9, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Ischemic Chest Pain and Hypertension: Use of Adjunctive Anti-ischemic Therapy
A middle aged male with several CAD risks has had several months of exertional angina relieved by rest and nitro. He had the onset of chest discomfort at rest and presented by ambulance about 3 hours later with "severe crushing chest pain," with a blood pressure of 200/100 and pulse of 100. The prehospital ECG cannot be found. Here is his initial ED ECG:Sinus rhythm, nearly tachycardia. Left axis deviation with QRS of 90 ms, R-wave peak time in aVL perhaps reaches 45 ms, so possible left anterior fascicular block. There is minimal ST depression (but also a wandering baseline) in V3-V6.Exam was...
Source: Dr. Smith's ECG Blog - January 7, 2014 Category: Cardiology Authors: Steve Smith Source Type: blogs
Beta Blockers in Anterior STEMI: Have We Come Full Circle?
A new small randomized trial suggests that early intravenous metoprolol, early after symptoms and prior to PCI for anterior STEMI, reduces infarct size.History --The data for beta blockers in the pre-reperfusion era was positive. --Based on this weak data, beta blockers were class I for STEMI for many years. --However, the data for them in the thrombolytic era was not positive, and one might say is was negative (COMMIT trial from China, huge, showed no benefit and an increased rate of cardiogenic shock). --Based on this, recommendations bec...
Source: Dr. Smith's ECG Blog - December 7, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
Several Wide Complex Rhythms in One Patient. Test yoursefl: Will You See What I Did Not See?
This time I'm going to tell you that the case is mine because the mistakes were mine. I sat down to write one narrative, but as I looked at all the ECGs, I realized that some of my rhythm analyses were wrong and had to write a different narrative.Now it all looks so clear and obvious when I'm sitting down without a sick patient in front of me. But, to test yourself, I'm going to let you look at the ECGs before I explain them:1. Presenting ECG in a dialysis patient feeling weak: 2. His previous ECG: What treatment would you give?3. This happened after immediately giving Calcium: 4. This was presen...
Source: Dr. Smith's ECG Blog - December 6, 2013 Category: Cardiology Authors: Steve Smith Source Type: blogs
The LITFL Review 115
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
Welcome to the 114th edition, brought to you by:
Kane Guthrie [KG] from LITFL
Tessa Davis [TRD] from LITFL and Don’t Forget The Bubbles
Brent Thoma [BT] from BoringEM, and
Chris Nickson [C...
Source: Life in the Fast Lane - November 11, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Intensive Care LITFL review LITFL R/V Source Type: blogs
Alzheimer's Like Symptoms After Leaving the Hospital
As medical care is improving patients are surviving critical illness more often; but, if they are surviving their critical illness with disabling forms of cognitive impairment like Alzheimer's something has to be done.
+Alzheimer's Reading Room
Patients treated in intensive care with no evidence of cognitive impairment often leave with deficits similar to those like mild Alzheimer’s disease (AD).
These symptoms or deficits often persist for at least a year, according to a Vanderbilt University Medical Center study published today in the New England Journal of Medicine.
Subscribe to the Alzheimer's Readin...
Source: Alzheimer's Reading Room, The - October 5, 2013 Category: Dementia Authors: Bob DeMarco Source Type: blogs
“Arrhythmia of life”. . . and . . . “Arrhythmia of death”are one and the same !
This is the story of a 55 year old women , who was received in our CCU with a dramatic STEMI (ECG looked like an action potential ) , LV S 3 and hypotension. It was impending cardiogenic shock.Since we do not have full fledged primary PCI program , thrombolysis was planned. She had cardiac arrest immediately after starting streptokinase infusion . She was promptly shocked and revived . The ECG changes rapidly reversed(ECG -3) . Every other hemodynamic parameter got stabilised as well . To our surprise ( few hours later ) this patient was so comfortable , sat up on ...
Source: Dr.S.Venkatesan MD - June 26, 2013 Category: Cardiology Authors: dr s venkatesan Tags: cardiology -Therapeutics Cardiology -unresolved questions cardiology- coronary care STEMI-Primary PCI arrhythmia of life and death are same primary ventricular fibrillation reperfusion arrhythmia Source Type: blogs
Basic instincts in cath lab : It is too tempting to poke the non IRA . . . What shall I do ?
Doing multivessel PCI during acute STEMI is forbidden except in cardiogenic shock . (or in some very unstable patients without cardiogenic shock)
The reason
During acute MI hemodynamics are precariously balanced.We do not know yet how emergency multivessel plasty alters this .
Our initial aim should be confined to myocardial salvage in the IRA . Total myocardial revascularization is niether the priority nor its desirable.
The more time you spend within the inflamed coronary artery , more its hazardous.
Multiple stenting is prone for thrombus and migration into side branch .
Stent oppos...
Source: Dr.S.Venkatesan MD - May 19, 2013 Category: Cardiology Authors: drsvenkatesan Tags: Cardiology -Interventional -PCI cath lab tips and tricks ira vs nonira angioplasty multivessel angioplasty in stemi primary pci Source Type: blogs
The LITFL Review 102
Welcome to the 102nd edition!The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.The Most Fair Dinkum Ripper Beaut of the WeekResus.MECliff Reid over at Resus.ME smashes his way to top spot this week, as he brings us 3 great hot-of-the-press art...
Source: Life in the Fast Lane - April 23, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs
The LITFL Review 102
Welcome to the 102nd edition!
The LITFL Review is your regular and reliable source for the highest highlights, sneakiest sneak peaks and loudest shout-outs from the webbed world of emergency medicine and critical care. Each week the LITFL team casts the spotlight on the best and brightest from the blogosphere, the podcast video/audiosphere and the rest of the Web 2.0 social media jungle to find the most fantastic EM/CC FOAM (Free Open Access Meducation) around.
The Most Fair Dinkum Ripper Beaut of the Week
Resus.ME
Cliff Reid over at Resus.ME smashes his way to top spot this week, as he brings us 3 great hot-of-the-pres...
Source: Life in the Fast Lane - April 23, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Health Intensive Care LITFL review LITFL R/V Source Type: blogs
Anterior Wall MI
Anterior wall MI is a distressingly common occurrence in patients. Important clinical considerations are:
ECG
1. Anterior septal MI – V1-V3
2. Anterior MI – V1-V4
3. Lateral Anterior MI – V4-V6
Coronary involvement
left anterior descending
Cardiac areas involved
1. anterior wall of left ventricle
2. anterior 2/3 of septum
3. bundle of His
4. anterior superior division of left bundle branch
5. right bundle branch
6. posterior inferior division of left bundle branch
Clinical complications
1. bundle branch blocks
2. advanced heart blocks including Mobitz II and complete heart block
3. congestive heart failur...
Source: Inside Surgery - April 10, 2013 Category: Surgeons Authors: Editor Tags: Cardiology Source Type: blogs
The LITFL Review 101
Conclusion: Imaging and repeat imaging in sciatic doesn’t really change the management..So why do it then!Focus Article: Early Imaging After Arrest Often Finds the Culprit. Bottom line from this study: The use of an early diagnosis protocol with immediate coronary angiography and/or CT scan provided the etiology of nearly two thirds of OHCA cases.ECG of the WeekECG of the Week – It looks bad and wide – whats going on!Ultrasound PodcastULTRASOUND OF RADIUS FRACTURE! What? That’s right. Diagnose it and guide your reduction with US!TJdogmaICE 007 – another great ICE case, simple, short and infor...
Source: Life in the Fast Lane - April 8, 2013 Category: Emergency Medicine Doctors Authors: Kane Guthrie Tags: Education eLearning Emergency Medicine Featured Intensive Care LITFL review LITFL R/V Source Type: blogs
