What is this ECG finding? Do you understand it before you hear the clinical context?
Written by Pendell MeyersFirst try to interpret this ECG with no clinical context:The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. After an initially narrow QRS, there is a very large abnormal extra wave at the end of the QRS complex. These are Osborn waves usually associated with hypothermia. There is also large T wave inversion and long QT.Clinical context:A man in his 50s was found down outside in the cold, unresponsive but with intact vital signs. He was intubated on arrival at the ED for mental status and airway protection due to vomiting. Initial vitals included...
Source: Dr. Smith's ECG Blog - February 2, 2024 Category: Cardiology Authors: Pendell Source Type: blogs
Should we activate the cath lab? A Quiz on 5 Cases.
Imagine you just started your ED shift. It ' s a busy Friday afternoon. Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECGs that has not been overread by a physician. All of the patients presented with chest pain, and they are all in triage.Which, if any, of these patients has OMI, with myocardium at risk and need for emergent PCI?ECG#1ECG#2ECG#3ECG#4ECG#5See outcomes of all 5 below, with the Queen of Hearts AI Bot interpretation.YOU TOO CAN HAVE THE PM Cardio AI BOT!! (THE PM CARDIO OMI AI APP)If you want this bot to help you make the early diagnosis of OMI and...
Source: Dr. Smith's ECG Blog - October 8, 2023 Category: Cardiology Authors: Magnus Nossen Source Type: blogs
A man in his 70s with weakness and syncope
DiscussionBrugada Type 1 ECG changes are associated with sudden cardiac death (SCD) and the occurrence of ventricular dysrhythmias. Patients that develop a Type 1 pattern without any precipitating or provoking factors have a risk of SCD of 0.5-0.8% per year. In patients that only have this pattern induced by a sodium channel blocking agent have a lower rate of SCD (0 - 0.35% per year)[1]. Drugs that have been associated with Brugada ECG patterns include tricyclic antidepressants, anesthetics, cocaine, methadone, antihistamines, electrolyte derangements, and even tramadol. [2]. Our patient had a Brugada Type ...
Source: Dr. Smith's ECG Blog - July 22, 2023 Category: Cardiology Authors: Pendell Source Type: blogs
Reviews – Recent Books
Technically, it’s one book that I recently read. Not an especially long read, but a hard one in many ways.
The title, Where You’ll Find Me, published in 2015, is an account of the rescue attempt of a hiker named Kate Matrasova, a New York City-based hiker who was attempting to traverse five peaks in New Hampshire’s Presidential Range. By all accounts, she was a physically fit, experienced hiker who had been to a number of different places worldwide where the hiking challenges were brutal.
Unfortunately, her talent and experience didn’t account for the challenge of these mountains. The Presidential Range is no...
Source: Qui Interrogat - March 24, 2023 Category: Nursing Authors: Walt Trachim Tags: Uncategorized Source Type: blogs
Unconscious + STEMI criteria: activate the cath lab?
Case submitted and written by Dr. Mazen El-Baba and Dr. Evelyn Dell, with edits from Jesse McLarenEMS brought a John Doe, in his 30s, who was found in an urban forest near a homeless encampment on a cool fall day. There were no signs of trauma on scene or on the patient. EMS reported an initial GCS of 8 with pupils equal and reactive. The patient had a witnessed generalized tonic-clonic seizure leading to GCS 4.Vitals: HR 45; systolic BP was 110-120; irregular respiratory rate; oxygen saturation was normal; tympanic temperature 30; glucose was 6. In the resuscitation room, the patient had another seizure that stopped after...
Source: Dr. Smith's ECG Blog - January 21, 2023 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Fight Aging! Newsletter, January 16th 2023
Conclusions
Implanted Hair Follicle Cells Produce Remodeling of Scar Tissue
Assessment of Somatic Mosaicism as a Biomarker of Aging
The Gut Microbiome of Centenarians
https://www.fightaging.org/archives/2023/01/the-gut-microbiome-of-centenarians/
The state of the gut microbiome is arguably as influential on health as exercise. Various microbial species present in the gut produce beneficial metabolites, such as butyrate, or harmful metabolites, such as isoamylamine, or can provoke chronic inflammation in a variety of ways. An individual can have a better or worse microbiome, assessing these and other...
Source: Fight Aging! - January 15, 2023 Category: Research Authors: Reason Tags: Newsletters Source Type: blogs
Commentary on More Drastic Scenarios of Partial Brain and Full Body Replacement
Is outright replacement of tissues a viable option for the treatment of aging? There are factions within the longevity-interested community who think that the paths to either (a) engineering replacement brain tissue for parts of the brain not involved in memory, or (b) transplantation of an old head onto a young body or brain into a young body, are short enough to be worth pursuing, where "short enough" means a few decades of work given sufficient funding. To my mind, major surgery of the sort implied by replacement of large sections of tissue or entire organs is something to be avoided in later life, given the risks and c...
Source: Fight Aging! - January 10, 2023 Category: Research Authors: Reason Tags: Daily News Source Type: blogs
Patient in Single Vehicle Crash: What is this ST Elevation, with Peak Troponin of 6500 ng/L?
A 30-something male was involved in a single vehicle crash and had multiple injuries. As a routine part of his critical trauma evaluation, he had an ECG recorded:There is an rSR " in V1 and V2, with downsloping ST segment and inverted T-wave which is very similar to a Brugada Type 1 phenocopy. I was shown this ECG and thought that it could perhaps be Brugada, butI was more suspicious for Right Ventricular (RV) myocardial contusion. The RV is the most anterior part of the chest and is most likely to be contused with anterior chest trauma. Moreover, this degree of ST Elevation is very unusual for B...
Source: Dr. Smith's ECG Blog - November 25, 2022 Category: Cardiology Authors: Steve Smith Source Type: blogs
Responding to Hypothermia
In our last post we looked at some of the causes of hypothermia, both typical and atypical. Then we talked a bit about the recognition of the hypothermia progression and what patients might look, feel and act like as they progress through their hypothermic condition.
Now let’s look at some of the guidelines for treating our hypothermia victims.
On the surface, treating hypothermia might seem deceptively simple. The treatment of mild hypothermia often is simple. Bring them in, stop the cooling and rewarm them. But as we progress into moderate and severe hypothermia, things get more complicated. Here are 12 gui...
Source: The EMT Spot - November 14, 2022 Category: Emergency Medicine Authors: Steve Whitehead Tags: EMT Source Type: blogs
Wrong Medicine
Some of the stacks of trip reports were nearing four feet high and they filled the musty closet. Dividing them up, we started sorting through them in earnest. The dates indicated that the calls had been run between 1972 and 1978. Most of the narratives were as brief as the treatment lists.
Hall Ambulance’s station one was an older house in an early residential area of Bakersfield, California. It had been, at one time, the residence of the company’s owner, Harvey Hall. In the early days of the ambulance service, Harvey had both lived in the home and run his fledgling ambulance service out of it.
One of the crews s...
Source: The EMT Spot - November 10, 2022 Category: Emergency Medicine Authors: Steve Whitehead Tags: EMT Source Type: blogs
A man in his 40s with multitrauma from motor vehicle collision
DiscussionThis is a case where clinical context is of vital importance, because the EKG manifestations of cardiac contusion are fairly unpredictable. Intramyocardial hemorrhage, edema, and necrosis of myocardial muscle cells are characteristics of cardiac contusion. All of these cause troponin elevation, making troponin a very specific marker for cardiac injury. It is suggested that a troponin that is within normal reference range at about 4-6 hours from the inciting event suggests strongly the absence of cardiac injury in blunt chest trauma (Sybrandy).The EKG is not generally sensitive for cardiac contusion. The right ven...
Source: Dr. Smith's ECG Blog - August 6, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
A man in his 60s with dizziness, nausea, chest pain, and LBBB
Submitted and written by Parker Hambright MD, peer reviewed by Meyers, McLaren, Grauer, SmithA man in his late 60s called EMS for acute dizziness, nausea, vomiting, and chest pain shortly after beginning his morning exercise. The symptoms lasted for only about 15 minutes and then resolved spontaneously. He was brought to the ED and evaluated in less than one hour from onset of symptoms. His history included known CAD, HTN, HLD, prior MI with LAD stent, AAA repair, and reported dizziness/vertigo.Here are his EMS and ED triage ECGs (unclear whether symptoms still present or resolved at time of these ECGs, but it seems that s...
Source: Dr. Smith's ECG Blog - August 1, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
See what happens when the consultant is " Not convinced of STEMI "
Sent by Arjun V, written by Pendell Meyers, edits by SmithA man in his early 40s with history of HTN and obesity suffered sudden out of hospital cardiac arrest. EMS arrived and found him in VF. He was defibrillated successfully, but had several more episodes of VF arrest on the way to the Emergency Department. Here are some examples of his prehospital rhythms:At the ED, sustained ROSC was achieved. He was intubated with minimal available neurologic exam.He had several ECGs recorded in the ED soon after ROSC:The ECGs show likelyAFib with RBBB morphology. There isprofound right axis deviation, which likely r...
Source: Dr. Smith's ECG Blog - July 13, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
Inferior ST elevation with reciprocal change: which of these 4 patients has Occlusion MI?
Written by Jesse McLaren, with comments by Smith and Grauer Four patients presented with cardiorespiratory symptoms, with inferior ST elevation and reciprocal change on their ECG. Which patient had occlusion MI? Note: according to the STEMI paradigm these ECGs are easy, but in reality they are difficult. First let ’s start with each ECG without clinical context. What do you think of each ECG? ECG 1: ECG 2:ECG 3:ECG 4:Now let ’s introduce some clinical context. How would this change management? Patient 1: 30 year old previously healthy, presenting with syncope, now asymptomatic with n...
Source: Dr. Smith's ECG Blog - May 23, 2022 Category: Cardiology Authors: Jesse McLaren Source Type: blogs
Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?
Submitted and written byDestiny Folk MD, peer reviewed by Meyers, Smith, Grauer, McLarenA man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. He complained of generalized weakness and left lower extremity numbness. He reported that 12 hours prior to arrival he used fentanyl and cocaine. He reported difficulty walking and felt as if his left leg was “asleep.” He denied any chest pain or shortness of breath and stated he felt at his baseline yesterday prior to drug use. On arrival in the ED, he wa...
Source: Dr. Smith's ECG Blog - May 5, 2022 Category: Cardiology Authors: Pendell Source Type: blogs
