Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketThis years ACEP 2016 conference took place in Las Vegas, NV from Oct 16th – 19th. There was greater than 350 courses, labs, and workshops given throughout the week. It was impossible to make all of these great lectures, but I was able to take away some very important […]
Archive for category: ECG
Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketLead aVR is a commonly ignored lead and I have even heard of it referred to as the Rodney Dangerfield of ECG leads as it gets no respect. I have anecdotally heard many EM physicians activate the cath lab for STE in lead aVR and many cardiologists say that […]
Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: The electrocardiogram (ECG) is one of the most useful diagnostic studies for identification of acute coronary syndrome (ACS) and acute myocardial infarction (AMI). The classic teaching is ST-segment elevation myocardial infarction (STEMI) is defined as symptoms consistent with acute coronary syndrome (ACS) + new ST-segment elevation at the […]
Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: Left Bundle Branch Block (LBBB) on the ECG makes accurate recognition of ST-Elevation Myocardial Infarction (STEMI) rather difficult. The 1996 and 2004 American College of Cardiology/American Heart Association (ACC/AHA) STEMI guidelines recommended immediate reperfusion therapy for patients with potentially ischemic symptoms and new, or presumed new, LBBB. In […]
Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketBackground: As emergency providers we must be smarter than our ECG machines. Many times subtle findings on ECGs are not read by the machine, but we must be the experts at making the distinction between findings that require emergent treatment versus more benign etiologies. One specific set of diagnoses […]
A 52 year old female with a past medical history of type II diabetes mellitus and tobacco abuse presents with a chief complaint of chest pain.
According to the patient she had about 2 – 3 months of stuttering, substernal chest pain without any radiation. She described the pain as pressure-like, with activity, but that it would typically resolve after a few minutes of rest. Today she awoke with substernal chest pain that never resolved and continued in the emergency department. She quantifies her pain as 7/10 and not relieved with 2L nasal cannula of oxygen, 325mg PO aspirin, and SL NTG x3.
BP 127/89 HR 76 RR 20 O2 sat 100% on 2L NC Temp 99.3
Awake, A&Ox3, appears uncomfortable
Mild JVD on examination
RRR w/o m/r/g
2+ pulses in her extremities, no edema
ECG is shown (No prior ECG for comparison)…..
Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketAnimal bites are a common cause of injury in the United States. About 4.5 million Americans/year (5% of all traumatic wounds in the ED) will sustain a bite injury. Dog bites compromise a majority of these wounds. The classic teaching is that dog bites should not be closed primarily […]
89 year old male with PMH of hypertension, stage 3 chronic kidney disease with chief complaint of shortness of breath. Several days ago patient had a laminectomy for radicular pain. He was doing fine post-operatively and began to develop gradual shortness of breath. He had no complaints of chest pain, nausea/vomiting, fevers, diaphoresis, but did have some weakness. There were no prior ECGs for comparison.
BP: 98/48 HR: 103 RR: 18 O2 on RA: 94% Temp: 38.6
JVD to the angle of the mandible
Bilateral lower extremity pitting edema
Labs: Na 125, K+ 4.2, Creatinine 2, BNP > 2500
ECG from triage is shown… Read more →
Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketHyperkalemia is an electrolyte abnormality seen in the emergency department as well as in hospitalized patients and it can be associated with adverse clinical outcomes and death if not treated appropriately. It is important to remember that the electrophysiologic effects of hyperkalemia are directly proportional to both the absolute […]
Facebook Twitter Google+ Pinterest LinkedIn Reddit PocketElectrocardiography is a fundamental part of cardiovascular assessment. It is an essential tool for investigating cardiac arrhythmias and ischemia. Just because electrocardiography is a basic skill in EM doesn’t mean that our skills should be basic…we must be the EXPERTS! Below is a summary of some ECG basics including: ECG […]