December 4, 2013

55 year old male with chief complaint of palpitations.  Denies any chest pain, shortness of breath, diaphoresis, or syncope.  His past medical history is significant for diastolic congestive heart failure, type 2 diabetes mellitus, hypertension, and hyperlipidemia. Per patient he had a diagnosis of atrial fibrillation vs ventricular tachycardia 2 years prior, but he is unsure of which one exactly. BP: 153/83     HR: 183     RR: 18     O2 on RA: 99%     Temp: 36.3 ECG from triage is shown...

December 3, 2013

The recognition of ST-segment elevation myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) remains difficult and frustrating to both emergency medicine physicians and cardiologists.  According to the 2004 STEMI guidelines, emergent reperfusion therapy was recommended to patients with suspected ischemia and new LBBB however, the new 2013 STEMI guidelines made a drastic change by removing this recommendation.  Several papers have recently been published discussing a modified Sgarbossa's criteria and a new algorithm to help decrease false cath lab activation and/or fibrinolytic therapy but, are they ready for primetime?

November 29, 2013

62 year old male with chief complaint of weakness.  Patient had a complicated hospital course including necrotizing fasciitis which required surgical debridement and IV antibiotics.  Patient was discharged home with oral antibiotics and returned to the ED with a chief complaint of weakness, abdominal pain, and 3 weeks of loose bowel movements. BP: 100/51     HR 93     RR 16     Temp 97.2     O2 Sat 98% on RA ECG from triage is shown...

November 22, 2013

Differentiating between SVT with aberrancy versus VT can be very difficult. It is crucial to be able to make this distinction as therapeutic decisions are anchored to this differentiation. Brugada et al prospectively analyzed 384 patients with VT and 170 patients with SVT with aberrant conduction to see if it was possible to come up with a simple criteria to help differentiate between the two with high sensitivity and specificity.

November 18, 2013

The subject of this ECG of the Week is a 47 y/o hispanic female with a past medical history of type 2 diabetes mellitus, hypertension, hyperlipidemia, and morbid obesity with a chief complaint of weakness.  Per the patient she cleans houses for a living and for the past 2 weeks she gets weak and short of breath earlier in the day while cleaning houses.  She used to be able to clean all day without issues, but for the past 2 weeks this has been getting less and less.  No chest pain, vomiting, diaphoresis, or syncope.  She has never had anything like this before.  She comes to the ER today because this is her only day off.  She has not had any symptoms today. BP 156/94  HR 68 RR 14 O2 sat 100% on RA   Temp 98.7 ECG from triage is shown...

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