Author: Dr. Hans Murcia Background: Early repolarization, also known as J-point elevation, may present with ST segment elevations similar to STEMI on ECG. Given the risks and expense of activating the Cath lab for every patient with ST elevation, it is important to recognize true STEMI from early repolarization. Study Question: How can we use…
Intro
There’s an old adage that wide complex tachycardia is VTach until proven otherwise. While this is true as do not want to miss any potentially lethal arrhythmia, it is also important to understand the differential for wide complex tachycardias so that we can tailor our potential treatments to the specific arrhythmia. It is also important to note that in any unstable patient with a wide complex tachycardia (or narrow complex tachycardia) that electricity is always safe.
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Intro
The differential for narrow complex tachycardia is extremely important as it is the most commonly seen abnormal EKG in the emergency department. It includes rhythms such as sinus tachycardia, AVnRT, AVRT, atrial flutter, ectopic atrial tachycardia (EAT), atrial fibrillation, atrial flutter, and multifocal atrial tachycardia (MAT).
The goal of this blog is to run through this differential and give some methods to differentiate the rhythms. Although we will not delve too deep into antiarrhythmics, it is important to note that electricity is safe in all unstable rhythms no matter the etiology.
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Dr. Patwari did a great review on differentiating ST elevations associated with pericarditis vs. acute MI. From medical school, I think we can recall many of the classic EKG findings that support pericarditis Diffuse ST elevations Concave upwards STE PR depressions in multiple leads (only reliable seen in viral pericarditis) PR elevation in aVR However,…
Last week’s 5-minute EKG discussion was lead by our APD, Dr. Scott Heinrich.
You get handed this EKG from a patient in triage with chest pain. Should you activate the cath lab?
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Pacemakers are becoming increasingly common as our population ages, and are seen more and more in the emergency department. The goal of this post is to summarize common pacemaker settings, the 5-letter nomenclature of pacemakers, indications for pacemaker placement, pacemaker components, common pacemaker complications (majority of blog), and lastly the management of pacemakers in the ED (including applying a magnet). …And as always, the blog ends with some medical history
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The 5-minute EKG was presented by our fan-favorite attending, Dr. Patwari. See EKG below (Answer to follow). You’re handed this EKG from triage. As always, it is important to approach an EKG in a systematic way including rate, rhythm, axis, intervals, and segments. However, the big takeaway from this EKG is that it is a…
This is a 31 year-old male who presented with palpitations. He said this has happened to him several times in the past. What is going on in this EKG and what would you do to fix it (if anything)? Here’s his EKG: 2017-08-08
Answer on Twitter.
For this week, a 44-year old female presents with trouble breathing when she walks. Here is her EKG, what’s going on here? 20170731
EKG of the Week
Okay, it’s been a while since I posted anything, but here’s a quick one. This is a 30 year-old person who presents to the ED with palpitations. What is it? Here’s the EKG.