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Brachial artery approach for managing retroperitoneal bleed following coronary intervention for STEMI

The British Journal of Cardiology

We present the case of a man in his 50s, admitted with cardiac arrest secondary to inferolateral STEMI. Successful PPCI was performed via right femoral artery, with access gained under ultrasound guidance.

STEMI 52
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1 hour of CPR, then ECMO circulation, then successful defibrillation.

Dr. Smith's ECG Blog

I suspect this is Type 2 MI due to prolonged severe hypotension from cardiac arrest. The ways to tell for certain include intravascular ultrasound (to look for extra-luminal plaque with rupture) or "optical coherence tomography," something I am entirely unfamiliar with. A list of conditions that can cause this is below.

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Severe shock, obtunded, and a diagnostic prehospital ECG. Also: How did this happen?

Dr. Smith's ECG Blog

On arrival, the patient was in shock, was intubated, and had an immediate cardiac ultrasound. What does a heart look like on ultrasound when the EKG looks like that? Here you go: It's not the world's greatest cardiac ultrasound video, but it does appear to show poor function and low volume. How would you treat?

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Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. She was defibrillated and resuscitated. ng/mL [IQR: 0.46, 2.35].

Plaque 52
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ECG with Aslanger's Pattern. CT Pulmonary Angiogram Reveals LAD Ischemia (Septal Transmural). But this is not Contradictory.

Dr. Smith's ECG Blog

Aslanger added in the limitations in his article: " Theoretically, an isolated basal inferoseptal infarction or an acute inferior MI in the presence of previous infarctions that may change the orientation of lesion vector can also cause a similar picture. Could this be Septal STEMI (STE in V1 and aVR, with reciprocal ST depression in V4-V6?),

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40-something with severe CP. True + vs. False + high lateral MI. ST depression does not localize.

Dr. Smith's ECG Blog

He had a previous MI with cardiac arrest 2 years prior. There was an old ECG for comparison: One year prior with no ST segment abnormalities A bedside cardiac ultrasound was done by the emergency physician. Case A 47 year old male called 911 for severe chest pain. He was clammy and looked unwell.

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Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

A bedside cardiac ultrasound was normal, with no effusion. 4 Unfortunately, this article provides no electrocardiographic, echo, or angiographic data, so it is not certain that these high levels were in the absence of acute MI. He had the following EKG recorded: Low voltage, suggests effusion.