EMS 12-Lead

MAY 15, 2024

TCP in the ROSC Patient: False Electrical Capture at 75mA Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the second installment of a blog series showing how transcutaneous pacing (TCP) can be difficult and how you can improve your skills. Patient had an unwitnessed cardiac arrest without bystander CPR performed.

Atrial Fibrillation 132

Atrial Fibrillation Bradycardia Pacemaker Cardiac Arrest 132

EMS 12-Lead

MARCH 30, 2024

TCP In Transit: A case reviewing transcutaneous pacing, false electrical capture, and re-arrest. Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the first installment of a blog series showing how transcutaneous pacing (TCP) can be difficult, and how you can improve your skills. Current 85mA.

Cardiac Arrest 124

Cardiac Arrest Pacemaker Pulmonary Bradycardia 124

Dr. Smith's ECG Blog

MAY 5, 2023

Krantz et al authored a State-of-the-Art Review on Cardiovascular Complications of Opioid Use ( JACC 77(2):205-223, 2021 ) — in which mechanisms from Opioid Overdose that detail arrhythmia production ( up to cardiac arrest ) are elucidated — thereby providing an explanation for the unusual arrhythmias in today's case.

Bradycardia 52

Bradycardia Cardiac Arrest Arrhythmia Pacemaker 52

Dr. Smith's ECG Blog

APRIL 29, 2020

A 60-something woman presented after a witnessed cardiac arrest. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. Final Diagnosis: Cardiac Arrest due to Torsades from long QT of unknown etiology.

Cardiac Arrest 52

Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

JULY 24, 2018

One hour later (labs not yet returned), here is the ECG recorded just after the team noticed a sudden wide complex with precipitous decompensation, just before cardiac arrest: Bizarre, Brady, and Broad (wide QRS). Unfortunately, this was not recognized at this time. I believe it was this point when hyperkalemia was first suspected.

Cardiac Arrest 52

Cardiac Arrest Chest Pain Tachycardia ICU 52

Dr. Smith's ECG Blog

JULY 21, 2024

There was no evidence bradycardia leading up to the runs of PMVT ( as tends to occur with Torsades ). If there had been — a temporary atrial pacemaker could have been considered as a way of increasing the heart rate to suppress a bradycardia-dependent arrhythmia ("overdrive pacing").

Arrhythmia 132

Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 132

Dr. Smith's ECG Blog

JANUARY 26, 2020

Her vital signs were within normal limits except for bradycardia at 55 bpm. It is probably sinus bradycardia with very small/depressed P-waves and prolonged PR interval. See these other related cases: A patient with cardiac arrest, ROSC, and right bundle branch block (RBBB). Is this just right bundle branch block?

Bradycardia 52

Bradycardia Ischemia Cardiac Arrest AFIB 52

Dr. Smith's ECG Blog

OCTOBER 25, 2023

Polymorphic Ventricular Tachycardia Long QT Syndrome with Continuously Recurrent Polymorphic VT: Management Cardiac Arrest. A New Seizure in a Healthy 20-something More cases of long QT not measured correctly by computer (these are all fascinating ECGs/cases): Bupropion Overdose Followed by Cardiac Arrest and, Later, ST Elevation.

Ischemia 125

Ischemia Chest Pain Cardiac Arrest Blog 125

Dr. Smith's ECG Blog

OCTOBER 20, 2024

This patient is actively dying from a left main coronary artery OMI and cardiac arrest from VT/VF or PEA is imminent! Complete LMCA occlusion is associated with clinical shock and/or cardiac arrest. The arterial blood gas showed a lactic acidosis with a lactate level of 17mmol/L.

Cardiogenic Shock 130

Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 130

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

Osborn waves have been reported with hypercalcemia, brain injury, subarachnoid hemorrhage, Brugada syndrome, cardiac arrest from VFib — and — severe, acute ischemia resulting in acute MI ( See My Comment in the November 22, 2019 post on Dr. Smith’s Blog ). Rituparna et al — as well as Chauhan and Brahma ( Int.

Cardiac Arrest 40

Cardiac Arrest Bradycardia Chest Pain Ischemia 40

Dr. Smith's ECG Blog

APRIL 8, 2016

There is also bradycardia. Bradycardia puts patients at risk for "pause-dependent" Torsades de Pointes. Torsades in acquired long QT is much more likely in bradycardia because the QT interval following a long pause is longer still. If cardiac arrest from hypokalemia is imminent (i.e., mEq/L, from 1.9

STEMI 52

STEMI Myocardial Infarction Cardiac Arrest Arrhythmia 52

Dr. Smith's ECG Blog

MAY 5, 2022

Hyperkalemia causes peaked T waves and the "killer B's of hyperkalemia", including bradycardia, broad QRS complexes, blocks of the AV node and bundle branches, Brugada morphology, and otherwise bizarre morphology including sine wave. Steve, what do you think of this ECG in this Cardiac Arrest Patient?" With a twist.

Chest Pain 52

Chest Pain Bradycardia Cardiac Arrest STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 27, 2023

We've presented numerous examples of hyperkalemia on Dr. Smith's ECG Blog. As a reminder of why determination of the cardiac rhythm can be so challenging when there is significant hyperkalemia — I've reproduced Figure-1 from My Comment in the January 16, 2022 post in Dr. Smith's ECG Blog. WHY Isn't the QRS Wide?

Tachycardia 52

Tachycardia Document Blog Bradycardia 52

Dr. Smith's ECG Blog

MAY 26, 2023

This was a very complex case and the details are too much for an ECG Blog, but suffice it to say that, s hortly thereafter, the patient had an asystolic arrest and was resuscitated. He was placed on ECMO. Peak troponin I at 24 hours was 480 ng/L. Laddergram Illustration: The mechanism of AV block in ECG #2 is complex.

Cardiogenic Shock 98

Cardiogenic Shock Arrhythmia Blog Education 98

Dr. Smith's ECG Blog

OCTOBER 8, 2023

Smith: This bizarre ECG looks like a post cardiac arrest ECG with probable acidosis or hyperkalemia in addition to OMI. The patient died of cardiogenic shock within 24 hours despite mechanical circulatory support. Below the J-point is marked out showing the ST pathologic deviations. What was the pH and K? Potassium 4,6.

Ischemia 124

Ischemia Chest Pain Cardiogenic Shock Cardiac Arrest 124

Dr. Smith's ECG Blog

MAY 19, 2020

There is sinus bradycardia with one PVC. There is "Shark Fin morphology" I saw this and thought for certain that this was going to be an LAD or left main occlusion as etiology of arrest, and etiology of profound ST Elevation in I, II, aVL, and V3-V6, and ST depression in III, V1 and V2. She then had a 12-lead: What do you think?

Defibrillator 52

Defibrillator Circulation Plaque Cardiac Arrest 52

Dr. Smith's ECG Blog

OCTOBER 11, 2020

About two hours after admission, he suffered a cardiac arrest (whether it was VF/VT or PEA is not available) and expired. Like other cases on this blog who died before cath was done, I cannot prove that this patient had OMI. He was admitted to the cardiology floor and diagnosed with an NSTEMI. I do not accept the transfer." "It

Chest Pain 52

Chest Pain STEMI Blog Tachycardia 52

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

As we've discussed on numerous other posts in Dr. Smith's ECG Blog ( See My Comment at the bottom of the page in the May 5, 2022 post) — a growing number of conditions other than Brugada Syndrome have been found to temporarily produce a Brugada-1 ECG pattern. What are the ECG Findings of Cardiac Contusion?

Arrhythmia 52

Arrhythmia Blog Chest Pain Cardiac Arrest 52

Dr. Smith's ECG Blog

DECEMBER 15, 2015

In any case, there is bradycardia. First, what kind of arrest was this? It was a PEA or bradyasystolic arrest , not a shockable rhythm. Although most cardiac arrest from MI is due to ventricular fibrillation, some is due to high grade AV block, and so this could indeed be due to large acute STEMI. What is going on?

STEMI 40

STEMI Embolism Pulmonary Ultrasound 40

Dr. Smith's ECG Blog

MAY 6, 2019

This ECG pattern may be diagnostic of B rugada S yndrome IF seen in association with: i ) a history of cardiac arrest; polymorphic VT; or of non-vagal syncope; and / or ii ) a positive family history of sudden death at an early age; and / or iii ) a similar ECG in relatives. Bradycardia. Acute febrile illness. Hypothermia.

Chest Pain 52

Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

In addition to a spontaneous or induced Brugada-1 ECG pattern, criteria for B rugada S yndrome require one or more of the following: History of cardiac arrest, of polymorphoic VT, or of non-vagal syncope — positive family history of sudden death at an early age — a similar ECG in close relatives.

Heart Rhythm 52

Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 18, 2019

U waves may also be found in patients with LVH and/or bradycardia , or occasionally as a normal variant. Low body magnesium is often encountered in association with other electrolyte abnormalities ( ie, low sodium, potassium, calcium or phosphorus ) ; acute MI; cardiac arrest; digoxin/diuretic use; alcohol use and abuse; renal impairment.

Chest Pain 52

Chest Pain Cardiac Arrest Bradycardia Ischemia 52

Dr. Smith's ECG Blog

APRIL 15, 2019

If a patient presents with chest pain and a normal heart rate, or with shockable cardiac arrest, then ischemic appearing ST elevation is STEMI until proven otherwise. CLICK HERE — for the ESC/ACC/AHA/WHF 2018 Consensus Document on the 4th Universal Definition of MI, in which these concepts are discussed and illustrated.

Tachycardia 40

Tachycardia STEMI Chest Pain Ischemia 40

Dr. Smith's ECG Blog

APRIL 6, 2018

Written by Pendell Meyers, with edits by Steve Smith Thanks to my attending Nic Thompson who superbly led this resuscitation We received a call that a middle aged male in cardiac arrest was 5 minutes out. He was estimated to be in his 50s, with no known PMHx. He arrived with chest compressions ongoing, intubated, and being bagged.

Cardiac Arrest 52

Cardiac Arrest Tachycardia Defibrillator ICU 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiac arrest in sleep. Regardless of further evaluation, she should avoid bradycardia, AV nodal blockers, Na channel blockers, and fevers. --If 8, 2019 ) — ( Jan. 30, 2019 ) — many others.

Sudden Cardiac Death 52

Sudden Cardiac Death Heart Rhythm Article Tachycardia 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. Hypothermia can also produce bradycardia and J waves, with a pseudo-STEMI pattern. This is the 2nd ECG from the February 8, 2022 post in Dr. Smith's ECG Blog ).

STEMI 52

STEMI Bradycardia Arrhythmia Cardiac Arrest 52

Dr. Smith's ECG Blog

FEBRUARY 10, 2025

Theres sinus bradycardia, borderline PR interval, narrow QRS; normal axis/R wave progression; low precordial voltages, and subtle peaked T waves (most obvious in V2, but all T waves are symmetric with a narrow base). Theres no prior ECG to compare - but the bradycardia, prolonged PR and peaked T waves could all be from hyperkalemia.

Bradycardia 119

Bradycardia Cardiac Arrest Hypertension ICU 119

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

The patient was unconscious BEFORE the cardiac arrest, at the same time that she had strong pulses. Therefore, cardiac arrest is NOT the etiology of the coma. More cases here to highlight: [link] Middle Aged Woman with Asystolic Cardiac Arrest, Resuscitated: Cath Lab? OMI is a clinical diagnosis.

STEMI 90

STEMI Hemorrhage Cardiac Arrest Tachycardia 90

Dr. Smith's ECG Blog

FEBRUARY 18, 2025

In just 90 minutes from presentation, the patient progressed from that very subtle ECG to cardiac arrest. Dr. McLaren recently wrote an excellent blog post on a similar case. As I emphasized in My Comment in the February 27, 2023 post in Dr. Smith's ECG Blog some patients may develop everything except QRS widening.

Blood Pressure 64

Blood Pressure Blog Cardiac Arrest Bradycardia 64