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Torsade in a patient with left bundle branch block: is there a long QT? (And: Left Bundle Pacing).

Dr. Smith's ECG Blog

CASE CONTINUED She was admitted to the ICU. Discontinue all negative chronotropic agents, since the risk of torsade is much higher with bradycardia or pauses. Smith has provided excellent overview of measuring and correcting QT interval in scenarios where QRS duration is prolonged (e.g., LBBB, ventricular pacing, etc.)." The plan: 1.

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A man in his 60s with syncope and ST depression. What does the ECG mean?

Dr. Smith's ECG Blog

The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. Syncope and Bradycardia Syncope in a 20-something woman Long QT: Do not trust the computerized QT interval when the QT is long An Alcoholic Patient with Syncope Cardiac Arrest. Is it STEMI? What is going on here?

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A middle aged man with unwitnessed cardiac arrest

Dr. Smith's ECG Blog

Because hyperkalemia kills by either VT or VF arrest, or by bradycardia with PEA arrest, this should be assumed to be VT until proven otherwise. He made it to the ICU, however the patient unfortunately expired approximately 24 hours after ICU admission. We set the machine to synchronized cardioversion.

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20-something with huge verapamil overdose and cardiogenic shock

Dr. Smith's ECG Blog

He was admitted to the ICU and was unstable, in shock, overnight. Case Continued: He was stabilized on more calcium, pressors, and high dose insulin. 3 hours later, this was recorded at a K of 2.8 mEq/L and total calcium of 14.7 mg/dL: The massive ST Elevation persists. What is going on here?

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Could you have prevented this young man's cardiac arrest?

Dr. Smith's ECG Blog

Upon arrival in the ICU, before getting Continuous Veno-Venous Hemodialysis (CVVHD), his potassium had risen again to 7.8 Hyperkalemia findings include the classic peaked T-waves, as well as the deadly B's of hyperkalemia: Broad (wide QRS), Brady (bradycardia), Blocks (AV blocks), and Bizarre. There is no ECG available from this time.

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What is this ECG finding? Do you understand it before you hear the clinical context?

Dr. Smith's ECG Blog

His temperature was brought back to normal over time in the ICU. Altered Mental Status, Bradycardia == MY Comment , by K EN G RAUER, MD ( 2/2 /2024 ): == Dr. Meyers began today’s case with the clinical challenge of asking you to identify the underlying cause of ECG #2. He was extubated and had normal neurologic function.

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Handed this ECG from triage. What will you do?

Dr. Smith's ECG Blog

The patient stabilized and was transferred for ICU admission. Learning points: Your differential for wide QRS (by itself) and bradycardia (by itself) must include hyperkalemia. Labs resulted, showing a potassium of 8.0 mEq/L, glucose of greater than 900 mg/dL, and anion gap metabolic acidosis consistent with DKA.

Nursing 115