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Unresponsive patient with bradycardia

Heart BMJ

The patient was grimacing and agitated, presented with bradycardia at 40 beats per minute, and was mottled and cold. Troponin is pending, and the ECG performed by the ED nurse is shown in figure 1. The patient was in a comatose state, the Glasgow Coma Scale Score was 8 (E2, V2, M4), with no localising neurological findings.

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Handed this ECG from triage. What will you do?

Dr. Smith's ECG Blog

An old ECG was available, confirming this wide QRS is new and appears to be a dramatically widened version of his normal, narrow QRS: I stood up from my desk and asked our nurses to draw a VBG and place the patient on a monitor. As I did this, another nurse said, “room 19 is in V-tach!” Labs resulted, showing a potassium of 8.0

Nursing 114
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The ECG told the whole story, but no one listened: ECG interpretation skills are critical to patient outcomes.

Dr. Smith's ECG Blog

One of my most talented readers is a health care assistant (a nursing assistant) who has taken a keen interest in ECGs. There is a junctional bradycardia. My most talented blog readers are paramedics because they have to put themselves on the line every time they activate the cath lab. And they teach me a lot. What was the diagnosis?

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Distractions

EMS 12-Lead

David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic (Ret) @DidlakeDW Expert contribution by Dr Robert Herman @RobertHermanMD @PowerfulMedical (Chief Medical Officer) An adult male called 911 for new-onset epigastric burning. Fire/EMS crews found him clammy and uncomfortable.

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31 Year Old Male with RUQ Pain and a History of Pericarditis. Submitted by a Med Student, with Great Commentary on Bias!

Dr. Smith's ECG Blog

However, the triage nurse wrote a note saying that he did admit to chest pain yesterday, which he vaguely endorsed when questioned again. He said that his pain does not feel like his previous episode of pericarditis, and is not related to meals. He denied chest pain, shortness of breath, nausea, fever, chills, rashes, cough, and leg pain.

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Should we activate the cath lab? A Quiz on 5 Cases.

Dr. Smith's ECG Blog

Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECG s that has not been overread by a physician. Imagine you just started your ED shift. It's a busy Friday afternoon. All of the patients presented with chest pain , and they are all in triage.

Ischemia 122
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Abstract 4134483: How succesfully can we presribe the 'four pillars' of medications for patients with heart failure with reduced LV systolic function?

Circulation

Reasons for not prescibing or discontinuing were: CKD 6, severe aortic stenosis 5, asthma 3, symptomatic bradycardia 5, hypotension 3, type1 diabetes 2, syncope 1, Raynauds 1, patient choice 8 and 6 patients died before all appropriate medications could be initiated. In 10 cases no clinical reason could be identified.It