Remove Cardiac Arrest Remove Chest Pain Remove Ultrasound
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Two patients with chest pain and RBBB: do either have occlusion MI?

Dr. Smith's ECG Blog

Written by Jesse McLaren Two patients in their 70s presented to the ED with chest pain and RBBB. Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths. Do either, both, or neither have occlusion MI? Vitals were normal.

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A woman in her 70s with chest pain

Dr. Smith's ECG Blog

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. Bedside ultrasound is another very important piece. Do you activate the Cath Lab?

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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

Written by Pendell Meyers and Peter Brooks MD A man in his 30s with no known past medical history was reported to suddenly experience chest pain and shortness of breath at home in front of his family. He had multiple cardiac arrests with ROSC regained each time. Now another, with ultrasound. What is the Diagnosis?

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Missed myocardial infarction with subsequent cardiac arrest

Dr. Smith's ECG Blog

There is no way to tell the difference between GI etiology of chest pain and MI. Such T-waves are almost always reciprocal to ischemia in the region of aVL (although aVL looks n ormal here) , and in a patient with chest pain are nearly diagnostic of ischemia. An emergency cardiac ultrasound could be very useful.

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Cardiac arrest, LBBB with STEMI on the ECG, but no Acute Coronary Syndrome!

Dr. Smith's ECG Blog

This 80 year old with a history of CABG had a cardiac arrest. He did not state he had chest pain, but, then again, he couldn't remember anything. We did a bedside cardiac ultrasound. The ECG and ultrasound could not have been differentiated from acute plaque rupture with occlusion of the RCA.

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LBBB: Using the (Smith) Modified Sgarbossa Criteria would have saved this man's life

Dr. Smith's ECG Blog

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. On arrival, GCS was 13 and the patient complained of ongoing chest pain. Vitals were HR 58 BP 167/70 R20 sat 96%.

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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. On medic arrival, she walked out of the house in no distress, but was diaphoretic.

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