Remove Chest Pain Remove Hemorrhage Remove Tachycardia
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Young man with Gunshot wound to right chest with hemorrhagic shock, but bullet path not near heart

Dr. Smith's ECG Blog

A young man presented with a gunshot wound to the right chest, with hemo-pneumothorax and hemorrhagic shock. He got a chest tube and intubation and massive transfusion and stabilized. CT of chest showed the bullet path through his right lung but nowhere near his heart. But he did get an EKG: What is this?

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Tachycardia must make you doubt an ACS or STEMI diagnosis; put it all in clinical context

Dr. Smith's ECG Blog

This 54 year old patient with a history of kidney transplant with poor transplant function had been vomiting all day when at 10 PM he developed severe substernal crushing chest pain. ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. He had this ECG recorded. Are the lungs clear?

STEMI 52
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Wide Complex Tachycardia. What is the Diagnosis?

Dr. Smith's ECG Blog

A man in his 40's with a h/o coronary disease complained of sudden dizziness and chest pain. Alternatively, it could be posterior fascicular ventricular tachycardia. Either the PSVT was broken and restarted, or there is sinus tachycardia. Maybe the patient has dehydration, sepsis, hemorrhage, or PE.

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A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

Chest trauma was suspected on initial exam. The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia. Massive Transfusion for Motorcycle Collision with Hemorrhage, Troponin Elevated. RBBB in blunt chest trauma seems to be indicative of several RV injury. ST depression.

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90 year old with acute chest and epigastric pain, and diffuse ST depression with reciprocal STE in aVR: activate the cath lab?

Dr. Smith's ECG Blog

The best course is to wait until the anatomy is defined by angio, then if proceeding to PCI, add Cangrelor (an IV P2Y12 inhibitor) I sent the ECG and clinical information of a 90-year old with chest pain to Dr. McLaren. A slightly prolonged QTc ( although this is difficult to assess given the tachycardia ).

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A woman in her 20s with syncope

Dr. Smith's ECG Blog

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? It is difficult to tell if there is collapse during diastole due to the patient’s tachycardia. MY Thoughts on the ECG in Figure-1: The rhythm in ECG #1 — is sinus tachycardia at ~125/minute.

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46 year old with chest pain develops a wide complex rhythm -- see many examples

Dr. Smith's ECG Blog

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. The patient continued having chest pain. These diagnoses were not found in his medical records nor even a baseline ECG.