article thumbnail

A teenager involved in a motor vehicle collision with abnormal ECG

Dr. Smith's ECG Blog

See these publications for more information Overall, management for cardiac contusion is mostly supportive unless surgical complications develop, involving appropriate treatment of dysrhythmias and hemodynamic instability. Circulation: Cardiovascular Imaging. 2015, March 1). Myocardial contusion in an 8-year-old boy. Cramer, M.

article thumbnail

A Relatively Narrow Complex Tachycardia at a Rate of 180.

Dr. Smith's ECG Blog

I also believe that we physicians and medics are eager to treat dysrhythmias, and we want to see them even when they are not there. Circulation 2008;117(14):1897-907. Dilated pupils and hypertension are a strong clue to sympathetic overload, but don't forget anticholinergic syndromes, including tricyclics! Pollan S, Tadjziechy M.

article thumbnail

Patient with severe DKA, look at the ECG

Dr. Smith's ECG Blog

So the real QT is shorter, but the computer does not mention the U-wave, and the U-wave is as important as the T-wave in predicting cardiac dysrhythmias. mEq of K pushed fast and circulated theoretically would raise serum K immediately by 1.0 This is an extremely dangerous ECG. The K returned at 1.9 This is extremely low for DKA.

article thumbnail

An athletic 30-something woman with acute substernal chest pressure

Dr. Smith's ECG Blog

Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. Circulation. Circulation, 137(19), p.e523. (For those of you who are accustomed to the units of high sensitivity troponin (ng/L), this is equivalent to 20,956.00 Again, cath lab was not activated. 112.105718.

SCAD 52
article thumbnail

Severe shock, obtunded, and a diagnostic prehospital ECG. Also: How did this happen?

Dr. Smith's ECG Blog

mEq of K pushed fast and circulated theoretically would raise serum K immediately by 1.0 I could find very little literature on the treatment of severe life-threatening hypokalemia. There is particularly little on how to treat when the K is less than 2, and/or in the presence of acute MI. Since it takes some time (how long?) mEq/L, from 1.9

article thumbnail

Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

Smith comment: In a large randomized trial of dopamine vs. norepinephrine (11) for shock which was published after the above-mentioned recommendations, dopamine had more adverse events (especially severe dysrhythmias, and especially atrial fibrillation). Circulation. Circulation 67, No. Circulation 1970;41:623-627 9.

article thumbnail

How to wean off Beta-blockers

Dr. Sanjay Gupta

Similarly, there have been case reports of patients who were taking beta blockers to control dangerous heart rhythm disturbances and when the beta blocker was abruptly stopped it led to precipitation of ventricular dysrhythmias and even in some cases death. This is termed as ‘Acute beta blocker withdrawal syndrome’.