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It turns out that the conventional algorithm was also worried, and because of that, the patient was brought to the criticalcare area. The STE in V1 is out of proportion to the S-wave, so V1 is also very worrisome (something I did not see on my phone). Probably significant infarction.
The software generates accurate reports in minutes using inexpensive devices, enabling emergency medicine, criticalcare, internal medicine, hospitalists and primary care physicians to make informed care decisions at the bedside. James Hillis, MBBS, DPhil, director of Clinical Operations at Mass General Brigham AI.
Given the presentation, the cardiologist stented the vessel and the patient returned to the ICU for ongoing criticalcare. Echocardiogram showed LVEF 66% with normal wall motion and normal diastolic function. Lesions less than 70% are generally considered to be non-flow limiting. Two subsequent troponins were down trending.
He was rushed by residents into our criticalcare room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. He had this ECG recorded.
First troponin I returns at 48 ng/L ECG 5 143 min No significant change ECG 6 261 min Same hs Troponin I profile (peaked at 1849): Formal Echocardiogram SUMMARY The estimated left ventricular ejection fraction is 74 %. Eur Heart J 2018. Full text link. The estimated pulmonary artery systolic pressure is 27 mmHg + RA pressure.
Colin is an emergency medicine resident beginning his criticalcare fellowship in the summer with a strong interest in the role of ECG in criticalcare and OMI. Written by Colin Jenkins. Edits by Willy Frick. This confirms the suspicion of prior anterior OMI. The thrombus is circled below in red.
Here is the post PCI EKG: And a few hours after that: The post PCI echocardiogram showed: Normal estimated left ventricular ejection fraction, 57%. Plus he did a 2 year combined EM Cardiology and CriticalCare Fellowship. Regional wall motion abnormality-mid to basal inferior wall.
This EKG was recorded as part of a standing order for criticalcare. After discussing all of the above with ED staff, we have made a decision to get stat echocardiogram and assess overall LV function and wall motion abnormalities and defer cath lab activation at the time." He had been smoking an opiate and suddenly collapsed.
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