Remove Critical Care Remove Tachycardia Remove Ultrasound
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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

He was rushed by residents into our critical care 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. ACS and STEMI generally do not cause tachycardia unless there is cardiogenic shock. He had this ECG recorded.

STEMI 52
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Noisy, low amplitude ECG in a patient with chest pain

Dr. Smith's ECG Blog

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. We can see enough to make out that the rhythm is sinus tachycardia. Written by Colin Jenkins. Edits by Willy Frick.

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A young lady with wide complex tachycardia. My first time actually making this diagnosis de novo in real life in the ED!

Dr. Smith's ECG Blog

Despite otherwise normal vital signs, she was appropriately triaged to the critical care area of the ED. She was awake, alert, well perfused, with normal mental status and overall unremarkable physical exam except for a regular tachycardia, possible rales at both bases, some mild RUQ abdominal tenderness. What is the Diagnosis?

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Regular Wide Complex Tachycarida with poor LV function and hypotension. Duration unknown. How to manage?

Dr. Smith's ECG Blog

There is a regular wide complex tachycardia. I brought the patient to the critical care area and told the providers I thought it was atrial flutter with 2:1 AV conduction, but there is an outside chance that it is VT. Remember : Adenosine is safe in Regular Wide Complex Tachycardia. If it is VT, there will be no effect.

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A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

Although the shock is no doubt partly a result of poor pump function, with low stroke volume, especially of the RV, it should be compensated for by tachycardia. They did not have an ultrasound on the ambulance (some local crews are starting to utilize POC limited US in our service areas). This is a perfect indication for atropine.