Remove Echocardiogram Remove Hemorrhage 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

More often, tachycardia with ST segment abnormalities (elevation or depression) is due to an underlying illness (PE, sepsis, hemorrhage, dehydration, hypoxia, respiratory failure, etc.). One must clearly rule out these processes before jumping on the ACS diagnosis. Furthermore, notice the well-formed Q-waves in inferior leads.

STEMI 52
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A Child with Blunt Trauma

Dr. Smith's ECG Blog

5) Myocardial contusion (edema and hemorrhage in the myocardium) which may result in dysrhythmias, blocks (especially RBBB as here), and poor cardiac contractility, including wall motion abnormalities. No further ECG, troponin, or echocardiogram was done because she was asymptomatic, and had a normal rhythm and rate.

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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

See this case: what do you think the echocardiogram shows in this case? Widespread ST-depression with reciprocal aVR ST-elevation can be cause by: Heart rate related: tachyarrhythmia (e.g., A emergent cardiology consult can be helpful for equivocal cases. POCUS showed good LV-function and no pericardial effusion.

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Cryptogenic Stroke

Dr. Sanjay Gupta

In hemorrhagic strokes, there is a bleed and therefore the blood that would have gone to supply the brain cells goes somewhere else. It will help delineate between hemorrhagic and ischemic stroke. Ultrasound – this is easily available, very portable and usually a very low risk investigation.

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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

Check : [vitals, SOB, Chest Pain, Ultrasound] If the patient has Abdominal Pain, Chest Pain, Dyspnea or Hypoxemia, Headache, Hypotension , then these should be considered the primary chief complaint (not syncope). Also consider non-hemorrhagic volume depletion, dehydration : orthostatic vitals may uncover this [see Mendu et al. (3)].