EMDocs

JANUARY 11, 2024

Data that do not establish neurological risk stratification in the first 6 hours after CA include the patient’s age, duration of CPR, seizure activity, serum lactate level or pH, Glasgow motor subscore in patients who received NMB or sedation, pupillary function in patients who received atropine, and optic nerve sheath diameter (95.3%, 20/21).

Critical Care 91

Critical Care E-9-1-1 OR ICU 91

Dr. Smith's ECG Blog

OCTOBER 26, 2020

In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts. Coronary spasm causing massive current of injury with shark fin ECG. I would not expect ST-E to vanish in four beats with dissolving thrombus (also we know that the coronaries were clean). I suspect LAD or LM.

Coronary 40

Coronary Defibrillator ACS CAD 40

Dr. Smith's ECG Blog

AUGUST 9, 2019

Post by Smith and Meyers Sam Ghali ( [link] ) just asked me (Smith): "Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR?" Furthermore, among 35 patients with acute left main coronary artery occlusion, 9 presented with RBBB (mostly with LAFB) on the admission ECG.

Coronary 52

Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

More past history: hypertension, tobacco use, coronary artery disease with two vessel PCI to the right coronary artery and circumflex artery several years prior. This is diagnostic of ACS; it appears to be a reperfused acute inferior OMI. It is unknown when this pain recurred and became constant.

Defibrillator 138

Defibrillator Coronary STEMI CPR 138

REBEL EM

JANUARY 29, 2024

Click here for Direct Download of the Podcast Paper: Aykan AC et al. PMID: 23102885 Aykan AC et al. Because the lungs receive 100% of cardiac output, it has been hypothesized that a lower dose of thrombolytic therapy may still be effective with a better safety profile [3][4]. Clin Exp Emerg Med 2023. JACC Cardiovasc Interv 2018.

ALS 135

ALS ACS OR CPR 135

Don't Forget the Bubbles

OCTOBER 7, 2024

However, vertical flow can result in myocardial injury secondary to coronary artery spasm. This is supplied via alternating current (AC), increasing the risk of titanic contraction of skeletal muscle, leading to kids holding on to the electrical power source. AC and DC shocks may result in different injury patterns.

ACS 78

ACS Life Support OR CPR 78

Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. If this is ACS with Aslanger's pattern , the ST depression vector of subendocardial ischemia (due to simultaneous 3 vessel or left main ACS) is directed toward lead II (inferior and lateral). It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation.

ACS 52

ACS CPR CAD Heart Attack 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. And so it is wise to look at the coronary arteries. This ECG certainly looks like myocarditis, and was due to myocarditis, but missing acute coronary occlusion is not acceptable.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. Rather it is due to coronary insufficiency due to a tight left main or 3-vessel disease with inadequate coronary flow. A middle-age woman with h/o hypertension was found down by her husband.

STEMI 52

STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

Is there likely to be fixed coronary stenosis that led to demand ischemia during pneumonia? --Was It is highly associated with proximal LAD occlusion or severe left main ACS and with bad outcomes. Here is a parasternal long axis without speckle tracking: There is very good function, but the lateral wall is not in this view.

STEMI 40

STEMI CPR CAD Coronary 40

Dr. Smith's ECG Blog

MARCH 9, 2017

CPR was initiated and she subsequently entered into V-Fib storm. ACS can be a very dynamic process. For example, a coronary plaque ruptures: the vessel can undergo occlusion, spontaneous reperfusion, maybe reocclusion, again reperfusion, etc. Shortly after this ECG she suddenly went unresponsive and into V-Fib.

CPR 52

CPR ACS Coronary ED 52

Dr. Smith's ECG Blog

APRIL 18, 2025

. __ Thus , in a patient presenting with symptoms of ACS, this EKG is diagnostic of subacute LAD occlusion, possibly reperfused. Does this patient have ACS Symptoms? He suffered another cardiac arrest in the ICU with ROSC after another dose of epinephrine and one round of CPR. PCI was not performed.

ED 84

ED ACS ICU OR 84

Dr. Smith's ECG Blog

MARCH 8, 2025

The arterial pressure waveform is transduced using the coronary catheter. Normally, the diameter of the coronary artery ostium is much greater than the diameter of the catheter so that catheter engagement does not significantly impair antegrade coronary perfusion. Here is the ECG and arterial waveform during RCA angiography.

E-9-1-1 78

E-9-1-1 OR Defibrillator Coronary 78