Cardiovascular
ECG Cases 61 ACLS Dysrhythmia Pitfalls Part 4: Stable Wide Complex Tachycardia
In this month's ECG Cases Dr. Jess McLaren explains how to differentiate various causes and mimics of Wide Complex Tachyardia: Artifact can mimic wide complex tachycardia, but have unaffected leads recorded at the same time, and regular narrow QRS complexes marching through the noise. Too wide or not fast enough? Consider hyperkalemia (empiric calcium) or sodium channel toxicity (empiric sodium bicarbonate). Regular wide complex tachycardia driven by P waves? Treat the secondary cause of sinus tachycardia. VT vs SVT? If the wide complex tachycardia is regular and not driven by P waves, and the differential is VT vs SVT, assume VT regardless of age or hemodynamic instability (eg fascicular VT in young patients) and much more...Please consider a donation to help ensure we continue to provide high quality Free Open Access Medical Education here: https://emergencymedicinecases.com/donation/
Ep 215 Cardiac Arrest Update: Beyond the 2025 Guidelines Part 1: CPR, Defibrillation and Ventilation
In this EM Cases update on cardiac arrest management, Dr. Sheldon Cheskes and Dr. Rob Simard join Anton to walk us through the evolving science and bedside practicalities of cardiac arrest management in the wake of the 2025 ACLS Guidelines. They answer questions such as: What are the most common failures in CPR quality, and how can we recognize and correct them in real time? Should we employ head up CPR, and if so how? How should we interpret ETCO₂ during cardiac arrest, and why shouldn’t we chase a single number? How can we minimize peri-shock pauses and optimize defibrillation success at the bedside? Is the traditional two-minute CPR cycle too rigid, and should we be shocking earlier in cases of refibrillation? What is the evidence behind dual sequential external defibrillation (DSED), and when should we use it? After 3 shocks or earlier? How does hyperventilation during cardiac arrest harm patients, and what strategies can reliably prevent it? What is compression-adjusted ventilation (CAV), and how can it improve ventilation consistency during resuscitation? What is the optimal dose of epinephrine in patient with Ventricular Fibrillation? and many more... Please donate to EM Cases to ensure ongoing Free Open Access Medical Education here: https://emergencymedicinecases.com/donation/ This is a deep dive into the critical inflection points in resuscitation where small changes in technique and decision-making may have the greatest impact on outcomes.
ECG Cases 60 – ACLS arrhythmia pitfalls, part 3: unstable tachycardia, cardiovert?
This is the third in a series of blog posts on the pitfalls of ACLS algorithms for adults with a pulse, and how a systematic approach to 12-lead ECG can help with ECG acquisition, interpretation, and application. The first looked at unstable bradycardia, the second stable bradycardia, and this one will look at unstable tachycardia. The ACLS algorithm for unstable tachyarrhythmia is simple: immediate cardioversion. This works well if it is a primary tachyarrythmia that is causing the instability (eg SVT or VT), but there are a number of pitfalls in this assumption. ECG acquisition: is it actually a tachy-arrhythmias? Artifact can mimic a tachy-arrhythmia. This can be identified by unaffected leads recorded at the same time, and narrow QRS complexes marching through the noise ECG interpretation: is the tachy-arrhythmia a primary electrical problem? There are other tachycardias in unstable patients that may fail to respond to cardioversion: AF (irregularly irregular rhythm), where the patient’s instability may be related to a secondary cause Sinus tachycardia (in response to a secondary cause): can best be identified by upright P waves in II and biphasic P waves in V1. ECG application: Is the rhythm causing the instability, or is there a secondary cause – including one that might be revealed by the 12-lead, like hyperkalemia or occlusion MI? For live and highly interactive ECG courses to elevate your skills - including online courses, or an in-person pre-conference course at CAEP, go to www.heartsECGcourse.com
ECG Cases 59 – ACLS Dysrhythmia Pitfalls Part 2: Stable Bradycardia? Or Dangerous Bradycardia Requiring Pacemaker?
Five patients presented with bradycardia and normal blood pressure. How does ECG interpretation change management? Despite apparent stability, which require immediate treatment and which require admission for a pacemaker?...
EM Quick Hits 69 Pediatric Urinary Retention & Acute Transverse Myelitis, Post-Dural Puncture Headache, Med Mal Cases: Clenched Fist Injury, IV Thrombolysis for Minor Stroke, EM Leadership Spotlight #4
On this month's EM Quick Hits podcast: Deborah Schonfeld on the differential diagnosis and work up of pediatric urinary retention & acute transverse myelitis, Jesse McLaren on his Tryptic Approach to Occlusion MI Diagnosis, Matthew McArthur on recognition and management of post-dural puncture headache, Joseph Yasmeh on Med Mal Cases: Clenched fist injury, Brit Long on IV thrombolysis for minor strokes and Victoria Myers & Lauren Westafer on mentorship and what it means to be a physician leader... Please consider a donation to EM Cases to support high quality Free Open Access Medical Education here: https://emergencymedicinecases.com/donation/
ECG Cases 58 – ACLS Dysrhythmia Pitfalls, Part 1: Unstable Bradycardia – BRADI mnemonic
In this ECG Cases blog with Dr. Jesse McLaren we go through exemplary cases and look for reversible causes of secondary BRADIcardias, some of which can be identified on 12-lead ECG: BRASH/hyperkalemia requiring empiric calcium, Reduced vitals requiring support (eg hypoxia, hypothermia), Acute coronary occlusion (especially inferior/posterior) requiring reperfusion, Drugs requiring withholding or reversal, and ICH requiring surgery or Infection (eg lyme) requiring antibiotics...
