cardiology emergency medicine

ECG Cases 36 – PACER Mnemonic for Approach to Pacemaker Patients

In this month's ECG Cases blog Dr. McLaren explains the PACER mnemonic approach to patients with pacemakers: Pacemaker spike: is it appropriately presence/absent, is there pacemaker-mediated tachycardia (apply magnet) or is there failure to pace (apply magnet to stop sensing, cardio consult)? Aware (sensing): is it normal, is there oversensing (underpacing: apply magnet) or undersensing (treat reversible causes, cardio consult). Capture: if there are pacemaker spikes is there capture, or failure to capture (treat reversible causes, cardio consult). ECG 12 lead: are there signs of hyperkalemia (extra wide QRS, peaked T) or Occlusion MI (Modified Sgarbossa Criteria) that need immediate treatment. Rest of patient: is there a complication of pacemaker insertion related to the pocket (hematoma, infection), lead (pneumothorax, DVT), or heart (pericardial perforation), or is there an emergency unrelated to the pacemaker (eg dehydration, sepsis, GI bleed)...

By |2022-10-11T11:25:43-04:00October 11th, 2022|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine, Medical Specialty|Tags: , , , |0 Comments
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ECG Cases 35 – ECG Approach to Takotsubo Syndrome

Takotsubo Syndrome is usually triggered by an emotional or physical stress leading to acute catecholaminergic myocardial stunning. The initial ST elevation phase of Takotsubo Syndrome mimics Occlusion MI, can not be distinguished by patient factors or POCUS findings, and requires immediate angiogram. The subsequent phase of Takotsubo Syndrome has T wave inversion in an apical distribution, which can mimic reperfusion, but often has very deep T wave inversions and a very long QT interval. Takotsubo Syndrome is a retrospective diagnosis of exclusion—with an angiogram ruling out occlusion, a ventriculogram showing apical ballooning, and a follow up echo showing recovery of LV function. Complications of Takotsubo Syndrome include LV failure, apical thrombus, and polymorphic VT from long QT. Jesse McLaren guides us through 10 ECGs to elucidate these important take home points...

By |2022-09-13T10:51:58-04:00September 13th, 2022|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: , , , , , , |0 Comments
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ECG Cases 34 – ECG Interpretation in Aortic Dissection

Which patients with ECG evidence of coronary occlusion require a CT scan to rule out aortic dissection? What are the range of ECG findings in acute aortic dissection and how do they change management? Dr. Jesse McLaren guides us through 9 cases to answer these and other questions on ECG interpretation in aortic dissection...

By |2022-08-16T09:14:54-04:00August 16th, 2022|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine, Medical Specialty|Tags: , , , |0 Comments
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Ep 172 Syncope Simplified with David Carr

In this main episode podcast, Dr. David Carr joins Anton to give us his simplified approach to syncope based solely on history, physical and ECG to help guide disposition decisions.  We answer questions such as: What features have the best likelihood ratios to help distinguish syncope from seizure? What key clinical features on history and physical exam can help us distinguish orthostatic and reflex syncope from the more sinister cardiac syncope? What is the best approach to ECG interpretation for the patient who has presents with syncope? Are syncope clinical decision tools any better than physician gestalt? and many more.... Please support EM Cases by giving a donation: https://emergencymedicinecases.com/donation/

By |2024-04-02T22:32:06-04:00August 2nd, 2022|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Uncategorized|Tags: , , , , , , , , |4 Comments
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EM Quick Hits 40 – GI Balloon Tamponade, SVT and Troponin, Falls in Older Patients, Vertical Vertigo, VAFEI Airway

In this month's EM Quick Hits podcast: Anand Swaminathan on GI balloon tamponade preparation and indications, Jesse McLaren on why troponin is rarely useful in SVT, Christina Shenvi on why we should not use the term "mechanical fall" in older patients, Nour Khatib & Jonathan Wallace on rural vertical vertigo case and Reuben Strayer on VAFEI - Video-Assisted Flexible Endoscopic Intubation for the anatomically challenging airway...

By |2022-07-19T12:55:32-04:00July 19th, 2022|Categories: Cardiology, EM Cases, EM Quick Hits, Emergency Medicine, Gastroenterology, Medical Specialty, Neurology, Resuscitation, Special Populations|Tags: , , , , , , , |1 Comment
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ECG Cases 33 Brugada Syndrome: 3-Step Approach to Diagnosis and Management

Jesse McLaren guides us through 7 cases and explains his 3-step approach to diagnosing and managing Brugada syndrome in this month's ECG Cases blog...

By |2022-07-19T12:07:33-04:00July 19th, 2022|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: , , , , |1 Comment
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Ep 171 Posterior Stroke, EP Lead, HEAR Score, Ketamine for Suicidal Ideation, Peer Support Workers – Highlights from Calgary EM Hodsman Lecture Day

In this special edition main EM Cases podcast episode we feature the highlights from live podcasts recorded at Calgary EM during their annual Hodsman Lecture Day, covering a variety of current EM topics: The challenges of posterior circulation stroke (PCIS); Emergency Physician Lead to improve ED overcrowding, access block and job satisfaction; When not to order a troponin - The HEAR Score; Ketamine to relieve suicidal ideation and reduce acute risk; Peer Support Workers for ED patients with mental health issues and substance use disorder, plus a description of the Pathway to Peers program...

By |2022-10-29T16:29:14-04:00July 5th, 2022|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Psychiatry, Special Populations|Tags: , , , , , , , , |1 Comment
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EM Quick Hits 39 Overdiagnosis, Lytics for Submassive PE, Pericardial Effusion, Hemophilia Treatment

In this month's EM Quick Hits podcast Justin Morgenstern & Eddy Lang discuss the problem of overdiagnosis in EM, Anand Swaminathan's approach to indications and dosing of thrombolytics for submassive (intermediate risk) pulmonary embolism, Tahara Bhate's QI Corner on a patient with unexplained shortness of breath, Brit Long on emergency treatment of the bleeding hemophilia patient...

By |2023-02-06T12:51:13-05:00June 21st, 2022|Categories: Cardiology, EM Cases, EM Quick Hits, Emergency Medicine, Hematology, Medical Specialty, Respirology|Tags: , , , , |5 Comments
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ECG Cases 32 Prehospital ECG pearls and pitfalls

In this ECG Cases blog we review 8 cases of patients with prehospital ECGs and explore prehospital ECGs for diagnosing STEMI, Occlusion MI, false STEMI, code STEMI, dynamic ischemic changes, truncated voltages. Can you avoid the pitfalls and spot the pearls that help to make the diagnosis?

By |2022-06-21T10:48:55-04:00June 21st, 2022|Categories: Cardiology, ECG Cases, EM Cases, Emergency Medicine|Tags: , , , , , , , |0 Comments
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Ep 170 Cardiac Arrest – PoCUS Integration, Communication Strategies, E-CPR, Calling the Code

In this part 2 of our 2-part podcast series on Cardiac Arrest - The When, Why & How, we discuss some of the finer art of cardiac arrest care and answer questions such as: how should we best communicate to EMS, the ED team and the family of the patient to keep the team focused, garner the most important info and keep the flow of the code going? How should we integrate PoCUS into cardiac arrest care so we do not interrupt the core components, yet we gain valuable data? What are the indications for consideration of ECPR/ECMO in cardiac arrest? What factors need to be taken into consideration to decide on when to terminate resuscitation of the cardiac arrest patient - when to call the code? and many more...

By |2022-10-23T08:02:12-04:00June 7th, 2022|Categories: Cardiology, EM Cases, Emergency Medicine, Episodes, Medical Specialty, Resuscitation, Ultrasound|Tags: , , , , , , , , |1 Comment
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