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?...
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...
In this ECG Cases we review 10 patients who presented with bradycardia, introduce an approach to reversible causes using the BRADI mnemonic and guide you through how to use the ECG to guide management...
Which of the following 9 patients had hyperkalemia? Can you estimate how high their serum potassium was based on the ECG? Jesse MacLaren guides us through 9 ECGs underscoring the fact that while the ECG cannot rule out hyperkalemia, significant hyperkalemia often produces ECG changes in the heart rate (bradycardia, junctional rhythm), electrical conduction (PR prolongation or loss of P waves, QRS prolongation, pacemaker delays), and ST/T waves (Brugada phenocopy, peaked T waves that are narrow/pointy) that can be easily recognized. He suggests when you might pull the trigger on giving empiric calcium treatment based on the ECG finding in this month's ECG Cases...
In this CritCases blog - a collaboration between STARS Air Ambulance Service, Mike Betzner and EM Cases, Dr. Michael Misch discusses the management controversies around a challenging pediatric drowning and hypothermia case, including the nuances of rewarming, oxygenation, CPR or no CPR, the role of ECMO, dosing of epinephrine and more...
Melanie Baimel's Best Case Ever on Post-Arrest Hyperkalemia on EM Cases. Post arrest patients can sometimes be challenging. We need to think of a variety of underlying causes of the arrest, antiarrhythmics, possible cath lab activation, targeted temperature management, sedation and more. To add to this, many post arrest patients do not have ideal vital signs that require attention. In this Best Case Ever, in anticipation of our upcoming episode on A Rational Approach to Hyperkalemia Dr. Melanie Baimel describes a post arrest patient who remains bradycardic and hypotensive despite multiple pressors....