Archive for May2014

Pulsus Paradoxus: Cardiovascular Function and Assessment

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Cardiovascular Assessment: Pulsus Paradoxus Assessing cardiac function, blood pressure and hemodynamic status play an important role during our overall patient assessment and treatment. Although 12 lead ECG evaluation is an essential part of patient assessment, especially cardiac etiology, understanding basic cardiac function plays a major role during treatment and overall patient status. During normal hemodynamic […]

Understanding Atropine

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As requested, during our previous Adenosine discussion, we will briefly review, Parasympathetic stimulation and Atropine pharmacodynamics on the heart. ACETYLCHOLINE (ACh) is one of the Neurotransmitters, a chemical signal, used by the Central Nervous System, which has many effects on the body, from stimulating muscle contraction, inducing peristalsis (digestion), Bile release by the liver, and […]

Masters Case #02: 60 Year Old Female – Chest Pain, Hx of Pericarditis

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***Update: The conclusion for this case is now posted here.*** This is the second in our occasional series of Masters Cases. These are some of the toughest ECG’s we have seen and that is reflected in both the level of responses that are expected along with the depth of the discussions that will entail. For […]

Understanding Adenosine (Adenocard)

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So, recently, I was involved in a conversation, where the topic of Adenosine administration came up. It seems like there is a misunderstanding regarding its use and mechanism of action. Although this is not our classic ECG interpretation topic, I believe its worth talking about for a bit. Adenosine, a Class V antiarrhythmic from the […]

76 year old male with chest pain and “peanut allergy” that turns out to be STEMI

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EMS is dispatched to the residence of a 76 year old white male with a chief complaint of chest pain. Upon patient contact the patient is found sitting on his couch, alert and oriented to person, place, time and event with GCS of 15. The patient appears to be in no distress, advising he believes […]

Conclusion to Masters Case #01

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I apologize for the giant delay and I know it’s a pain when these cases are so spread out. This is the conclusion to Masters Case #01; be sure to check out the original post first if you haven’t yet done so. This was a tough one and I didn’t take the decision to call these […]

QRS AXIS DETERMINATION

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During ECG interpretation, cardiac Axis, or direction of electrical impulses, may be normal (physiologic) or abnormal (pathologic), suggesting abnormal cardiac conductivity. Although every deflection obtained on the ECG will have an axis, we will focus on the ventricular axis. When we think of our cardiac monitoring lead placement, we have to understand cardiac Vectors, which is the […]

Revisiting Transcutaneous Cardiac Pacing

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“Transcutaneous cardiac pacing is an effective procedure for patients experiencing unstable bradycardia.” Or is it? If you’ve read Tom’s introduction to the subject of false capture you’re already ahead of the game. We’ve shown case after case of unstable bradycardia patients receiving ineffective transcutaneous pacing due to a lack of capture. In each case, phantom pacing impulses […]