Contributor: Peter Bakes, MD Educational Pearls: Tachycardia describes a heart rate of >120 beats per minute Wide Complex describes a QRS duration of >120 ms or 3 small boxes on a standard EKG The major differential for a wide complex tachycardia is Ventricular Tachycardia (VT), aka “V Tach”, or Supraventricular Tachycardia (SVT) with Aberrancy SVT…
Read MoreContributor: Peter Bakes, MD Educational Pearls: Patients in renal failure may have elevated serum potassium levels which can result in EKG changes. EKG changes in the setting of hyperkalemia generally depend on the serum level. Mild elevation may cause peaked T waves. At higher serum levels there will be loss of P waves plus wide…
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A Shocking Adverse Effect Chief Complaint: Defibrillator shock HPI: 50-year-old biologic male who identifies as a female presented after reportedly being shocked by her defibrillator 5 times before calling EMS, EMS noted that they witnessed 1 shock. They also noted that blood pressure was in the low 100s and heart rate was between 200-260 before…
Read More Contributor: Nick Hatch, MD Educational Pearls: Transcatheter aortic valve replacement (TAVR) is an increasingly common endovascular procedure to treat aortic stenosis TAVR is an alternative to the open approach surgical aortic valve replacement (SAVR) for patients who are inoperable or are high risk surgical candidates Following TAVR, there is increased risk of stroke, particularly…
Read MoreContributor: Jared Scott, MD Educational Pearls: A study randomized 34 healthy patient to have their left anterior descending artery (LAD) occluded by balloon for 0, 15, 30, or 90 seconds Subsequently, cardiac troponins (cTns) and Copeptin were measured every 15 minutes for 3 hours, then every 30 minutes for the next 3 hours 5 conclusions…
Read MoreOn this episode of On the Streets, our host, Jordan Ourada, talks with cardiologist, Dr. Chirag Chauhan, about all things cardiac. Highlighted topics: Wrist versus femoral access in the cath lab The most important prehospital interventions for an MI Nitroglycerin: Who gets it and what are the precautions Lidocaine and amiodarone in a heart attack…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Atrial fibrillation is an irregular heart rhythm that sometimes requires rate control in setting of rapid ventricular response (RVR) Calcium channel blocker and beta blockers are the most frequently used medications to block the AV node and slow down the heart rate in atrial fibrillation with RVR If a…
Read MoreContributor: Don Stader, MD Educational Pearls: In a secondary analysis of the PART trial, the mortality effect of timing of airway management for patients in cardiac arrest was examined Study looked at whether timing played a part in both laryngeal tube placement or endotracheal intubation during cardiac arrest Did not find any association of timing…
Read MoreContributor: Aaron Lessen, MD Educational Pearls: Hypotension after cardiac arrest often requires a vasopressor to improve blood pressure Recent observational study from France examined outcomes of patients who received either epinephrine or norepinephrine for post-resuscitation shock Norepinephrine had significantly better outcomes Death from shock was 35% in the epinephrine group vs. 9% in the norepinephrine…
Read MoreContributor: Peter Bakes, MD Educational Pearls: 3% of cases of acute coronary syndrome are due to Takotsubo Takotsubo cardiomyopathy or “broken heart syndrome” can occur with severe physiologic or emotional stressors, as these events can result in a profound outpouring of sympathetic neurotransmitters (epinephrine/norepinephrine) Receptors for these catecholamines are very dense around the apex of…
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