Written by: Alec Feuerbach, MD Edited by: Robby Allen, MD; Antonia Quinn, DO A 60(ish)-year-old woman presents to the ED describing an intermittent substernal chest pain that began the night before. She last experienced it again in the morning and has felt it intermittently in the ED. The pain is Read more…
Remember where we left off: you just spoke to a fifty-year-old woman describing severe, intermittent chest pain radiating to the back and left arm. You order aspirin and nitroglycerin, along with a troponin and you are now looking at her ECG: You note the rate is about 75 Read more…
Author: Alec Feuerbach MD Edited by Robby Allen MD (Thanks to Dr. Robby Allen for contributing this ECG) The Case: A 50-year-old woman with no history of cardiac disease presents with severe, intermittent chest pain radiating to the back and left arm with associated left arm numbness. She has Read more…
By: John Riggins Jr MD, Taylor Douglas MD Answer to Rhythm Nation June 2020… You look at the ECG handed to you and interpret it. ECG interpretation: Rate: 144/min Rhythm: sinus tachycardia; then regular, monomorphic wide-complex tachycardia Axis: normal; then inferior QTc: 582 ms Now look at the transition from Read more…
Answer from Rhythm Nation- February 2020 Answer: Spontaneous coronary artery dissection (SCAD) Interpretation: Rate: 60/min Rhythm: sinus Axis: Normal Intervals: Normal ST-T-Q: STE in lead III, aVF. STD I, aVL; Wellens type A pattern in V1 and V3, short/symmetric T wave inversions in V2, V4, V5. Biphasic T waves in Read more…
This article is reposted from The American Journal of Emergency Medicine. Introduction The coronavirus disease 2019 (COVID-19) pandemic has caused a total of nearly 300,000 deaths worldwide [1]. Pediatric patients PCR-postive for SARS-CoV-2 present differently than adults with 40% either asymptomatic or with URI symptoms and commonly have pharyngeal erythema Read more…
Note: The cases discussed in this post happened before COVID-19. Given that D-Dimer may be elevated in patients with COVID-19, the pretest probability of PE in your patient population may be elevated at this time. Thus, the assumptions derived from Kohn et al’s paper highlighted in this post may not Read more…
Which aortic dissections need surgery? Although it is not the ED team’s decision whether to take a patient with dissection to the OR, it is vitally important for us to be familiar with the indications, so we can effectively advocate for our patients as needed. Management of aortic dissections differs Read more…
Last month Academic Emergency Medicine published the article “Can emergency physician gestalt ‘rule in’ or ‘rule out’ acute coronary syndrome: validation in a multi-center prospective diagnostic cohort study”. The following is a critique by Dr. deSouza and Dr. Sinert: In this large multi-center, prospective diagnostic accuracy study, the investigators conclude Read more…
In last week’s post, we reviewed Pluymaekers et al (1), a randomized control trial from the Netherlands on early or delayed cardioversion for recent-onset atrial fibrillation (AF). In this post, we will analyze our practice in the U.S. and discuss some of the arguments for and against cardioversion in the Read more…