Can’t Miss ECG Findings for the Emergency Medicine Provider

Sudden cardiac death accounts for almost 400,000 deaths per year in the United States, and EM providers must be adept at discerning subtle, high-risk ECG findings. With the advent of triage ECG protocols, one of the most common interruptions in the ED is a request to “sign off” on an ECG. We present a reference of some of the most important high-risk ECG findings, intended to help ED providers systematically screen patients in triage and the waiting room.
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By Christian Rose, MD|2021-11-19T17:01:50-08:00Jul 11, 2018|ECG|

QI Series: Pitfalls in Diagnosing Hyperkalemia

A 55 year old male was brought to the Emergency Department (ED) by paramedics complaining of weakness and chest discomfort. His past medical history was notable for coronary artery disease with bypass grafting, diabetes mellitus, and end stage renal disease. He reported being non-compliant with his last 2 scheduled hemodialysis sessions. Paramedics noted pallor and recorded a blood pressure of 80/palpated and a heart rate of 44. Upon arrival to the ED, a 12 lead ECG was obtained.

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By Steven Polevoi, MD|2016-11-11T19:17:44-08:00Dec 16, 2013|ECG, Endocrine-Metabolic|

Modified Sgarbossa Criteria: Ready for Primetime?

The recognition of ST-segment elevation myocardial infarction (STEMI) in the presence of left bundle-branch block (LBBB) remains difficult and frustrating to both emergency medicine physicians and cardiologists. According to the 2004 STEMI guidelines, emergent reperfusion therapy was recommended to patients with suspected ischemia and new LBBB however, the new 2013 STEMI guidelines made a drastic change by removing this recommendation. Several papers have recently been published discussing a modified Sgarbossa’s criteria and a new algorithm to help decrease false cath lab activation and/or fibrinolytic therapy, but are they ready for primetime? (more…)

By Salim Rezaie, MD|2016-11-11T19:17:42-08:00Dec 3, 2013|Cardiovascular, ECG|

Introducing REBEL in EM and IM

As a physician and newcomer to FOAM, I am finding that I have learned a lot of myths and pearls that are not true as I matriculated through school. This has taught me that learning from textbooks may be great for board exams, but more importantly it is not optimal for patient care and has made me question a lot of different practices. We all want to know clinically relevant information that is evidence based and up to date that will make a difference in our care of patients. The purpose and goal of REBEL is to create a sustained change in beliefs, attitudes, and behavior through review of the best evidence available.

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By Salim Rezaie, MD|2019-09-10T13:33:39-07:00Oct 30, 2013|Cardiovascular, ECG|

Acute Pulmonary Embolism: Size does matter and ECG can give us clues

Acute pulmonary embolism (PE) is a common condition that can be both severe and difficult to diagnose. Half of all acute PE cases are diagnosed in the emergency department, and acute PE follows acute coronary syndrome as the second most common cause of sudden unexpected death in outpatients. Also, right ventricular dysfunction is a consequence of massive/submassive acute pulmonary embolism and correlates with a poor prognosis and high mortality rate. Although an ECG lacks both sensitivity and specificity for acute PE, there are some clues that can help in determining the size of an acute PE.

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By Salim Rezaie, MD|2019-09-10T13:35:37-07:00Oct 8, 2013|Cardiovascular, ECG, Pulmonary|

Bundle Branch Blocks (BBBs) 101

Recently, I have been asked by several students at my home institution (UTHSC at San Antonio) to help them understand bundle branch blocks. This is different than some of my usual posts because it is meant to be more educational than evidence based. So here we go. The normal conduction system of the healthy heart is shown to the right. If there is a delay or block in the left or right bundle, depolarization will take longer to occur. Therefore we get a widened QRS (>0.12 sec or >3 small boxes).

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By Salim Rezaie, MD|2019-09-10T13:36:03-07:00Aug 29, 2013|Cardiovascular, ECG, Expert Peer Reviewed (Clinical)|

R-Wave Peak Time (RWPT) in Lead II: One Simple Step to Differentiate Wide Complex Tachycardias

There are several algorithms that are currently used to help distinguish Supraventricular Tachycardia (SVT) with aberrancy and Ventricular Tachycardia (VT). Many of these algorithms lack specificity, and let’s face it, who can remember if the absence of an RS complex in the precordial leads is VT or SVT with aberrancy. So what if there was a criterion that had a good sensitivity (SN), specificity (SP), and was one simple step?

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By Salim Rezaie, MD|2019-09-10T13:36:27-07:00Aug 28, 2013|Cardiovascular, ECG|

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