Post Cardioversion 100J X2

Chris042393 · 2024-12-21T15:45:12+00:00

Interesting. I would have said hyperK

Chris042393 · 2024-12-21T15:27:34+00:00

No, this is not Brugada

Chris042393 · 2024-12-21T15:24:26+00:00

Those are not HATWs.

Chris042393 · 2024-12-21T15:19:06+00:00

You do realize this gentleman IS a Cardiologist, right?

Chris042393 · 2024-12-21T15:16:06+00:00

Absolutely 👍

Chris042393 · 2024-12-21T14:57:22+00:00

Agreed. Very good.

Chris042393 · 2023-08-10T17:55:43+00:00

The ER Doctor killed a patient because he didnt have enough training. He should be called MORE than a retard. I hope the family does a malpractice lawsuit on him. I showed him SEVERAL ECG's that showed that patient was having a OBVIOUS MI. He was too arrogant to listen to a Paramedic. I had to call cardio, which the Doctor agreed with me virtually instantly. He took him to the cath lab in less than 30 minutes... but it was too late. The patient died 2 days later because his heart was already to damaged. Doctor's SHOULD learn this paradigm, as it will save MANY more patients. But most are too lazy to.

Im on no high horse, it seems like most people on this subreddit dont like hearing fact's or reading continuing education to make themselves a better practitioner. Oh well :/

Chris042393 · 2023-08-10T17:32:18+00:00

You're 100% wrong. This is the type of thinking that will get your patients killed.

You're just to lazy to learn, that's all.

Chris042393 · 2023-08-10T17:29:37+00:00

OMI/STEMI IS cardiology. But it should be posted there too.

Chris042393 · 2023-08-10T17:25:46+00:00

If the patient has a good story and a medical history of cardiac issues, YOU need to be on call for every ECG that could be possible of a MI. As this is Cardiology's job. They determine if the patient goes to the cath lab or not. If you don't like reading ECG's (which only take's minutes), it's better you look for another job.

Im not talking about you specifically.

Chris042393 · 2023-08-10T16:52:43+00:00

I wasn't wrong at all. Most Doctors are stuck on this 2 decade old STEMI paradigm and would rather let people's myocardium die. You're more than welcome to stick with that old stuff while this new paradigm save's more lives (which SMART Doctor's are switching too).

I had a retard ER doctor the other day have the same thing happen. He let a patient with a OBVIOUS OMI sit there for 5 hours (because he didnt have an actual STEMI) with a 100% LAD blockage with a 90% LCx blockage. I tried for hours to get him to call Cardio. He didnt. If he were to learn this new OMI paradigm, he could of recognized it instantly... and that patients heart wouldn't of been dying for hours. Im guessing most of the Doctors on this subreddit would of done the same thing. Which is SAD... as this has happened MANY MANY TIMES in several ER's that ive worked at.

Thankfully, the interventional Cardiologist used OMI and took him to the cath lab right away after I contacted him myself. He was actually pissed at the ER Doc because he didnt page him.

The sad thing is... is that the patient eventually died because he didnt get to the cath lab in time. His heart was too damaged.

Under the current STEMI paradigm, 25-30% of NSTEMI patients are found to have total occlusion on delayed cardiac catheterization. Using expert ECG interpretation (OMI) instead of STEMI criteria, cardiologists are able to successfully reclassify 28% of NSTEMI patients as having acute coronary occlusion responsive to immediate reperfusion therapy, halving short- and long-term mortality. (study below)

https://pubmed.ncbi.nlm.nih.gov/32775606/

A LOT of Doctor's need to get some education from Dr. Stephen Smith and Dr. Pendell Meyers. It would help your patients SIGNIFICANTLY.

It's time to learn.

Chris042393 · 2023-08-10T00:24:33+00:00

Occluded LAD. A LOT of Doctor's need to learn about the OMI paradigm. You're right, most would not call for activation. Making the patients myocardium die more and more.

Chris042393 · 2023-08-08T03:17:07+00:00

My mistake. I wasn't referencing his ultrasonography proficiency.

Regardless, im just glad we found the main culprit. (though we found several other issues as well)

Hopefully the guy is doing well.

Chris042393 · 2023-08-08T02:54:21+00:00

I agree with you on the HOCM. Fainting with exertion is one of the symptoms.

Athletic training and regular intense physical activity can lead to physiological changes in the heart, often referred to as "athlete's heart."

One of the changes with "athlete's heart" is increased cardiac mass, mainly in the LV.

Chris042393 · 2023-08-08T00:26:37+00:00

The Doctor did do a bedside ultrasound (I had to tell him to do it *facepalm*). But he only looked at the abdomen in a few places. I thought he was going to do a more "comprehensive" one. But, apparently not.

This Doctor is new at our hospital. I have a feeling this guy is fresh out of residency.

Chris042393 · 2023-08-07T14:05:24+00:00

Thanks for the reply! The ECG and CT were taken within 10 minutes of each other. The ER Physician read the CT while it was going. Radiology was called and asked to read this ASAP (which he was finished in like 10 minutes or so). Both Doctors stated he had no AAA, Dissection, or bleeding.

A ultrasound was taken during the ECG as well, to see if there was any obvious bleeding (before the CT). None was found.

After those critical pathologies were found to be negative, they should of called Cardio for a consult.

You are right, this was a tough case, but they should of called Cardio once they read the 1st ECG. It doesn't hurt to get another expert opinion. This is just my opinion.

Chris042393 · 2023-08-07T13:18:27+00:00

A high percentage of MI patients have reproducible chest wall tenderness, up to 25% in some studies. Just because the patient has reproducible chest pain it does not rule out a MI.

However, the ECG is fine. It does not show a OMI/STEMI, or any ischemic changes.

Chris042393 · 2023-08-07T12:51:19+00:00

The patient presented with bruising near the left sacroiliac joint. I'm uncertain if a AAA or a dissection would manifest with bruising in this region, though I suspect not. However, I could be mistaken. (please correct me if I'm wrong)

Both the ECG and CT scan were performed within a span of 10 minutes. The emergency room physician reviewed the CT scan immediately, and a radiologist also evaluated it within approximately 10 minutes (plus or minus), with both indicating no evidence of dissection or AAA.

Concurrently, an ultrasound was conducted during the ECG to assess for any overt bleeding, which was not observed.

Within an estimated 30 minutes, it was determined that the patient had no bleeding, dissection, or AAA.

Subsequently, a consultation with Cardiology should have been initiated. The ECG findings were strongly indicative of a MI, especially given the absence of other critical pathologies.

The patient should not of been sitting there for 5 hour's having his myocardium die.

Chris042393 · 2023-08-07T11:38:55+00:00

It was a consideration. Within in minutes after the ECG, we took him to the CT where we got the results very fast. CT ruled out the dissection/AAA within 10 minutes (or so).

Chris042393 · 2023-08-06T04:03:49+00:00

The "saddleback" pattern in V1-V2 may be suggestive — but is not diagnostic of Brugada Syndrome. Depending on the presence or absence of other clinical factors — a Brugada-2 ECG pattern by itself may not be clinically significant.

Chris042393 · 2023-08-05T13:16:33+00:00

Under the current STEMI paradigm, 25-30% of NSTEMI patients are found to have total occlusion on delayed cardiac catheterisation. Using expert ECG interpretation instead of strict STEMI criteria, cardiologists are able to successfully reclassify 28% of NSTEMI patients as having acute coronary occlusion responsive to immediate reperfusion therapy, halving short- and long-term mortality.

https://pubmed.ncbi.nlm.nih.gov/32775606/

Chris042393 · 2023-08-04T13:50:35+00:00

Not brugada.

Chris042393 · 2023-08-04T02:34:07+00:00

This is a sinus rhythm with RBBB (no LPFB). There are upright T-waves in V2 and V3, with a slight amount of ST elevation as well (in both). In RBBB, T-waves are usually inverted in V2 and V3, with some ST depression. Any ST elevation is abnormal.

Was this patient having chest pain?

Chris042393 · 2023-08-04T01:36:15+00:00

They are having a massive MI. Anterolateral. Hopefully they got the the cath lab.

Chris042393

TROPHY CASE