Cardiology

#EMconf: 24 y.o. with Near Syncope

For the final week of our cardiology module, Dr. Lisa Filippone presented a great case.  A 24 y.o. male  playing basketball developed palpitations, lightheadedness, dizziness and almost 'passed out'.  On arrival to the ED the patient looked well and had no complaints except for palpitations:  HR 190, BP 130/70.  Lungs were clear, heart without an audible murmur and neuro exam was unremarkable.  ECG shown is shown.  What is the diagnosis and treatment?   

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Advanced Practice - Got a rhythm and it won't let go....

A patient presents in ventricular tachycardia with a blood pressure of 90 systolic. He is diaphoretic and complaining of chest pain. You decide to attempt electrical cardioversion and it fails. You attempts again....and again....and again....without success. You realize this is no ordinary VT...this is electrical storm. Read on for pearls on how to deal with this frightening and deadly condition.

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#EMconf: Acute SOB

This week at our EM/Cardiology interdisciplinary conference, Dr. Lisa Filippone presented a case of a 75 year old male who presented with acute SOB.  This patient presented to the ED 3 days after a NSTEMI with hypotension and hypoxia.  No injury pattern was identified on his ecg but his CXR was consistent with pulmonary edema.  A bedside ECHO was performed that revealed the diagnosis....

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Advanced Practice - Discharge Afib with RVR from your ED!

atrial fibrillation

Ever wonder if all of your patients presenting with recent onset (<48 hrs) atrial fibrillation and a rapid ventricular response really need to be admitted? Is there evidence of a safe and effective treat and street algorithm that EM physicians can employ? Read on for a review of the Ottawa Aggressive Protocol for rapid afib that enables discharge of 97% of patients!

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Acute Triggers of Atrial Fibrillation

It is understood that chronic conditions such as hypertension, coronary artery disease, heart failure, hypertrophic cardiomyopathy, and valvular disease (just to name a few) are risk factors for the development of atrial fibrillation. However, in the ED it is important that we are aware of the acute triggers of atrial fibrillation, some of which are associated with significant morbidity and mortality.

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Advanced Procedures: How to Create a Pericardiocentesis Model

Pericardiocentesis is a rarely performed, but potentially life-saving procedure. Commerical models are prohibitively expensive, but students and residents (and critical care fellows) still need to learn the mechanics, ideally with an ultrasound compatibile model. This week's post gives a step by step guide towards making a cheap, easy to fabricate phantom based on this fantastic paper published in the Journal of Emergency Medicne 2012: https://www.ncbi.nlm.nih.gov/pubmed/21925818

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