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Tactical Medicine News

ECG Cases 32 Prehospital ECG pearls and pitfalls

by Jesse McLaren
Jun 21, 2022
In this ECG Cases blog we review 8 cases of patients with prehospital ECGs and explore prehospital ECGs for diagnosing STEMI, Occlusion MI, false S...
Tactical Medicine News

ECG Cases 31 Is a 15 lead ECG better than 12? Diagnosing Posterior MI and RVMI

Is 15 lead ECG better than 12 lead for diagnosing posterior MI or right ventricular infarction? When do you need a 15 lead ECG? Jesse McLaren guide...
Tactical Medicine News

ECG Cases 30 Beware Computer Interpretation Errors

Computer interpretation of the ECG has been called a double-edged sword: when correct, it increases physician accuracy, but when incorrect it incre...
Tactical Medicine News

ECG Cases 29 Misdiagnosis from Lead Misplacement, Artifact and Lead Reversal

In this ECG Cases blog we review 10 cases of possible artifact, lead reversal and lead misplacement. Can you spot the abnormalities and avoid the m...
Tactical Medicine News

ECG Cases 27 Pericarditis – Diagnosis of Exclusion

Jesse McLaren guides us through 9 cases and explains how pericarditis is a diagnosis of exclusion through 3 simple steps: 1. Exclude more serious c...
Tactical Medicine News

SAEM Clinical Image Series: A Young Woman with Chest Pain

A 35-year-old female with a history of intermittent palpitations who is three months post-partum presented to the emergency department (ED) with th...
Tactical Medicine News

EM Quick Hits 33 Polytrauma Tips & Tricks, Toxic Megacolon, ECG in PE, Patch Calls, CT Before LP, Nebulized Ketamine

In this month's EM Quick Hits podcast, Anand Swaminathan on tips and tricks in polytrauma, Rohit Mohindra on diagnosis and management of toxic mega...
Tactical Medicine News

ECG Cases 26: Pulmonary Embolism and Acute RV Strain

In this month's ECG Cases Dr. Jesse McLaren runs through 10 cases and explains how the ECG can be integral in the diagnosis and management of pulmo...
Tactical Medicine News

Rebellion21: Subtle Ts on the ECG You Can’t Afford to Miss via Amal Mattu, MD

In this 28-minute lecture from Rebellion in EM 2021, Dr. Amal Mattu, MD goes over several cases of ECGs and subtle T waves you can’t afford to miss.
Tactical Medicine News

Diagnosis on Sight: “I have a rapid heart rate”

  A 31-year-old male presented to the emergency department with palpitations. The patient stated that he thinks his symptoms began "last night" and...
Tactical Medicine News

ECG Cases 24 Reciprocal Change and Occlusion MI

Dr. Jesse MacLaren reviews 10 ECG cases highlighting how reciprocal change can be secondary to LBBB/LVH, primary changes, or both, how it can be th...
Tactical Medicine News

ECG Cases 23 – Wellens syndrome, reperfusion and reocclusion MI

Eight patients presented with potentially ischemic symptoms and T-wave inversions. Which had occlusion MI, which were reperfused and which were reo...
Tactical Medicine News

ECG Cases 22: T-wave INVERSION mnemonic

The differential for T-wave INVERSION includes: Incorrect lead placement, No bundle (RBBB, LBBB), Ventricular hypertrophy (LVH, RVH), Embolism, Rec...
Tactical Medicine News

ECG Cases 21: Hyperacute T-waves and Occlusion MI

In this month's ECG Cases blog, Dr. Jesse MacLaren guides us through 10 cases of patients whose ECGs show tall T-waves and gives us the tools to di...
Tactical Medicine News

ECG Cases 20 – Approach to Bradycardia and the BRADI Mnemonic

In this ECG Cases we review 10 patients who presented with bradycardia, introduce an approach to reversible causes using the BRADI mnemonic and gui...
Tactical Medicine News

ECG Cases 17 – ST ELEVATIONS mnemonic and Occlusion MI

In this ECG Cases blog we look at 10 patients who presented with ST elevation, and review the differential diagnosis of ST elevation using the ELEV...
Tactical Medicine News

ECG Cases 15: Tall R Wave in V1

8 patients presented with ECGs showing a tall R wave in V1. What was the diagnosis? Jesse MacLaren reviews ECG interpretation of a tall R wave in V...
Tactical Medicine News

ECG Cases 14: Q-wave and Occlusion MI

9 patients presented with potentially ischemic symptoms and Q-waves. Which had Occlusion MI? What is the differential diagnosis of Q-waves? How can...
Tactical Medicine News

Pearls from ResusX Rewired 2020

From Oct 6th – 8th, 2020, Haney Mallemat (@CriticalCareNow) and his team put on an absolutely amazing online critical care conference called ResusX...
Tactical Medicine News

The DIFOCCULT Trial: Time to Change from STEMI/NSTEMI to OMI/NOMI?

Background: Prior to the discovery of thrombolytics, clinicians could only observe their patients completing their myocardial infarctions and then ...
Tactical Medicine News

ECG Cases 13: LVH and Occlusion MI

LVH produces secondary repolarization abnormalities that can mimic STEMI. Signs of occlusion MI in patients with LVH include: new Q waves/loss of R...
Tactical Medicine News

ECG Cases 12: RBBB and Occlusion MI

In this ECG Cases blog we look at 7 patients with RBBB and potentially ischemic symptoms. Which had RBBB and occlusion MI?... The post ECG Cases 12...
Tactical Medicine News

ECG Cases 11: LBBB + Occlusion MI

In ECG Cases 11 - LBBB + Occlusion MI Jesse McLaren runs through 5 patients who present with potentially ischemic symptoms and LBBB and explains th...
Tactical Medicine News

ECG Cases 10 – Hyperkalemia: The Great Imitator

Which of the following 9 patients had hyperkalemia? Can you estimate how high their serum potassium was based on the ECG? Jesse MacLaren guides us ...
Tactical Medicine News

ECG Cases 9 – First Diagonal Occlusion

Seven patients with ischemic symptoms, none meeting STEMI criteria but all identified by a specific pattern of first diagonal branch occlusion are ...
Tactical Medicine News

ECG Cases 8 Cardiovascular Emergencies During The COVID-19 Pandemic

In this ECG Cases blog we look at 6 patients who presented with cardiorespiratory symptoms, possibly from COVID and illustrate the dangers of ancho...
Tactical Medicine News

ECG cases 7: ST elevation in aVR, STEMI-equivalent?

10 patients presented with the "STEMI-equivalent" ST elevation in aVR with diffuse ST depression. Which had acute coronary occlusion? Jesse McLaren...
Tactical Medicine News

ECG cases 6: Posterior MI – Still Under-recognized

In this ECG Cases blog we look at 8 patients with potentially ischemic symptoms, none of whom had STEMI on the 12 lead ECG. Which had occlusion MI?...
Tactical Medicine News

ECG Cases 5: Cardiac Syncope

In this ECG Cases blog we look at seven patients with cardiac syncope, and a systematic approach to ECG interpretation... The post ECG Cases 5: Car...
Tactical Medicine News

ECG Cases 4: Lateral STEMI or Occlusion MI?

In this ECG Cases blog we look at seven patients with potentially ischemic symptoms and subtle ECG changes in the lateral leads. Which had acute co...
Tactical Medicine News

ECG Cases 3: Can you find the subtle inferior MI?

In this ECG Cases blog we look at 8 patients with potentially ischemic symptoms, to highlight pearls and pitfalls of inferior MI. Can you identify ...
Tactical Medicine News

REBEL Core Cast 21.0 – ECG in Syncope

  REBEL Core Cast 21.0 – ECG in Syncope Click here for Direct Download of Podcast
Tactical Medicine News

SAEM Clinical Image Series: Another Heart Attack?

[Figure 1: Click for larger view] Chief Complaint: Chest pain History of Present Illness: An 89-year-old female with a past medical history of...
Tactical Medicine News

ACMT Toxicology Visual Pearls: Abnormal ECG

This abnormal ECG would be typical following an overdose on which of the following medications? Amitriptyline Buspirone Citalopram Haloperidol
Tactical Medicine News

Ultrasound For The Win! – 57F with Chest Pain and Dyspnea #US4TW

Welcome to another ultrasound-based case, part of the “Ultrasound For The Win!” (#US4TW) Case Series. In this case series, we focus on a real clini...
Tactical Medicine News

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-ri...
Tactical Medicine News

Chest Pain, “Negative” Stress Tests, POCUS, & ECG Equations

I was working a busy shift in the ED, like many of us do, and the next patient I was going to see was a 57 year old male with no real medical probl...
Tactical Medicine News

Triage ECGs: Reducing Interruptions in a Busy ED

Background: Lets face it. All of us have been interrupted by the onslaught of triage ECGs for interpretation.  This constant flow of pink paper wit...
Tactical Medicine News

Five ECG Patterns You Must Know

Background: The electrocardiogram (ECG) is one of the most useful diagnostic studies for identification of acute coronary syndrome (ACS) and acute ...
Tactical Medicine News

REBEL ECG of the Week #8

A 52 year old female with a past medical history of type II diabetes mellitus and tobacco abuse presents with a chief complaint of chest pain. Acco...
Tactical Medicine News

REBEL ECG of the Week 7

  89 year old male with PMH of hypertension, stage 3 chronic kidney disease with chief complaint of shortness of breath. Several days ago patient h...
Tactical Medicine News

ECG Changes of Hyperkalemia

Hyperkalemia is an electrolyte abnormality seen in the emergency department as well as in hospitalized patients and it can be associated with adver...
Tactical Medicine News

ECG Basics

Electrocardiography is a fundamental part of cardiovascular assessment. It is an essential tool for investigating cardiac arrhythmias and ischemia....
Tactical Medicine News

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 histor...
Tactical Medicine News

REBEL ECG of the Week #6

The case from this week is from one of the PGY-1 residents at University of Texas Health Science Center at San Antonio (UTHSCSA).  Several of the d...
Tactical Medicine News

REBEL ECG of the Week #5

55 year old male with chief complaint of palpitations.  Denies any chest pain, shortness of breath, diaphoresis, or syncope.  His past medical hist...
Tactical Medicine News

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 frus...
Tactical Medicine News

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 frus...
Tactical Medicine News

REBEL ECG of the Week #4

62 year old male with chief complaint of weakness.  Patient had a complicated hospital course including necrotizing fasciitis which required surgic...
Tactical Medicine News

SVT With Aberrancy Versus VT

Differentiating between SVT with aberrancy versus VT can be very difficult. It is crucial to be able to make this distinction as therapeutic decisi...
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