Emergencies
Results:
Post-Arrest STEMI: Cath Lab or Caution?
A 72-year-old man is brought to the ED after witnessed cardiac arrest. Bystander CPR was started quickly, EMS found a nonshockable rhythm, epinephrine was given, and ROSC was achieved. Forty…
Post-Cardiac Arrest ECGs Hub
Key Points: The first post-ROSC ECG is essential but imperfect. Obtain it immediately, but interpret it in context. Global ischemia, defibrillation, acidosis, hypothermia, vasopressors, artifact, and severe metabolic derangements can…
Post-Arrest STEMI: Cath Lab Decisions
Key Points: Persistent ST elevation after ROSC remains a guideline-supported indication for emergency coronary angiography. The 2025 ACC/AHA/ACEP/NAEMSP/SCAI ACS guideline recommends emergency angiography for patients after cardiac arrest with suspected…
Post-Arrest No STEMI: When Cath Can Wait
Key Points: Stable post-arrest patients without ST elevation should not go to reflex immediate cath solely because cardiac arrest occurred. Randomized trials in OHCA patients without ST elevation have not…
Pediatric ECG in Cardiac Arrest
Key Points: Pediatric arrest is usually respiratory, hypoxic, or shock-related, not primary coronary occlusion. The ECG still matters because it can reveal reversible metabolic, toxicologic, structural, inflammatory, or inherited electrical…
A Post-Arrest ECG With a Dangerous New Bundle Branch Block
A 72-year-old man is brought to the ED after a witnessed out-of-hospital cardiac arrest. Bystander CPR is started quickly, EMS finds a non-shockable rhythm, and ROSC is achieved after one…
The Cath Lab Was Activated, But Something Didn’t Fit
A 70-year-old woman with CHF, COPD, intermittent atrial fibrillation, chronic pain medication use, and recent poor intake develops sudden dyspnea at rest and is found somnolent and bradycardic in the…
UMEM Cases, Part 4: When the Computer Misses the Rhythm and Flutter Fakes a STEMI
A 44-year-old man with severe cardiomyopathy, an LVAD, chronic amiodarone therapy, and an AICD presents with palpitations. His ECG shows a regular wide-complex tachycardia, but the rate is only 135….
New RBBB + LAFB (Bifascicular Block) in ACS: OMI Pattern
Key Points: In a patient with ischemic symptoms, new RBBB + LAFB should raise concern for proximal LAD or septal ischemia until proven otherwise, especially if the patient has ongoing…
Wide QRS Complex: DDx
Key Points: A QRS duration greater than 120 ms reflects delayed or abnormal ventricular depolarization. A wide QRS may be chronic and benign in context, or it may be the…
UMEM Cases, Part 3: When the Diagnosis Seems Clear and When It Is Not
A 71-year-old man presents with shortness of breath, and his ECG is initially read as a junctional rhythm. On later review, it is even mistaken for atrial fibrillation. But the…
Dysrhythmias in LVAD Patients
Key Points: Continuous-flow LVADs can mask cardiovascular collapse. Patients may remain awake during sustained VT or even VF because the pump can provide temporary flow. Treat the rhythm and the…
Pediatric ECG Red Flags
Key Points: Any wide QRS (>90 ms) in an infant or small child is abnormal and should trigger evaluation for VT, sodium-channel blockade, or conduction disease. QTc >450 ms in…
Severe Hypothermia
Key Points: Severe hypothermia causes predictable ECG slowing and conduction delay. Sinus bradycardia, PR/QRS/QT prolongation, and atrial fibrillation with a slow ventricular response are common as core temperature falls. Osborn…
UMEM Cases, Part 2: When the ECG Conceals and When It Reveals
An 81-year-old woman presents with lightheadedness and marked bradycardia. Her ECG shows more P waves than QRS complexes, but the mechanism is not immediately clear. The key question is whether…
Computer Interpreted “Normal” ECGs
Key Points: Do not trust a computer read of “normal” without your own review. Computer interpretation is especially unreliable for subtle or early ischemia, including hyperacute T waves, minimal ST…
UMEM Cases, Part 1: When the ECG Lies and When It Evolves
A 72-year-old man presents with chest pain and shortness of breath. His ECG shows sinus rhythm with LVH, mild inferior ST elevation, and lateral ST-T abnormalities that some interpret as…
STEMI vs Wide QRS (BBBs & Paced Rhythms): DDx
Key Points: Wide QRS rhythms distort repolarization. Bundle branch block and ventricular pacing create secondary ST-T changes even without occlusion MI. Appropriate discordance is expected. ST segments and T waves…
South African Flag Sign: OMI Pattern
Key Points: Pattern: The South African Flag sign is the combination of ST elevation in I, aVL, and V2 with reciprocal ST depression in III. It is a subtle but…
Three ECG Traps You Cannot Afford to Miss
A 60-year-old woman presents with palpitations and an irregular wide-complex tachycardia. The computer calls atrial fibrillation with a left bundle branch block, but a subtle clue in the precordial leads…
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