Emergencies

ECG STAT July 17, 2025

Terminal QRS Distortion: OMI Pattern

Key Points: What it is: In V2 or V3, there is no S wave (the R does not descend below the PQ baseline) and no J wave (no notch/slur at…

ECG STAT July 16, 2025

Digoxin Toxicity

Key Points Narrow therapeutic window: Small dosing errors or renal decline can push serum digoxin above the safe range. Excess automaticity + AV block: Toxicity increases atrial and ventricular irritability…

ECG STAT July 15, 2025

Right Axis Deviation + ST Elevation: DDx

Key Points RAD combined with ST-segment elevation (STE) is an uncommon but high-risk finding. While STE often suggests acute coronary occlusion, this pattern rarely reflects classic STEMI. Several non-ischemic conditions…

ECG STAT July 1, 2025

Pseudonormalization of T Waves

Key Points Definition: Pseudonormalization is the apparent normalization of previously inverted T waves, often signaling reocclusion of a coronary artery that had recently reperfused. Mechanism: During reperfusion, ischemic T wave…

ECG STAT June 6, 2025

Hyperkalemic Periodic Paralysis (Impressive Syndrome)

Key Points What It Is: A rare autosomal dominant sodium channelopathy that leads to episodic muscle weakness or paralysis in the setting of elevated serum potassium. Named after “Impressive,” the…

ECG STAT May 14, 2025

Trifascicular Block

Key Points Definition: Trifascicular block describes ECG evidence of impaired conduction across all three fascicles: right bundle branch (RBB), left anterior fascicle (LAF), and left posterior fascicle (LPF). Common Usage:…

ECG STAT April 25, 2025

Slow Atrial Fibrillation

Key Points Definition: Atrial fibrillation with a slow ventricular response, usually < 60 bpm. ECG: Irregularly irregular rhythm, no discrete P waves, slow R-R intervals. Common causes: AV-nodal blockers (digoxin,…

ECG STAT April 20, 2025

Precordial Swirl: OMI Pattern

Key Points Definition: The precordial swirl sign refers to a rotational pattern of ST-segment abnormalities across the precordial leads, suggesting a dynamic and evolving occlusion myocardial infarction (OMI). It is…

ECG STAT March 28, 2025

Sodium Channel Blocker Toxicity

Key Points: Recognizing the Danger: Sodium channel blocker toxicity can present with a variety of ECG changes that are critical to recognize, especially in patients with altered mental status or…

ECG STAT February 28, 2025

EMS ECGs in Acute Coronary Syndromes (ACS)

Key Points for EMS Providers: You are the first critical link in the chain of survival for ACS patients—your actions set the course for their care, directly impacting time to…

ECG STAT January 17, 2025

Subtle ST Segment Elevation: OMI Pattern

Key Points: ACS Dynamics: Occluded arteries in ACS can spontaneously reperfuse and reocclude, making ECG findings variable. Limitations of Computer Interpretation: Subtle STE is often missed by computerized ECG interpretation;…

ECG STAT January 11, 2025

Brugada Syndrome (BrS)

Key Points: Life-Threatening Sodium Channelopathy: Predisposes to ventricular arrhythmias (VF/VT) and sudden cardiac death (SCD), often in otherwise “healthy” hearts. When to Suspect BrS: Patients with syncope, unexplained “seizures,” ventricular…

ECG STAT January 6, 2025

Hypokalemic Periodic Paralysis

Key Points Definition: A rare ion channelopathy that causes sudden, reversible episodes of symmetric flaccid paralysis triggered by low serum potassium. It may be inherited or secondary to thyrotoxicosis or…

Weekly Workout October 23, 2023

Wide Complex Tachycardias: does response to Valsalva maneuvers or adenosine rule out ventricular tachycardia?

A 54-year-old man with no significant PMHx presents to the ED with palpitations. He is hemodynamically stable with a normal blood pressure. The following ECG is obtained prior to the…

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