Key Points
- Definition: Critical ECGs are time-sensitive, life-threatening cardiac or systemic conditions that demand immediate ECG recognition to prevent death or irreversible organ injury. These are the “can’t-miss” rhythm strips and ECG tracings that can save lives.
- Goal: Provide rapid pattern recognition and bedside action steps for the most lethal ECG presentations encountered in emergency, critical care, and prehospital settings.
- Impact: Fast, accurate ECG interpretation can determine survival. In the first minutes of cardiac compromise, the ECG remains the single most decisive diagnostic tool at the bedside.
- Critical ECG Emergencies brings together the highest-stakes ECG diagnoses in acute care. These are the rhythms and patterns that decide life or death. Recognize them instantly, act decisively, and use this hub as your launchpad into each detailed STAT post listed below.
How to Use This Section:
Each topic below represents a potentially life-saving ECG diagnosis. Browse and learn how to recognize, differentiate, and manage these critical entities at the point of care.
Cardiac Arrest and Electrical Instability:
More Unstable Rhythms:
Ischemic and Structural Life Threats:
Tox & Metabolic Emergencies:
Systemic or Neurologic “Cardiac Mimics”:
Foundations and Recommendations:
KEY CLINICAL PEARLS:
1. Time is critical: For STEMI, occlusion MI, and malignant arrhythmias, every minute counts. Target reperfusion or definitive intervention within 90 minutes of arrival. Early recognition saves myocardium—and lives.
2. Red flags that demand immediate action:
- Wide-complex tachycardia → treat as VT until proven otherwise; but also consider VT mimics before antiarrhythmics.
- Severe bradycardia with instability → initiate atropine, pacing, or pressors per ACLS, but don't forget about hyperkalemia as a possible cause.
- Right heart strain pattern (S₁Q₃T₃, new RBBB, T-wave inversions V1–V4) → consider high-risk PE and initiate empiric therapy if unstable.
- Sinus tachycardia + low voltage → suspect pericardial effusion/tamponade.
3. Clinical context always matters: ECGs never exist in isolation—always interpret findings within a clinical framework.
- ST elevation can mean STEMI, pericarditis, early repolarization, or many other things. Consider the DDx.
- Wide QRS complexes may represent hyperkalemia, BBB, or sodium-channel blockade.
- Integrate ECG + bedside exam + hemodynamics.
4. Serial ECGs save lives: Repeat ECGs every 10-15 minutes in unstable or evolving cases. Dynamic ECG changes confirms ischemia, reperfusion, or deterioration.
5. Team coordination is key: Rapid communication with EMS, emergency physicians, cardiology, and interventional teams ensures parallel activation of life-saving pathways (cath lab, ECMO, EP lab).
6. Master the patterns before the patient arrives: These ECGs represent seconds-to-decide diagnoses. Pattern recognition and repetition are the foundation of rapid response.
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