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2024 EMS Cases Part I
A 64-year-old man is being brought in by EMS for chest pain and shortness of breath. The following EMS ECG is obtained:
Literature Review: Brugada Syndrome
A 55-year-old man with no significant PMHx (on no medications) presents to the emergency department with right lower quadrant pain. He is afebrile on arrival, with mild sinus tachycardia. He…
Literature Review: Fever and ST segment elevation after syncope
A young woman presents to the ED after a syncopal episode. She hit her chest after falling and has reproducible chest wall tenderness on exam. She is also noted to…
Literature Review: Fever and ST segment elevation after syncope
A young woman presents to the ED after a syncopal episode. She hit her chest after falling and has reproducible chest wall tenderness on exam. She is also noted to…
Paralysis Unmasked: Impressive ECGs That Saved the Day
A 45-year-old woman with PMHx of HTN, DM, ESRD (MWF hemodialysis) presents with complete paralysis below the neck. She reports being normal and fully functional before going to bed the…
New Year’s Resolution: a patient who is trying to get healthier presents to the ED with this unstable bradycardia
A 50-year-old man decides to get “his life in order” for the new year. He quits smoking, decides to eat healthier, exercise more, and to be more compliant with his…
Christmas Case: Decoding the ECG of a 7-year-old boy with lightheadedness and palpitations
A 7-year-old boy visiting from London is brought into the emergency department for palpitations and lightheadedness. He has a history of prior long bone fractures, walks with crutches, and appears…
Literature Review: ST segment elevation after syncope and cardiac arrest
A 22-year-old man with no known significant PMHx presents after syncope. He is asymptomatic on arrival with normal vital signs. History and physical exam is non-diagnostic. While an ECG is…
Literature Review: Precordial lead placement and its impact on ECG interpretation and clinical care
A 46-year-old man with no known significant PMHx aside from tobacco smoking presents to the emergency department with sharp midsternal chest pain. Symptoms have been ongoing for 1 day without…
Do these biphasic T waves and ST segment abnormalities suggest acute coronary occlusion MI?
A 40-year-old man is brought to the emergency department for acute chest pain. The following ECG was obtained:
Must Know ECGs and Differentials in Patients with Acute Chest Pain or Shortness of Breath
A 63-year-old woman is brought to the emergency department by EMS for chest pain and shortness of breath. The following ECG was obtained:
Wide Complex Tachycardias: clues to VT mimics when the heart rate is too slow or the QRS complexes are too wide
An unknown aged female is being transported to the emergency department by EMS for altered mental status. She is agitated and slurring words. Vitals: 98/65, RR 24, HR 162. The…
Wide Complex Tachycardias: precordial concordance and what to do when some leads appear narrow and others appear wide
A 38-year-old man is brought to the emergency department by EMS for palpitations after he is found to be tachycardic. He is noted to be hypotensive with SBP of 70…
Wide Complex Tachycardias: beware the many mimics of ventricular tachycardia
A 73-year-old woman with PMHx of HTN, DM, HLD presents to the emergency department with 2 days of vomiting, malaise, and indigestion with chest discomfort. The following ECG is obtained:
Wide Complex Tachycardias: using modified ECG leads to distinguish ventricular tachycardia from supraventricular tachycardias (VT vs. SVT)
A 60-year-old man presents to the emergency department with left sided chest pain and lower extremity edema. Initial vitals: HR= 155, BP = 120/96, RR = 22, SpO2 = 90%,…
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…
Wide Complex Tachycardias: can ECG algorithms safely rule out ventricular tachycardia in the emergency department?
A 45-year-old man with PMHx of hypertension, obesity, and tobacco use presents to the ED with palpitations. Symptoms have been intermittent throughout the day with an associated episode of syncope….
Differential Diagnoses: ST segment elevation in a patient with altered mental status, a stepwise approach
A 60-year-old man with PMHx of pancreatic cancer and prior cerebrovascular accidents presents to the ED with altered mental status. Family is concerned that his symptoms are similar to prior…
Differential Diagnoses: what to consider in patients who have isolated syncope and present asymptomatic
A 26-year-old woman presents to the ED after 2 episodes of lightheadedness and near syncope that lasted 30-60 seconds each. She is now asymptomatic with normal vital signs and a…
Differential Diagnoses: must know cardiac causes of syncope
A 22-year-old man presents to the ED after syncope. He reports walking around and experiencing chest discomfort and shortness of breath prior to the episode. He feels anxious on arrival…
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