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Archive for October 2019

Resuscitation Literature Review October 2019

This week, I wanted to quickly review some of the latest resuscitation literature. Let’s look at 3 studies. STUDY 1 Yamamoto M et al. Diagnostic value of lead aVR in electrocardiography for identifying acute coronary lesions in patients with out of hospital cardiac arrest. Resuscitation 2019 142:97-103 Background Emergency coronary angiography is currently recommended in…

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The Lewis Lead

The Lewis lead(1), is a means of detecting atrial activity and can be used where p waves are not readily evident. It is particularly helpful in wide complex tachycardias, where the presence of atrial activity can be used to exclude a diagnosis of ventricular tachycardia. It is meant to be seen on the cardiac monitor…

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Benediction Sign

The Benediction Sign is mistakenly called an Ulnar nerve injury. It is in fact a MEDIAN nerve injury at the level of the Elbow. It occurs as the median nerve supplies the lumbricals 1 and 2, which flex the the first 2 digits at the metacarpophalangeal joints. Another way to test this is to ask…

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ST Elevation in aVR

A 70 year old woman presents with severe shortness of breath and chest pain. She loses output briefly. Her ECG is shown below She has ST elevation in aVR. What is the diagnosis? Read below and then view the angiogram. We diagnosed critical Left Main Coronary Artery(LMCA) obstruction and urgently transferred the patient for angiography and…

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Brugada Syndrome

A 25 year old male presents to the emergency department following a near syncopal episode. His ECG shows a supraventricular tachycardia(SVT). Vagal manoeuvres are attempted, unsuccessfully. Adenosine is then given for reversion. He reverts and his post-reversion ECG is shown below. One of the registrars is concerned that the ECG is showing a Brugada pattern.…

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