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The U wave and the ECG: Don’t miss this

The U wave is an often ignored deflection on the ECG. It is usually < 1mm, upright and has the same polarity(is in the same direction) as the preceding T wave(1). It is usually seen in the anterior leads V2-V3. It may be present in normal individuals and is sometimes ignored…… beware. Here is a quick look…

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Upright T wave in V1

A 65 year old woman presents with a 20 minute episode of chest pain. Her ECG is shown below. Are there any concerning features for ischaemia? Significance of an upright T wave in V1 Normally the T wave is inverted or flat in lead V1. An upright T wave in V1 may be considered a…

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Syncope in Children

Syncope is not uncommon, occurring in up to 25% of children. Most causes are benign, however we need to be aware of the of 3 major groups as these can be very serious diagnoses: Those with a cardiac cause Those with a neurological cause Very young children, as syncope shouldn’t occur in this group. Making…

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Paediatric Heart Conditions You MUST KNOW

Congenital heart conditions present at birth, but can also present within the first month of life. We look at a simplified approach to the assessment and management of patients presenting with symptoms of congenital heart disease. In this video Dr Claire Wilkins, talks about these conditions and spits them into three categories: Patients presenting with SHOCK…

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Myocarditis

Myocarditis is simply an inflammation of the heart muscle, that can lead to myocardial cell damage, myocardial dysfunction and heart failure. A Recent Case A 15 yo male presents to the emergency department with sharp central chest pain that is worst on inspiration. The pain has woken him from sleep. There is no radiation although…

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Should We Shock Patients in Asystole?

Should cardiac arrest patients in asystole be shocked? Is there any advantage to this? What do we know about asystole in cardiac arrest? Patients in asystole are known to have a very poor prognosis, with 0% to 2% surviving to hospital discharge. There is a slightly better prognosis if the rhythm converts spontaneously to a shockable rhythm…

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Syncope Rules

Patients presenting with syncope to the Emergency Department can pose a significant diagnostic challenge. The two main reasons for this are: Syncope is a symptom, not a diagnosis. We need to search for the underlying cause. Adverse events can occur, when none are obvious or predictable during our Emergency Department evaluation. We know that the rate…

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Diagnosing Ventricular Tachycardia in 5 easy steps

Here is a simple case of potential ventricular tachycardia(VT) How do you manage this? A patient has been brought into your resuscitation cubicle with the a complaint of palpitations. His ECG is as follows: The patient is obviously unstable, so the management decision is easy: ELECTRICITY. What if the patient is stable with a BP…

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Pericardiocentesis

How to Perform Pericardiocentesis Pericardiocentesis is used to treat symptomatic pericardial effusions and cardiac tamponade. It was first described in the 1650’s and since the introduction of the subxiphoid approach in 1911, has been used very successfully, with significant reduction in morbidity and mortality. The use of echocardiography and other guidance techniques have reduced the…

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The Unstable Atrial Fibrillation Patient

THE CASE A 75 yo man is brought into your small rural ED after 3 hours of ischemic chest discomfort.  His background is significant for hypertension, a CVA 5 years ago for which he is on aspirin/dipyrimidole, and 2 coronary artery stents in 1995.  The ambulance officers found the patient to be in AF, with…

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Pulseless Electrical Activity

Pulseless Electrical Activity(PEA) occurs in about 30% of cardiac arrest cases. Given that it’s not a shockable rhythm, it has a very poor prognosis, especially when associated with acute myocardial Infarction(MI)(1). More recently, the term pseudo-PEA, is used for those patients where we can’t find an output by feeling for a pulse, but there may in fact be…

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