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emDOCs Podcast – Episode 98: Post ROSC Mental Model

EMDocs

Today on the emDOCs cast Brit Long interviews Zachary Aust on the use of a mental model in post ROSC patients. Episode 98: Post ROSC Mental Model What’s the problem?

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A man in his 50s with unwitnessed VF arrest, defibrillated to ROSC, and no STEMI criteria on post ROSC ECG. Should he get emergent angiogram?

Dr. Smith's ECG Blog

His family started CPR and called EMS, who arrived to find him in ventricular fibrillation. Here is his ECG after stabilization of vitals (at least 30 minutes since sustained ROSC). The ECG is diagnostic of acute LAD occlusion MI. Post angiogram ECG The patient was eventually able to be weaned off of ECMO and impella.

EKG/ECG 117
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VF arrest at home, no memory of chest pain. Angiography non-diagnostic. Does this patient need an ICD? You need all the ECGs to know for sure.

Dr. Smith's ECG Blog

His daughter immediately started CPR and another family member called EMS. Here is his presenting ECG: ECG 1, t = 0 What do you think? His transfer packet included notes, labs, cath report, and ECG reports, but no actual ECG images. Smith's ECG Blog. He did not have access to ECG 1.

EKG/ECG 120
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A 50-something with chest pain.

Dr. Smith's ECG Blog

This ECG was recorded in triage. The computer interpretation is: “Sinus Brady with moderate intraventricular conduction delay, nonspecific t wave abnormality, abnormal EKG” What do you think? Case Continued The ECG findings were not recognized. Therefore, no matter the initial ECG, record serial ECGs.

EKG/ECG 137
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Texted from a former EM resident: 70 yo with syncope and hypotension, but no chest pain. Make their eyes roll!

Dr. Smith's ECG Blog

Here is the case: Report from EMS was witnessed syncope, his son did CPR, but the patient had pulses when EMS arrived. Here is the ED ECG (a photo of the paper printout) What do you think? Instead — the "syncopal episode" prompted the patient's son to start CPR, and was associated with persistent hypotension.

EMS 115
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Resuscitated from ventricular fibrillation. Should the cath lab be activated?

Dr. Smith's ECG Blog

They started CPR. The patient was brought to the ED and had this ECG recorded: What do you think? The ECG shows severe ischemia, possibly posterior OMI. For clarity in Figure-1 — I've reproduced today's ECG — obtained following successful resuscitation of out-of-hospital cardiac arrest. He was defibrillated into VT.

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STREAM-2: Half-Dose Tenecteplase vs Primary PCI in Older Patients with STEMI?

RebelEM

ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% The upper range of this time was 120 minutes from diagnostic ECG in the majority of patients.

EKG/ECG 137