2018 Bradycardia Clinical Guidelines

Colours correspond to Class of Recommendation.*Atropine should not be given in patients after heart transplant.†In patients with drug toxicity and severe symptoms, preparation for pacing should proceed simultaneously with pharmacologic treatment of drug toxicity.AADs indicates antiarrhythmic drugs; AV, atrioventricular;BB, beta blocker; CCB, calcium channel blocker; COR, Class of Recommendation;ECG, electrocardiographic; H+P, history and physical examination; IMI, inferior […]

T-Waves

Hyperacute T-waves are often the first manifestation of complete vessel occlusion; they are wide, bulky and prominent. Hyperacute T-waves are not necessarily tall, and small T-waves can still be hyperacute when paired with a low-amplitude QRS complex. De Winter T-waves represent LAD occlusion (a STEMI equivalent) requiring immediate revascularization. Previously inverted T-waves can appear normal and upright in […]

Heart Blocks: A Primer

Heart blocks can be a sign of underlying pathology such as MI, Lyme disease, myocarditis, structural heart disease, pulmonary embolism, autoimmune disease, electrolyte disturbances, medication side effects, Lenegre’s or Lev’s disease, increased vagal tone, or could be a normal variant. Treatment with Atropine is indicated in bradycardic, symptomatic and/or unstable patients with a 1st or […]

Top 10 Posts of 2017

Mistakes that Kill during Cardiopulmonary Resuscitation Too Slow or Too Fast Chest Compressions Too Shallow or Too Deep Chest Compressions Too Many or Too Slow Breaths Leaning on the Chest Too Many Interruptions Giving Up Too Soon Too Slow Adaptation     Oxygen Bubble Bottles or Bacteria Swimming Pools? Humidified oxygen is widely administered in hospitals […]

Did you know Adrenaline doesn’t work for Cardiac Arrest?

Adrenaline may improve return of spontaneous circulation, but it does not improve survival to discharge or neurologic outcome. The timing of epinephrine may affect patient outcome, but Basic Life Support measures are the most important aspect of resuscitation and patient survival.  

Chest Pain in Atrial Fibrillation

This is a great example of how the dichotomy between STEMI and Non-STEMI is false.  They are both due to thrombus in the coronary artery and both are very dangerous.  STEMI and NonSTEMI exist on a spectrum.  Thrombus can lyse and propagate, and NonSTEMI can convert to STEMI.  

Post ROSC

System Action Airway Intubate → Ventilation tidal volume @ 6-8 mL/kg Place OG or NG tube Confirm endotracheal and OG/NG tube placement with chest x-ray Breathing SpO2 goal >94% → adjust PEEP & FiO2 to achieve goal EtCO2 goal 30-40 mmHg → adjust respiratory rate to achieve Circulation 12-lead ECG → Activate cardiac catheterization lab […]

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