a 37 year old patient comes in with chest pain, you obtain the following ECG. Is this a STEMI or Pericarditis?
How can you tell? well, you follow the algorithm Dr. Mattu taught us....
The ECG above, if you go through the algorithm you will see that it is most likely pericarditis.
note that PR depression can be transient and you might not see them.
When in doubt, it is not wrong to consult cardiology. Getting serial ECGs also is important, STEMIs will usually evolve.
We hope that you enjoy your Memorial Day!
Don't forget your Sandy Beach Sign vs Barcode Sign of Lung Ultrasound:
Normal lung will have good pleural sliding. When you image the lung with M-Mode it looks like a Sandy Beach.
A lung with a pneumothorax will have poor lung sliding. When you image the lung with M-Mode it looks like a classic barcode or "stratosphere sign."
Make sure that you are on "Lung Mode" or decrease the gain to better image the movement of the pleural line. The negative predictive value for lung sliding on ultrasound is 99%. This means that if you see lung sliding you do not have a pneumothorax in that area. However, lung sliding is affected by certain conditions such as blebs, pulmonary fibrosis, pleural adhesions and right mainstem intubation. So, like any other radiology study, clinically correlate!
Thinking about placing a chest tube or have a patient with multiple rib fractures? Take a look at how to perform a Serratus Anteror Plane Block here: https://www.thepocusatlas.com/thoracoabdominal-blocks#Serratus
Clinician Well-Being and the Patient Experience
Did you know that most patient experience responses are overwhelmingly positive? Rather than focusing all our attention on the bad, let’s focus on the good to promote clinician well-being. See below for a few key points from a recent study on this:
Consider emphasizing positive patient experiences when providing feedback to emergency physicians. It will promote clinician well-being and help improve performance in your practice.
Did you know that you can use the linear probe with pulse wave (PW) doppler over the femoral artery to look for a pulse during CPR pauses?
Well, the researchers of this article took this skill one step further to evaluate if they could use the femoral artery PW doppler while CPR was in progress to look for signs of a pulse.
The authors found that:
- pulsations due to compressions were organized with uniform pulsations.
- when there was also native cardiac activity, the pulsations were nonuniform and may have an irregular cadence.
Although there were several limitations, Arterial doppler was 100% specific and 50% sensitive in detecting organized cardiac activity during active CPR.
Take Home Point: Take a look at your arterial doppler for signs of organized cardiac activity during a resuscitation.
