Dr. Smith's ECG Blog

Instructive ECGs in Clinical Context ----Archives, Popular Posts, and an Index of all ECGs are down the right-hand side.

Friday, May 4, 2012

Lecture: Acid Base Disorders (Sorry, no ECGs!) -- 50 minutes

Posted by Steve Smith at 8:20 AM

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1 comment:

MinaMay 8, 2012 at 8:49 PM
Thanks a lot Dr Smith.
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This site contains case studies from around the world. Patient identifiers have been redacted or patient consent has been obtained. The contents of this site have not been reviewed nor approved by Hennepin County Medical Center and any views or opinions expressed herein do not necessarily reflect the views or opinions of Hennepin County Medical Center

about Dr. Smith

Dr. Stephen W. Smith is a faculty physician in the

Emergency Medicine Residency at
Hennepin County Medical Center (HCMC)
in Minneapolis, MN, and
Associate Professor of Emergency Medicine at the
University of Minnesota.

Smith-Modified Sgarbossa Rule for Diagnosis of STEMI in the Presence of Left Bundle Branch Block

Here is a link to the pdf of the article

The equation for differentiating the ST elevation (STE) of subtle LAD occlusion from early repol

Here is a link to the full text of the article in Annals of EM

It is critical to use it only when the differential is subtle LAD occlusion vs. early repol. If there is LVH, it may not apply. If there are features that make LAD occlusion obvious (inferior or anterior ST depression, convexity, terminal QRS distortion, Q-waves), then the equation MAY NOT apply. These kinds of cases were excluded from the study as obvious anterior STEMI. ST elevation (STE) is measured at 60 milliseconds after the J-point, relative to the PR segment, in millimeters.

(1.196 x STE at 60 ms after the J-point in V3 in mm) + (0.059 x computerized QTc) - (0.326 x R-wave Amplitude in V4 in mm).

Use the calculator below. A value greater than 23.4 is quite sensitive and specific for LAD occlusion.

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Comments not appropriate for general posting, or interesting ECGs, may be sent here (do this judiciously!): dr.smiths.ecg.blog@gmail.com.

I highly recommend using this blog as an atlas or textbook. Use the "label" below the archive (below) to search for all kinds of ECG cases, with discussion.

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Video Lectures of Dr. Smith

The Best of Smith (2 hours on subtle occlusion from Best of Hennepin conference)

Here is a lecture on the diagnosis of Acute MI in the presence of left bundle branch block

Here is a lecture on Acid-Base Disorders (55 minutes)

Here are 2 lectures on Acute Coronary Syndromes on hqmeded.com. ACS 1 is on Unstable Angina and NSTEMI. ACS 2 is on STEMI. Each is one hour.

Here are 2 lectures: narrow complex tachycardia and wide complex tachycardia.

The blog is featured on Podcast 42 of EMCrit, with an interview on various aspects of the ECG in MI, and another EMCrit feature on left bundle branch block, with an interview.

Links

Critical Decisions in Acute Care electrocardiography -- ACS section by Dr. Smith
EMS 12-Lead
Ken Grauer's excellent EKG site
Dr. Smith's book (Amazon) (now out of print and out of stock; some used copies available, hoping to publish it electronically)
EM Crit
hqmeded.com

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