tag:blogger.com,1999:blog-549949223388475481.post2330779256601909814..comments2024-03-28T14:02:08.119-05:00Comments on Dr. Smith's ECG Blog: Test almost all of your most important ECG rhythm interpretation skills with this case. Unknownnoreply@blogger.comBlogger15125tag:blogger.com,1999:blog-549949223388475481.post-16793676908823678572017-11-25T10:21:03.398-06:002017-11-25T10:21:03.398-06:00One last question (I find tgis case fascinating). ...One last question (I find tgis case fascinating). When you mention treating possible hiper K+ before lab results, which would be your treatement of choice?<br />Would you just stabilize whith some sort of calcium and hidration?, or do you mean the whole lot (insulin, bbloquers, Henle diuretics...).<br />Thanks.Fernandohttps://www.blogger.com/profile/11496808512836930126noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80085624516414897002017-11-25T08:00:37.040-06:002017-11-25T08:00:37.040-06:00Fernando,
Calcium!!
SteveFernando,<br />Calcium!!<br />SteveSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-60780026883924956552017-11-25T06:32:34.075-06:002017-11-25T06:32:34.075-06:00One last question (I find tgis case fascinating). ...One last question (I find tgis case fascinating). When you mention treating possible hiper K+ before lab results, which would be your treatement of choice?<br />Would you just stabilize whith some sort of calcium and hidration?, or do you mean the whole lot (insulin, bbloquers, Henle diuretics...).<br />Thanks.Fernandohttps://www.blogger.com/profile/11496808512836930126noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80441429773972163392017-11-20T17:30:11.227-06:002017-11-20T17:30:11.227-06:00Just one point not mentioned which saved one simil...Just one point not mentioned which saved one similar (I'd say almost the same) patient I had not long ago from drugs/electricity... While figuring out 'what the hell to do', the patient was lifted from one bed to another by parameds with spontaneous reversal to sinus. Valsalva (unintentioned, I must admit), saved the patient from any possible secondary effect.<br />I'll never forget if patient not crashing.<br />Thanks a lot. Very interesting, as usual.Fernandohttps://www.blogger.com/profile/11496808512836930126noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-86435521487827493542017-11-20T17:22:39.608-06:002017-11-20T17:22:39.608-06:00I would only like to share one possible, quick and...I would only like to share one possible, quick and harmless manouvre which can solve out the situation in case it really is SVT. I had a very similar case with negative V5-V6 otherwise LBB-like morphology. While thinking 'what the hell to do', the patient was transfered from bed to bed with spontaneous reversal to sinus... VALSALVA!Quick and harmless. Always worth it (if not critical patient).<br />Thanks a lot again, very interesting!Fernandohttps://www.blogger.com/profile/11496808512836930126noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-68912385303448085982017-10-27T09:30:42.547-05:002017-10-27T09:30:42.547-05:00Thanks for answering , yea i mean DI by D1 . Thanks for answering , yea i mean DI by D1 . Anonymoushttps://www.blogger.com/profile/10142312163431658873noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-24855185461419742252017-10-27T08:52:23.291-05:002017-10-27T08:52:23.291-05:00Thanks for reading! See the other comments about t...Thanks for reading! See the other comments about the QRS complex. Not perfect LBBB, but pretty close. The initial part of the QRS depolarizes rapidly, which is a clue that it's using the conduction system.Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-16324721559022637792017-10-27T08:48:33.818-05:002017-10-27T08:48:33.818-05:00Glad you enjoyed the case! See my comment above ab...Glad you enjoyed the case! See my comment above above in response to a similar question. I do not think it is a universal rule that lead I and V6 must always have the same axis or else it's lead misplacement, but usually they do agree, and I would definitely have lead misplacement as a possibility in this situation.<br /><br />By "D1", do you mean lead I? So many different terminologies and lead displays throughout the world. Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-31870738235527798412017-10-27T08:41:18.979-05:002017-10-27T08:41:18.979-05:00Depending on who you ask, this is either LBBB with...Depending on who you ask, this is either LBBB with simply a slightly unusual precordial axis (because we still don't have an R wave even in lead V6), or it has to be called nonspecific IVCD because of this one technicality. All other leads have perfect LBBB morphology, which makes me call it basically just LBBB. Probably doesn't meet the perfect criteria for LBBB just because of V6, but it is definitely acting like LBBB and obeying the LBBB pattern of ST-T discordant changes, etc. <br /><br />2 of the EKGs above have a positive QRS complex in V6, suggesting that lead misplacement may be a possibility as to why we still have predominantly negative QRS complex in V6. It is also possible that the heart is positioned in an unusual way, such that even correct chest wall placement of the electrodes does not go far enough to witness the transition to positive QRS complex.Pendellhttps://www.blogger.com/profile/01445330667624442976noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-52933043107889411602017-10-27T07:03:28.459-05:002017-10-27T07:03:28.459-05:00Our pleasure!Our pleasure!Steve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-80029730909793284592017-10-27T03:53:40.763-05:002017-10-27T03:53:40.763-05:00very cool indeed, guys (A, M and S). a friend bro...very cool indeed, guys (A, M and S). a friend brought this one to my attention, am glad he did. wide complex tachy's always frighten me a bit. there seems to be much that can go wrong. but this pod certainly helps. thank you.<br />tomtom fieronoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-29760721795343357282017-10-26T11:42:41.015-05:002017-10-26T11:42:41.015-05:00Hello ! i am a medical student and i admit that i...Hello ! i am a medical student and i admit that i was not really able to follow the hole history ^^ but however i loved reading it that was really really interesting! thank you very much , things like this just make me loving médical study more . So there is something i want to ask too , as D1 and v6 share the same axis , does it means that if the two leads doesnt show the same polarity on one tracing , there are forcely lead misplacement ? or are there other situations that can make D1 and v6 having différent axis ? cause on the two last ecg their are not the same so its a bit weird that there was always a lead misplacement i think . Sorry for asking that , and sorry too for my english , i tried my best :) Anonymoushttps://www.blogger.com/profile/10142312163431658873noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-6041859216242985292017-10-26T10:43:07.597-05:002017-10-26T10:43:07.597-05:00When i focus on the first ecg, there was a confusi...When i focus on the first ecg, there was a confusion about P wave morphology, and the wide QRS complex in V1-V6 is not a typical morphology for LBBB, and, especialy, there was positive complex in aVR made me confused. Thanks for great lesson.Kiên Phannoreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-87901794942214795632017-10-26T10:05:39.188-05:002017-10-26T10:05:39.188-05:00Great case thanks... More knowledge shared than ju...Great case thanks... More knowledge shared than just ECG esp the Stable/unstable criteria laid down by AHA...I don knw what to believe in anymore :)<br /><br />But one thing of note is, the concept of lead misplacement..from what i learnt; lead V6 and lead aVR are good to determine leads misplacement, so in all the ECGs in this case these both leads are opposite to each other except when you have mentioned that there is lead misplacement(ECG 3)<br />would it be better called IVCD?.or the leads were misplaced in all tracings except that one ECG or is it the other way around??<br /><br />Thank you again for a great case...MGhttps://www.blogger.com/profile/06233522417024317416noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-5987455990088197672017-10-26T09:08:56.874-05:002017-10-26T09:08:56.874-05:00Great case and explanation. Thank you Sir Great case and explanation. Thank you Sir Anonymousnoreply@blogger.com