tag:blogger.com,1999:blog-549949223388475481.post7904271411376755146..comments2024-03-26T22:42:04.176-05:00Comments on Dr. Smith's ECG Blog: This ECG is NOT Pathognomonic of Brugada SyndromeUnknownnoreply@blogger.comBlogger5125tag:blogger.com,1999:blog-549949223388475481.post-41071021092282566312015-08-11T06:41:43.690-05:002015-08-11T06:41:43.690-05:00Thanks, Brooks - that's very interesting. I d...Thanks, Brooks - that's very interesting. I don't know quite why but that same confusion doesn't seem to exist over this side of the Pond, the worst I've had is medical students getting fixated on calcium resonium and me having to emphasise that's nothing to do with acute management! (some from certain areas also seem to really like mentioning salbutamol nebs, which have a slight role but nothing compared to calcium chloride!). I think our renal physicians here are pretty strong in their hyperkalaemia teaching when we're students, which helps! Nice case though - thanks :)Alan Robertsonhttps://www.blogger.com/profile/13091964669629378196noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-92097337870531487502015-08-11T03:30:26.446-05:002015-08-11T03:30:26.446-05:00"There still exists confusion.." was poo..."There still exists confusion.." was poor phrasing on my part. The evidence and guidelines aren't confusing, they're quite clear! <br /><br />The wide variation in clinical practice, however, can be confusing for medical trainees. They still see some of their mentors pushing IV amps of sodium bicarbonate and PO aliquots of sodium polystyrene. In addition, many EMS protocols in the US continue to list sodium bicarb as first-line for suspected hyperkalemia. This unfortunate situation makes treatment priorities "confusing" for many people, at least in the US.<br /><br />Brooks Walsh<br />Brooks Walshhttps://www.blogger.com/profile/16108633682893762401noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-8823613583774114472015-08-10T09:16:53.665-05:002015-08-10T09:16:53.665-05:00I agree completely, but did not edit that out.
We...I agree completely, but did not edit that out. <br />We always use Calcium first and really bicarb has little effect. Other things that help but take longer are beta agonists, insulin, and furosemide if the patient produces urine.<br />Thanks for the comment!<br />Steve SmithSteve Smithhttps://www.blogger.com/profile/08027289511840815536noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-34493574844793134062015-08-09T17:44:39.265-05:002015-08-09T17:44:39.265-05:00Good case, although I'm surprised about the co...Good case, although I'm surprised about the comment re confusion around treatment of hyperkalaemia. The ALS guidelines we have in the UK are very clearly re calcium being first line and it's in all our emergency drug boxes. Never heard of folk using sodium first line. I've got a nice sequence of ECGs I use from a real life case of K 7.0 after 10 then 30mmol CaCl, then after dialysis - shows a nice sequence! Alan Robertsonhttps://www.blogger.com/profile/13091964669629378196noreply@blogger.comtag:blogger.com,1999:blog-549949223388475481.post-46549190282122138772015-08-09T11:23:12.266-05:002015-08-09T11:23:12.266-05:00EXCELLENT POST! That said — I take issue on the se...EXCELLENT POST! That said — I take issue on the semantics of the discussion. The initial ECG IS diagnostic of a Type I Brugada pattern (in my opinion) — since that distinction is based on ECG appearance, which does fit criteria. What differs, is that this is not a spontaneous Brugada pattern, but rather one induced by acute electrolyte/metabolic abnormality (hyperkalemia). Since ECG abnormalities promptly resolve on treatment of the causative factor (hyperkalemia) — clinical implications are NOT as they would be if this ECG picture had been spontaneous. Referral for further evaluation is not necessarily needed ... Again — Excellent post!ECG Interpretationhttps://www.blogger.com/profile/02309020028961384995noreply@blogger.com