EMS rolls in performing CPR on your new patient an elderly man found down. After achieving ROSC you receive the following EKG. Where will you find this patient's lesion?
That is correct, this patient has an intracranial hemorrhage causing increased intracranial pressure. Keep in mind up to 10% of cardiac arrests outside the hospital are from intracranial hemorrhage. Typical ECG characteristics are:
Widespread deep wide T waves (cerebral T waves)
Qtc prolongation
Bradycardia
less common findings include:
St depression/elevation
Increased U wave amplitude
Other rhythm derangements such as premature ventricular contractions or afib
Keep in mind ICH can cause wall motion abnormalities visible on echocardiogram
The following ecg with diffuse ST elevations is from a trauma patient with ICH
Your next patient is brought in for chest pain and has this ecg:
You diagnose your patient with pericarditis indicated by:
Diffuse ST elevations in the limb leads, V2-6, with ST depression seen in AVR,
ST changes are concave
Note that all ST segments are concordant with their QRS,
PR depressions wide spread and sometimes down sloping
tachycardia
You activate your cardiac catheterization lab for your third patient with the following ECG
While performing your bed side Echo you see the following
There is free fluid around the heart and the aortic root is dilated! Your patient is one of the lucky 0.1% of STEMIs that are actually dissection.
usually inferior STEMI due to extension of dissection into right coronary
if tamponade develops ECG shows electrical alterans
any chest pain with neuro symptoms or back pain consider dissection