#ECG@Clincal_word

#ECG

In an emergency setting, several ECG findings can indicate life-threatening conditions. Here are some of the most common emergency cases seen in ECG:

1. Myocardial Infarction (STEMI & NSTEMI)

ST-Elevation Myocardial Infarction (STEMI)

ST-segment elevation in two or more contiguous leads.

Reciprocal ST depression in opposite leads.

T-wave inversion or hyperacute T-waves.

Non-ST Elevation Myocardial Infarction (NSTEMI)

ST-segment depression or T-wave inversion without ST elevation.

Elevated cardiac biomarkers (troponin).

1. Cardiac Arrest Rhythms

Ventricular Fibrillation (VF)

Chaotic, irregular, fibrillatory waves.

No identifiable P, QRS, or T waves.

Requires immediate defibrillation.

Ventricular Tachycardia (VT)

Wide QRS complexes (>120 ms), regular or irregular rhythm.

Monomorphic (same QRS shape) or polymorphic (different QRS shapes).

Can lead to VF and cardiac arrest.

Pulseless Electrical Activity (PEA)

Organized ECG activity without a detectable pulse.

Asystole

Flatline or nearly flat ECG, no electrical activity.

1. Arrhythmias

Atrial Fibrillation (AF) with Rapid Ventricular Response (RVR)

Irregularly irregular rhythm without distinct P waves.

Can lead to hemodynamic instability.

Supraventricular Tachycardia (SVT)

Regular, narrow QRS complexes (>150 bpm).

Can be treated with vagal maneuvers or adenosine.

Torsades de Pointes

Polymorphic VT with twisting QRS complexes.

Often associated with prolonged QT interval.

1. Electrolyte & Metabolic Disturbances

Hyperkalemia ("Peaked T-waves")

Tall, peaked T waves, wide QRS, flattened P waves.

Can progress to sine wave pattern → cardiac arrest.

Hypokalemia

Flattened T waves, U waves, ST depression.

Hypocalcemia / Hypercalcemia

QT prolongation (hypocalcemia) or QT shortening (hypercalcemia).

1. Pulmonary Emergencies

Pulmonary Embolism (PE) ("S1Q3T3 Pattern")

S-wave in lead I, Q-wave in lead III, inverted T-wave in lead III.

Sinus tachycardia is the most common finding.

1. Pericardial Emergencies

Pericarditis

Diffuse ST-segment elevation (concave) with PR depression.

Cardiac Tamponade (Electrical Alternans)

Alternating QRS amplitude due to heart movement in pericardial effusion.

1. ST-Elevation Myocardial Infarction (STEMI)

2. Ventricular Fibrillation (VF)

3. Ventricular Tachycardia (VT)

4. Atrial Fibrillation (AF) with RVR

5. Supraventricular Tachycardia (SVT)

6. Torsades de Pointes

7. Hyperkalemia (Peaked T Waves)

8. Pulmonary Embolism (S1Q3T3 Pattern)

9. Pericarditis (Diffuse ST Elevation)

10. Cardiac Tamponade (Electrical Alternans)

Let me generate these ECG images for you.

#Acute_pancreatitis⬇️

Patients presented with epigastric pain that usually radiated to back and relief with forward position (prayer )ass with vomiting

بشكل عام مافي حاجة اكيد تفرقها مع الاشياء الثانية خصوصا PUD والphysical exam ماتحصل فيه شي غالبا الا في sever case

بخصوص التشخيص
*️⃣high lipase *️
كافي للتشخيص مع sensitivity 94%and specificity 96%
ولا داعي لعمل amylase

*️⃣ U/S
غالبا لايشخص لكن مهم ويجب ان يعمل مع كل حالة لمعرفة GB stone

*️⃣CT with contrast
ضرورية في حالة توقع complications
او unclear diagnosis
⬇️⬇️
بعد ماخلصت موضوع diagnosis وقده اكيد الان محتاج تعرف underlying cause من خلال
US ,Liver enzyme, ALP bilirubin

ومحتاج ايضا تعرف complications
ضروري تشيك ع
RFT ,Ca ,ABG
بعد مايكون معك كل ذولا الاشياء استخدم
Ramson criteria for assessment severity
⬇️⬇️
بالنسبة للعلاج في ER
◼️started emest 8mg or plasil 10mg
◼️analgesic as Morphine 0.1mg/kg or fentanyle 1_2mcg/kg or roughly 50_100mcg iv bolus
◼️Antibiotic as Meropenem 1g iv plus Metronidazole 500mg iv

◼️surgical and may be gastroenterolgy consultant

Ceftriaxone Notes