Shock with Dr.s Ran and Bender

We were fortuante enough to have two guest presenters for Noon Report this week- Dr. Ran Ran with Critical Care and Dr. Aron Bender with Cardiology. They talked through a case from the MICU of undifferentiated shock found to have markedly troponinemia. The discussion not only involved urgent management of an unstable patient but also interpretation of EKG findings and troponin elevation. Below are a few key teaching points. For full details, please refer to the posted materials on MedHub.

EKGs require a lot of practice to maintain proficiency. And, proper interpretation for ischemia is a must as rapid mobilization of resources is necessary in the event of acute plaque rupture or thrombus driven MI. Dr.s Ran and Bender reviewed the Third Universal Definition of Myocardial Infarction and provided some of their own tips. 

1. Interpret the electrographic regionality 

ekg and heart.PNG

2. Look for reciprocal change

3. Don't forget Sgarbossa's criteria for LBBB

 Concordant ST elevation > 1mm in leads with a positive QRS complex (score 5)  Concordant ST depression > 1 mm in V1-V3 (score 3)  Excessively discordant ST elevation > 5 mm in leads with a -ve QRS complex (score 2)

Concordant ST elevation > 1mm in leads with a positive QRS complex (score 5)

Concordant ST depression > 1 mm in V1-V3 (score 3)

Excessively discordant ST elevation > 5 mm in leads with a -ve QRS complex (score 2)