Current ECG Podcast

This episode features Matt Pigott from Medic Minute with Matt to share his insights about Posterior RCA Occlusions.

Also In This Episode

Anatomy of the RCA
Scenario - 62 Y/O F C/C of nausea
Standard 12 lead placement
Modified 12 lead
Posterior RCA diagnosis
LAD Occlusions
Anatomy of the LAD
Scenario - 58 Y/O m C/C of chest pain
Hyperacute T waves

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This episode features Matt Pigott from Medic Minute with Matt to share his insights about 12 Lead ECG and Coronary Anatomy.

Also In This Episode

Before you get started
Looking at your 12 Lead
How does this reflect Coronary Anatomy?
Changes in morphology
Perfusion issue
Blood flow through the heart
Electrical issue
Electrolyte issue
Cardiac action potential
PQRST segment
"STEMI mimics"
RCA Occlusions
55 y/o patient case example(s)
- Proximal or Distal?

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On this episode Dave shares about acute coronary syndrome and some of the important ECG shapes and morphologies that can occur in the very beginnings of the injury to the Cardiomyocytes of your heart.

Also In This Episode

Abnormally wide T waves
ECG Tracing examples
Don't get confused with Hyperkalemia

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On this episode Dave is joined by Dr. Jerry W. Jones, MD FACEP FAAEM, to discuss why ST elevation is not always an infarction. Dr. Jones will highlight why we need to think about morphology and shape when interpreting ECGs and why reciprocal changes are just as important as the primary changes and more!

Dr. Jones is the CEO and Founder of Medicus of Houston. Medicus of Houston is a continuing medical education company that specializes in advanced ECG interpretation and instruction.

He is a Board-certified emergency physician, author, speaker, instructor and and internationally-recognized expert in electrocardiography.

Dr. Jones is a diplomate of the American Board of Emergency Medicine who has practiced internal medicine and emergency medicine for over 40 years.

Also In This Episode

How to diagnose real infarctions
How ischemia damages the cell
Cells creating electrical current
How electrical current creates is responsible for ST depression and elevation
Systolic and Diastolic currents of injury
How not to confuse subendocardial ischemia with reciprocal change

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In this episode, Dave is joined by Tarlan Hedayati, MD, FACEP, to discuss how to decipher dysrhythmias in devices such as Pacemakers and ICD's.

Dr. Hedayati is a practicing Emergency Physician in Cook County, Chicago. She is also the Associate Professor and Chair of Education for the Emergency Medicine Department.

Also In This Episode

What does normal paced rhythm look like?
- ECG Tracing example
Failure to Pace
- What does a magnet do to a Pacemaker?
Failure to Capture
- ECG Tracing examples
- Pacemaker X-Ray examples
- Twiddler's Syndrome
Failure to Sense
- ECG Tracing examples
- Pacemaker Mediated Tachycardia
- Runaway Pacemaker
Magnet in ICD's
Review - Look at the ECG
- Look at the rate?
- Are there pacer spikes?
- Are there p's and/or QRS after every spike?
- Are the spikes appropriate?

Connect with Tarlan Hedayati:

Twitter: @HedayatiMD https://twitter.com/HedayatiMD

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In this episode, Dave shares about moving away from the concept of ST-Elevation Myocardial Infarction (STEMI) and focusing on Occlusion Myocardial Infarction (OMI).

Also In This Episode:

OMI vs. STEMI
Patient Case: 70 YO Male
De Winter's T Waves
ECG Tracing example
ECG Diagnostic criteria
ECG Tracing examples
Review - Patient Case: 70 YO Male
- Activate Cath Lab
Take home points

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In this episode, Dave talks about End-tidal CO2 (EtCO2), and how to use Capnography to better assess and treat your patients.

Also In This Episode:

What is Capnography?
Patient Case: 25 YO Male
When CO2 is not exhaled effectively
Oxygenation and Ventilation
4 phases of EtCO2
EtCO2 and airway management
Using EtCO2 during cardiac arrest
Supporting graphs and stats
Waveform and EtCO2 examples - What do you think is happening with this patient?
EtCO2 + COPD - Shark fin pattern
Waveform examples - troubleshooting
Head injury
Patient Case: 25 YO Male - revisit

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On this episode Dave is joined by Dr. Jerry W. Jones, MD FACEP FAAEM. Dr. Jones is the CEO and Founder of Medicus of Houston. Medicus of Houston is a continuing medical education company that specializes in advanced ECG interpretation and instruction.

He is a Board-certified emergency physician, author, speaker, instructor and and internationally-recognized expert in electrocardiography.

Dr. Jones is a diplomate of the American Board of Emergency Medicine who has practiced internal medicine and emergency medicine for over 40 years.

Also In This Episode

What is a Reciprocal Change?
The rules of Reciprocal Change
- Only in the same plane as ST elevation
- The leads manifesting reciprocal change should be as close to 180 degrees away from the leads with ST elevation as possible.
ST Elevation / Reciprocal Pairs
Inferior Epicardial Ischemia with Reciprocal Change
Basolateral Epicardial Ischemia with Reciprocal Change
Posterior / Lateral Epicardial Ischemia
Epicardial Ischemia with Reciprocal Change ECG Tracing example
An impulse travelling perpendicular to a lead axis cannot be seen in that lead.
ECG Tracing example
- Ventricular Aneurysm
The Problem with Anterior ST Elevation
LAD Occlusion and Reciprocal Changes
ECG Tracing examples
- Acute Pericarditis
Danger is hiding in Reciprocal changes
ECG Tracing example
ECG Tracing example
Subendocardial Ischemia or Reciprocal Change?
- ECG Tracing examples of Reciprocal changes
- ECG Tracing examples of Subendocardial Ischemia
Six points to remember
Dave's take-home points

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In this episode, Dave is joined by Tarlan Hedayati, MD, FACEP, to discuss how to differentiate between Pseudo PEA and True PEA.

Dr. Hedayati is a practicing Emergency Physician in Cook County, Chicago. She is also the Associate Professor and Chair of Education for the Emergency Medicine Department.

Also In This Episode

Patient Case: 57 YO Male
- POC Ultrasound
Pulse checks, are fingers are dumb
POCUS for Pulse
FEEL for cardiac activity (Focused Echocardiographic Evaluation in Life support)
The downside of POCUS
POCUS in the emergency department
CASA (Cardiac Arrest Sonographic Assessment)
- Tamponade
- RV strain
- Motion
PEA Evaluation
Pressor Infusions vs. Standard ACLS
PEA Bottom line: POCUS & minimize pauses

Connect with Tarlan Hedayati:

Twitter: @HedayatiMD https://twitter.com/HedayatiMD

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In this episode, Dave shares the importance of practicing quality CPR with the goal of being the 'ultimate compressor'.

Also In This Episode:

Patient case which deteriorates to cardiac arrest-
- AHA/ILCOR ECC guidelines to begin immediate chest compressions and application of the cardiac monitor with an attempt at defibrillation.
- Work as a team on the choreography of resuscitation. Ensuring no one provider has a cognitive overload and is able to focus on a specific assigned task.
- Ensure the provider who is performing the skill of chest compressions is able to focus on the appropriate rate, minimizing pauses, and allowing for complete chest recoil.
- CPP - Coronary Perfusion Pressure is the key to providing the cardiomyocytes with the sugar, water, oxygen they need to survive by perfusing the coronary ostia and building CPP.
- Post ROSC care should include maintaining a systolic blood pressure of at least 90mmhg, 02 sats between 94-99%, patient normothermia, 12 lead ECG interpretation and finally working with other health care providers on a coordinated transfer of care.

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In this episode, Dave is joined by Brad Reid to discuss Medical Math and how you can be sure that you are making accurate calculations at 3 o'clock in the morning when you are hungry and tired!

Brad is an Advanced Care Paramedic in Nova Scotia and currently is the Program Manager for Medavie HealthEd that delivers Primary and Advanced Care Paramedic programs. Brad has worked as a Paramedic in Nova Scotia for 25 years. He also continues to work clinically as a Department Paramedic for the Nova Scotia Health Authority.

 Also In This Episode:

Patient example: 63 Y/O F
Starting with the basics
Patient example: Dopamine infusion
Medical Math
- What do we need?
- What information do we have?
- How much do we need?
- What is the drip rate?
Is there another equation? Yes!
The Clock Method
The Digital Method

More about Brad:

Brad has been involved in education for over 20 years. Initially delivering programs for St. John Ambulance, Brad helped develop the Maritime School of Paramedicine delivering the first Primary Care Program in 2001. Brad obtained his diploma in Adult Education from St. Francis Xavier University.

Brad has represented Nova Scotia as the Provincial Director, and Vice President for the Society of Prehospital Educators (SPEC) and held the position of Medical Advisor, ACP for the Professional Standards and Accreditation Committee for St. John Ambulance National.

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In this episode, Dave highlights one some consider to be the ultimate imposter- Hyperkalemia. Hyperkalemia is a life threatening electrolyte abnormality that can be easily missed in the emergency setting, and it is vitally important that we can recognize this by interpreting our patients ECG.

Also In This Episode

ECG example - Diagnosis
Depolarization - what's happening at the cellular level. You don't want to miss it.
What is Hyperkalemia?
ECG example
Hyperkalemia is a primary cellular problem which is why is produces global changes on the ECG.
Is that Asystole? Nope it's sinus rhythm in Hyperkalemia "mic drop"!
Calcium backdoor solution to temporary stabilization of the cardiomyocytes. Buying your patient time to definitive care.
Potassium levels produce characteristic ECG changes but it's not sharp and point T waves...

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In this episode, Dave is joined by Tarlan Hedayati, MD, FACEP, to discuss STEMI equivalents: ECG patterns that need the Cath Lab.

Dr.Hedayati is a practicing Emergency Physican in Cook County, Chicago. She is also the Associate Professor and Chair of Education for the Emergency Medicine Department.

Also In This Episode

What are STEMI equivalents?
STEMI defined
ECG families
Case example: 63 female
- Wellen's waves
Case example: 66 female
- STE aVR > V1, STD Diffuse
- Ask about DAPT
Case example: 67 male
- Discordant ST-segments and T-waves
- Sgarbossa's criteria
- Sgarbossa-Smith modification
Case example: Non obstructive CAD
LBBB
Case example: 43 male
- De Winter's waves
OHCA with ROSC: Who goes to the Cath lab?
Pattern Recognition: "HOW BAD" is the ECG

Connect with Tarlan Hedayati:

Twitter: @HedayatiMD https://twitter.com/HedayatiMD

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In this episode, Dave presents on some of the ECG interpretation basics and how to avoid being making incorrect interpretation at 3am when you are hungry and tired.

Also In This Episode

Interpretation basics
Atrial Fibrillation
ECG Tracing Example 1 - 3
Turn the volume up on your monitor
ECG Tracing Example 4 - 9

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In this episode, Dave is joined by Amal Mattu, MD, FAAEM, FACEP, to discuss high risk Arrhythmias.

Dr. Mattu is the Professor and Vice Chair, Department of Emergency Medicine, University of Maryland School of Medicine.

Also In This Episode

Case #1 - 60 yo. woman with weakness
- Moderate Hyperkalemia
- Severe Hyperkalemia
Case #2 - 45 yo. man with lightheadedness, BP 110/60
- Hyperkalemia (K+ 9.2)
- Amiodarone infusion
ECG - 42 yo. man with dyspnea and weakness
ECG - RRWCT: Severe acidosis (pH < 7.1)
ECG - RRWCT: Hyperkalemia
ECG - RRWCT: Pacer with wide QRS
ECG - RRWCT: Nortriptyline OD
ECG - RRWCT: Flecainide toxicity
Case #3 - 37 yo. man with respiratory distress, pulmonary edema...
- Ventricular Tachycardia Mimics ("Slow V.Tach.")
  - ECG - 42 yo. man presents c/o fever, cough, dyspnea, vomiting
  - ECG - Case 1
  - ECG - Case 2
  - ECG - Case 3
  - ECG - Case 4
  - ECG - Case 5
  - ECG case examples
Summary

Connect with Dr. Mattu: amalmattu@comcast.net

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In this episode, Dave discusses how it is important as practitioners to understand how blood PH can effect how we manage and treat our patients.

Also In This Episode

How do we provide oxygen and what is it doing?
Oxygen disassociation curve
Acidotic environment
Alkalotic environment
The cells need sugar, water, oxygen to survive!

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In this episode, Dave is joined by Tarlan Hedayati, MD, to discuss Tachycardia.

Dr.Hedayati is a practicing Emergency Physican in Cook County, Chicago. She is also the Associate Professor and Chair of Education for the Emergency Medicine Department.

Also In This Episode

Defining Tachycardia
Stable vs. Unstable vs. Cardiac arrest
Sinus vs. Not sinus
P and QRS
Narrow vs. Wide
Regular vs. Irregular
History of presenting illness matters
ECG Tracing example 1,2,3,4
- What's the polarity?
- LBBB
- Regular and wide
- SVT with LBBB
Fusion Beat: Wide QRS + Narrow QRS
Capture Beat: Narrow QRS
Treatment
- Procainamide vs. Amiodarone
Irregular wide complex Tachycardia
ECG Tracing example 5
- Polymorphic VT
ECG Tracing example 6
- A Fib with RVR and LBBB
ECG Tracing example 7
- A Fib with RVR in WPW
ECG Tracing example 8
- Sometimes the QRS is too wide
ECG Tracing example 9
- Syncope
ECG Tracing example 10
- Fascicular VT

Connect with Tarlan Hedayati:

Twitter: @HedayatiMD https://twitter.com/HedayatiMD

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In this episode, Dave is joined by Tarlan Hedayati, MD, to discuss Bradycardias and Blocks.

Dr.Hedayati is a practicing Emergency Physican in Cook County, Chicago. She is also the Associate Professor and Chair of Education for the Emergency Medicine Department.

Also In This Episode

Defining Bradycardia
Stable vs. unstable
Sinus vs. not sinus
Narrow vs. wide
AV Blocks
ECG Tracing example 1
- 1st Degree AV Block
- 2nd Degree AV Block
ECG Tracing example 2
ECG Tracing example 3
- 3rd Degree Heart Block
What is causing this Bradycardia?
ECG Tracing example 4
- Bradycardia in ACS
Clinical context
- ECG Tracing example 5
The Brady Bunch
- Beta Blockers, CCB, Clonidine, Digoxin
ECG Tracing example 6
- Hyperkalemia
ECG Tracing example 7
- Slow and narrow
ECG Tracing example 8
- Regular and wide
ECG Tracing example 9
- Osborn waves
ECG Challenge
The Cardiac Monitor is a dirty rotten scoundrel

Connect with Tarlan Hedayati:

Twitter: @HedayatiMD https://twitter.com/HedayatiMD

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In this episode, Dave discusses global ST Segment elevation, the flawed line of thinking that leads us to think "it must be Pericarditis", and how to differentiate between Acute Coronary Syndrome and Pericarditis.

Also In This Episode

Pericarditis - signs and symptoms
ECG Tracing example 1
ECG Tracing example 2
Morphology counts!
ECG Tracing example 3,4
ST Segment depression in aVL - reciprocal change
ECG Tracing example 5
What about the ST Segment depression in aVR or V1, what does that mean?
ECG Tracing example 6

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In this episode, Dave talks about augmented Vector Right (aVR). Many of us have been told, "Don't bother using lead aVR as part of your interpretation, you can't see anything in lead aVR, it won't give you any useful information." Nothing could be further from the truth.

Also In This Episode

Lead aVR, the forgotten lead
Looking down through the heart, an intracavitary lead
True trifurcation of the left main
ST-Elevation in lead aVR and SD-Depression everywhere else
Injury vectors
ECG Tracing example 1
What about triple vessel disease?
ECG Tracing example 2,3,4,5,6

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In this episode, Dave tackles the question: What's the difference between a normal Q Wave and a pathological one?

Also In This Episode

The hexaxial reference grid, the Cabrera system
Septal Depolarization
A window to the other side of the Heart!
Negative deflection
Pathological Q wave criteria
ECG examples

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In this episode, Dave talks about COVID-19 and some additional information that clinicians and emergency care providers can use to help them identify and manage some of these patients.

Also In This Episode

ECG Tracing examples
What does COVID-19 do to the heart?
Not all viruses are the same
Systemic inflammatory response
Myocarditis: STEMI, HF, Shock
Cytokine release
ECG Tracing examples
Risk factors
Treatment

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In this episode, Dave talks about VTACH, monomorphic and polymorphic, how to define them and finding the root cause of a rhythm.

Also In This Episode

Monomorphic VTACH defined
Dave's story - When you're following ACLS but the patient doesn't respond as expected
ECG Tracing example - wide tachycardia

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On this episode, Current ECG teams up with Master Your Medics to present a TCA Overdose case!

Dave discusses the pathophysiology behind sodium channel blocking medications and how they affect cardiac depolarization at the cellular level. This is important because it affects how we interpret the ECG.

Cardiac toxicity can develop quickly in TCA overdose, so get an ECG early in the clinical course if suspecting the diagnosis.

Dave also discusses how sodium bicarbonate works to alter the patients ph level as well as competitively binding to sodium channel receptors helping to reverse the acidosis and TCA availability in the blood.

Treatment options include:

Oxygen
Sodium bicarbonate for a QRS complex wider than 100ms.
Assisted ventilations via BVM with potential for early intubation consideration which will help to blow off C02
0.9% Normal Saline

What are some signs of TCA Overdose on the ECG?

Sinus Tachycardia – most frequent dysrhythmia
Widening of the QRS complex
Prolongation of the PR or QT interval
Right bundle branch block
Non-specific intraventricular conduction delay (IVCD)
Brugada pattern
Wide-complex tachycardia (not ventricular tachycardia)
Ventricular tachycardia / fibrillation

How wide is too wide?

A QRS duration >100ms is predictive of seizures and QRS >160ms is highly likely to experience a ventricular dysthymia.

The ECG from our patient had a QRS of 144!

Check out Master Your Medics: https://podcasts.apple.com/ca/podcast/master-your-medics/id1235264636

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In this episode, Dave talks about the importance of interpreting ECG tracings with a focus on Sensitivity and Specificity on the cardiac monitor.

Dave explains what Sensitivity and Specificity is and how it applies to you as a clinician.

Also In This Episode

Interpreting ECG tracings
The psychology of chest pain
Cardiac monitor
ILCOR
Sensitivity and specificity

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On this episode Dave talks about collateral circulation, the lateral wall and the importance of understanding cardiovascular and coronary anatomy and physiology when you are interpreting an ECG.

Also In This Episode

Electrical Silence
Changes in the lateral wall appear subtle
ECG tracing example #1
Why is there no changes in the low lateral leads?
ECG tracing example #2
ECG tracing example #3
Morphology and reciprocal changes

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On this episode Dave talks about the phenomenon of Cancellation of Electrical Forces - when an injury current is travelling to the front of the heart and at the exact same moment an injury current is travelling to the back of the heart.

Also In This Episode

The importance of recognizing Inferior Wall MI's and knowing if the right ventricle is involved.
Using lead V4R
ECG tracing example - Spotting the RVI
Lead 3 and V1 have the best view
ECG tracing example - V4R
What if the back of the heart is being effected?
ECG tracing examples

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On this episode Dave is joined by Dr. Jerry W. Jones, MD FACEP FAAEM. Dr. Jones is the CEO and Founder of Medicus of Houston. He is a Board-certified emergency physician, author, speaker, instructor and and internationally-recognized expert in electrocardiography.

Dr. Jones is a diplomate of the American Board of Emergency Medicine who has practiced internal medicine and emergency medicine for over 40 years.

Also In This Episode

History of the presenting illness & patient presentation
ECG Tracing #1
- ST deviations
- Morphology of the ST Segment
- Cancellation of electrical forces
ECG Tracing #2
- Low Voltage
- ST deviations
- Reciprocal changes focus on AvL and Lead3
- Jone's Rule - any patient with credible symptoms of acute coronary syndrome (MI), any ST depression should be considered a reciprocal change until proven otherwise.
ECG Tracing #3
- Sinus rhythm
- ST deviations
- Inferior MI
- Right ventricular MI
- Starling law
ECG Tracing #4
- Sinus rhythm
- ST deviations
- Acute Inferior MI
- Multiple MIs
- Right coronary artery lesion
- Cancellation of electrical forces

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On this episode Dave talks about Millimetres, does size really matter? For years we based our ECG diagnosis of myocardial infarction using a very specific set of millimetre criteria. Times have changed and ECG interpretation is changing too!

Also In This Episode

Dr. Steven Smith's thoughts on the millimetre measurement of the ST segment
Biology does not work on millimetre criteria
Trusting your gut

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On this episode Dave talks about how the QT interval is a big deal and how we should be looking at it each time we perform an ECG.

QT Interval - The time from the beginning of the Q wave to the end of the T wave.

Also In This Episode

Please start looking at the QTc as part of your regular ECG interpretation
Torsades de Pointes is a specific form of 'Polymorphic Ventricular Tachycardia' caused by a 'Long QT'. Watch out and prepare!
QT little 'c' which stands for (corrected). What it is correcting for? It's correcting for 'RATE' and averaging everything to 60 beats per minute.
QTc > 0.50 sec = a clinically significant prolonged QT interval and you need to tell somebody about it!!
Patients at higher risk - Methadone and medications of the Mycin family are notorious for prolonging the QT interval to name just a very few. Brush up on all the other medications that prolong the QT.
Take a closer look at the QTc in patients who are elderly and perhaps suffer from chronic renal insufficiency...they are higher risk patients for a prolonged QT.
And don't forget...If you encounter a patient in Torsades. Once you fix the rhythm, immediately as yourself...Hmm why did this patient have a prolonged QT interval??? So it doesn't happen again.

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On this episode Dave talks about 1st, 2nd and his all time favorite 3rd Degree AV Blocks, as well as Cannon A Waves and the importance of morphology when determining which type of block your patient may be experiencing.

Also In This Episode

PR Interval, QRS Complex & QT Interval
AV Blocks
1st Degree Block - It's not benign! I'll show you 2 types of patients where it's life threatening
1st Degree Block - ECG example
2nd Degree Block - Type 1 & Type 2
3rd Degree Block - The absolute greatest trick I ever learned for spotting a 3rd degree block without even putting the cardiac monitor on!
Cannon A Waves
When trying to differentiate between 2nd or 3rd Degree AV blocks, focus on the morphology of the T waves.

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On this episode Dave talks about how we have hit a wall when it comes to ECG interpretation and how we need to break through that wall by focusing on Morphology.

Also In This Episode

The Lateral Wall MI, which is notorious for producing really subtle changes but still associated with really bad things on the ECG.
Electrical Silence - Necrotic tissue & Collateral circulation, & electrode distance from the heart
The further the electrode is from the heart the smaller the image on the ECG.
ECG Tracing example
Sometimes the reciprocal change is more evident than the primary change.
High Lateral leads and low Lateral leads
Combining cardiovascular anatomy and physiology with what we see on an ECG.
ECG Tracing example

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On this episode Dave talks about Electrical Conduction which is a basic concept but has several key elements that are often misunderstood.

Also In This Episode

Electrographic representation of healthy human heartbeat
Where is the re-polarization of the Atria
You can't see the electrical conduction system on an ECG
Is it possible to have the individual cardiac myocytes of a heart not de-polarizing and not contracting but the electrical conduction system working normally?

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Yesterday our system had some issues! Basically a technology STEMI! Please except this bonus episode as a small token of our appreciation for your patience and for sticking with us!

On this episode Dave talks about one of the most important tools we carry as emergency medicine practitioners. Dave shares his personal story of how he learned the value of the stethoscope and the importance of Auscultation.

Also in this episode

You don't yet know what normal sounds like
Respiratory Auscultation pattern example
Listening from the back
Auscultation is tougher on paediatric patients

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Bonus Ep. 9 - What's That Thing Around Your Neck?... The Importance of Auscultation

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The content of Ep.9 has been updated Dave has made some small but important changes to the content, if you have the previous version of this episode you can kick that one aside and make this version your new best friend.

** In addition, our website and our podcast platforms had a fight this morning, the video version of episode 9 barged through the door and jump into the podcast feed! It has since been removed. We apologizes for this confusion, the videos are available exclusively in the members area at currentecg.com. Thank you!

On this episode Dave discusses the difference between a Modified 12 lead and a 15 lead, the advantages of the Modified 12 lead and how to use it.

Also in this episode:

The standard 12 lead placement
Don't forget to check the back of the heart
The modified 12 lead placementModified 12 Lead, Right Ventricular damage and No Nitrates
Modified 12 lead placement example
Is there value in lead V7?
Even small ST Segment changes in V4R, V8 & V9 equal big problems
Remember to label V4R

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On this episode Dave talks about electrode placement, limb leads and precordial leads. Cardiac monitoring has advanced to a point where in certain circumstances it may be appropriate to place limb leads on or near a patients torso.

Also in this episode:

Limb leads: Lead 1,2,3 and augmented vector leads - aVR, aVL, aVF
Take the bra off so you can properly palpate and place leads correctly.
Where's the mid-clavicular line really located?
Placing the precordial leads for a 12 lead interpretation example
When conducting multiple ECGs ensure the position of your patient is consistent.
Serial ECGs make bad clinicians good ... and good clinicians great!

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On this episode Dave talks about CPR - Cardiopulmonary Resuscitation. As clinicians and emergency medicine practitioners, resuscitation is an important part of our role.

Dave outlines how early defibrillation and quality chest compressions are the corner stone of resuscitation and how chest recoil may be one of the most under appreciated components of resuscitation.

Also in this episode:

100-120 compressions within a 60 second period
Compressions should be 5cm deep
Minimize pausing and allow for full chest recoil
CPP - Coronary perfusion pressure
Systole, Diastole, valve operation and Coronary Ostia

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On this episode Dave talks about the evolution of ECG interpretation, but remember, it starts with our assessment of the patient and how it relates to the ECG and our ability to interpret it.

Before you get your hands on the ECG to make your interpretation remember these critically important things:

What is the history of the presenting illness?
What is the patients presentation?

Considering these things first will give you a better clinical picture so you can applying them to what you are seeing and interpreting on the ECG.

Also in this episode:

What about the 1mm and 2mm stuff? Biology doesn't work on millimetres.
Trusting you gut
Evolution of STEMI
Morphology and the shape of the ST segment
Morphology example
An easy trick to remember at 3 am!
ECG tracing example

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On this episode Dave talks about lead aVL - Augmented Vector Left. Lead aVL is a game changer! For years we were told that you need to have ECG changes in two or more contiguous leads but not anymore! aVL is such a cool lead because the most stunning first change you will see in the presence of Impending Inferior wall MI is ST depression in lead aVL alone.

Also in this episode:

Understanding aVL with the Hexaxial Reference Grid
Reciprocal change in lead aVL
ECG tracing examples
Perform Serial 12 leads to capture dynamic changes

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On this episode Dave highlights Sgarbossa criteria, which helps us to accurately identify STEMI in the presence of a LBBB.

Also in this episode:

Example of how a LBBB works
Rules to apply when diagnosising LBBB on an ECG
Example of a normal LBBB
Sgarbossa criteria A & B - inappropriate concordance
ECG examples of criteria A & B
Pacemakers and diagnosing STEMI

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Check out this episode from Current ECG!

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Welcome to Current ECG!

David Klein is an Advanced Care Paramedic, ECG Morphologist and the Founder of the Current ECG Workshop. David has a passion for ECG Interpretation and how this skill improves the ability to deliver quality patient care as a practitioner of Emergency Medicine.

Current ECG was developed to create a direct link between cardiovascular anatomy and physiology and how this relates to our understanding of ECG Interpretation.

The goal of this podcast is to advance the skill of ECG Interpretation by providing current ECG research and making it a little less scary and a little more fun.

You will learn the basics to build a strong ECG foundation and more advanced topics like the importance of understanding Morphology as well as currents of injury and their impact on what you see on an ECG tracing.

If you would like to continue your learning, improve your skills and provide a higher level of patient care, come be part of our community.

If you're a student who wants to breakthrough in Emergency Medicine, learn how to work the trucks in the streets, this is for you!

If you're a seasoned veteran who wants to brush up on your skills and stay up to date on the most current ECG information, this is for you!

Join the community at CurrentECG.com

Lets make Emergency Medicine education and ECG Interpretation a little less scary and a little more fun!

And Stay 'Current'

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On this episode Dave highlights Sgarbossa criteria, which helps us to accurately identify STEMI in the presence of a LBBB.

Also in this episode:

Example of how a LBBB works
Rules to apply when diagnosising LBBB on an ECG
Example of a normal LBBB
Sgarbossa criteria A & B - inappropriate concordance
ECG examples of criteria A & B
Pacemakers and diagnosing STEMI

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On this episode Dave talks about the importance of Oxygen. We know the body and the body's cells need sugar, water and oxygen to survive and as emergency medicine practitioners we have oxygen available to us as a potential treatment for our patients.

We need to be aware and careful of the amount of oxygen we give our patients.

Did you know that oxygen is poison to your body if it is not being used for cellular respiration?

Also in this episode:

How we breathe in oxygen and measure it
When the oxygen saturation in the blood is over 100%
Oxygen free radicals
How and why oxygen free radicals hunt their prey
Oxygen can exacerbate the size of infarction
Optimal oxygen saturation percentage

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On this episode Dave talks about how we no longer read ECGs, we interpret them. This is a fundamental concept and we interpret them within the clinical context of our patient.

Don't focus on recognizing patterns, you need to understand how to interpret various segments and morphologies. If you see a particular morphology you need to know why it is there, which vessel may contain the culprit lesion and how large is the area of myocardial risk.

Also in this Episode:

The skill of interpretation
ECG interpretation at 3am when you're tired
2 Examples of what you might be missing
History presenting illness -> patient presentation -> interpret ECG

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Aspirin, Aspirin, give the patient Aspirin!

On this episode Dave highlights the value and importance of giving your patient Aspirin. Unless there is a major contraindication, if you think your patient is suffering from cardiac ischemia or acute coronary syndrome, give them the Aspirin!

Also in this Episode:

Evidence based research supporting the importance of ASA
ASA vs TNK in the treatment of ACS and mortality reduction
ASA use case story - sort of ;)

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And Stay Current!

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Welcome to Current ECG!

Current ECG was developed to create a direct link between cardiovascular anatomy and physiology and how this relates to our understanding of ECG Interpretation.

The goal of this podcast is to advance the skill of ECG Interpretation by providing current ECG research and making it a little less scary and a little more fun.

If you would like to continue your learning, improve your skills and provide a higher level of patient care, come be part of our community.

If you're a student who wants to breakthrough in Emergency Medicine, learn how to work the trucks in the streets, this is for you!

If you're a seasoned veteran who wants to brush up on your skills and stay up to date on the most current ECG information, this is for you!

Join the community at CurrentECG.com

Lets make Emergency Medicine education and ECG Interpretation a little less scary and a little more fun!

And Stay 'Current'

Current ECG Podcast: Recent Episodes

David Klein