TEST - Book of PDFs-01_Guild_CHEST- ST elevation (submitted)_CMS PC.pptx

01_Guild_CHEST- ST elevation (submitted)_CMS PC.pptx - 1

Pdf Summary

This document discusses the differentiation of causes of ST elevation in critically ill patients in the ICU. It provides a list of potential causes, including myocardial injury (acute MI), coronary spasm (Prinzmetal's), pericarditis, myocarditis, normal variant (young individuals), early repolarization, LVH, LBBB, ventricular pacing, ventricular aneurysm, hyperkalemia, hypercalcemia, hypocalcemia, hypothermia, pulmonary embolism, CNS events, type 1C antiarrhythmics, tricyclic antidepressant overdose, Brugada syndrome, ARVD, post transthoracic DCCV, Chagas disease, and hypothyroidism/thyrotoxicosis. <br /><br />Several case examples are provided to illustrate the diagnostic process. In one case, a patient with multiple fractures and a right hemothorax had diffuse ST elevation, except in aVR and V1, indicating pericarditis. An echocardiogram confirmed normal wall motion and no pericardial effusion. <br /><br />In another case, a profoundly hypothermic patient with no pulse had Osbourne waves on ECG, indicating hypothermia. Resuscitation should continue until the patient is "warm and dead" due to the neuroprotective effects of profound hypothermia. <br /><br />Other cases discussed include a patient with acute chest pain and SOB after hip replacement, indicating pulmonary embolism; a patient with severe headache and altered consciousness, indicating subarachnoid hemorrhage; a patient with epigastric pain and increasing lethargy, indicating diabetic ketoacidosis; and a patient with acute chest pain and SOB, indicating the need for coronary angiography. <br /><br />The summary emphasizes that ECGs are not 100% specific for ST elevation myocardial infarction (STEMI) and suggests considering the clinical setting, evolution of the ECG, and quick echocardiograms to check for wall motion as additional diagnostic clues.

Keywords

ST elevation

critically ill patients

ICU

pericarditis

hypothermia

pulmonary embolism

subarachnoid hemorrhage

diabetic ketoacidosis

coronary angiography

ECGs