<![CDATA[EMERGENCY MEDICINE GUIDEWIRE - Cards for EM ShowNotes]]>

<![CDATA[EMERGENCY MEDICINE GUIDEWIRE - Cards for EM ShowNotes]]>Tue, 17 Feb 2026 04:10:19 -0800Weebly<![CDATA[Hyperkalemia EKG Changes]]>Fri, 22 Feb 2019 02:40:05 GMThttps://www.emguidewire.com/cards-for-em-shownotes/hyperkalemia-ekg-changes

]]><![CDATA[PEA: A Better Approach]]>Sun, 27 May 2018 17:57:48 GMThttps://www.emguidewire.com/cards-for-em-shownotes/pea-a-better-approach

The H's and T's are of taught for Ddx of PEA... but...
- They are difficult to remember
- They only apply if you work in an area that speaks English
- They are not perfect
  - HYPOkalemia rarely causes PEA
  - HYPOthermia is usually not a medical mystery

A Clinically Useful Approach by Dr. Laszlo Littmann et al.
- Littmann L, Bustin DJ, Haley MW. A Simplified and Structured Teaching Tool for the Evaluation and Management of Pulseless Electrical Activity. Medical Principles and Practice. 2013;23(1):1-6. doi:10.1159/000354195.
- PEA? Wide or Narrow Complexes?
  - Narrow
    - Electrical activity in cardiac muscle is normal, but there is a mechanical obstruction of flow (Pseudo-PEA)
      - Pulmonary Embolism
      - Tension pneumothorax
      - Cardiac Tamponade
      - Mechanical Hyperinflation
    - "Need Needles" to resolve (ex, Needle to give thrombolytics, Needles to decompress)
  - Wide
    - Cardiac muscle electrical activity has been "poisoned". True PEA.
      - Hyperkalemia
      - Sodium channel blocker
      - Agonal rhythm
    - Treat with Calcium and/or Sodium Bicarbonate.

]]><![CDATA[Wide Complex Tachycardia Part 3: The Unstable Patient]]>Sat, 19 May 2018 00:33:13 GMThttps://www.emguidewire.com/cards-for-em-shownotes/wide-complex-tachycardia-part-3-the-unstable-patient

]]><![CDATA[Interpreting Rhythm Strips with Wide Complexes]]>Thu, 26 Apr 2018 23:45:07 GMThttps://www.emguidewire.com/cards-for-em-shownotes/interpreting-rhythm-strips-with-wide-complexes

]]><![CDATA[Wide Complex Tachycardia- Part 2 - Irregular Wide Complex Tachycardia]]>Thu, 19 Apr 2018 22:09:07 GMThttps://www.emguidewire.com/cards-for-em-shownotes/wide-complex-tachycardia-part-2-irregular-wide-complex-tachycardia

]]><![CDATA[Wide COmplex Tachycardia - Part 1]]>Fri, 16 Mar 2018 23:33:52 GMThttps://www.emguidewire.com/cards-for-em-shownotes/wide-complex-tachycardia-part-1

]]><![CDATA[Atrial Fibrillation (AFib) Management for the Acutely Ill in the ED]]>Sat, 10 Mar 2018 15:03:28 GMThttps://www.emguidewire.com/cards-for-em-shownotes/atrial-fibrillation-afib-management-for-the-acutely-ill-in-the-ed

In the acutely ill patient with rapid Afib, management should focus on quick rate control
IV diltiazem should be the treatment of choice
Bolus is crucial; re-bolus is crucial – they brake the vicious cycle of fast ventricular rate, reduced LV filling, reduced stroke volume, all resulting in further adrenergic activation
Diltiazem drip does not reduce the heart rate; it maintains whatever you achieved with the bolus
Never order “diltiazem drip, titrate to heart rate”
Ideal dose of initial diltiazem bolus is 0.25 mg/kg over 2 minutes
Ideal dose of re-bolus is 0.35 mg/kg over 2 minutes

Marked hypotension may limit giving the optimum doses of diltiazem boluses
Under these circumstances, there are several options for pre-treatment before the IV diltiazem bolus
- IV fluid boluses
- IV digoxin, 0.5 mg
- Phenylephrine, 100-300 mcg IV push over 10-30 sec
With the help of one or more of the above, IV diltiazem can almost always be given safely

Consider IV beta blocker (esmolol) instead of diltiazem for patients with rapid Afib and acute MI, ongoing ischemia, thyrotoxicosis and HOCM crisis
IV amiodarone is almost never needed for rate control
If rate control is still inadequate despite maximum tolerated doses of diltiazem, adding 0.5 mg of IV digoxin will frequently “finish the job”

For critically ill patients with rapid Afib, consider emergent cardioversion
Do not shock the patient with MAT or with repetitive Afib characterized by the presence of occasional sinus complexes
These patients are frequently good candidates for rhythm management with amiodarone or beta blocker

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