Critical Decisions in Emergency and Acute Care Electrocardiography

William Brady, Department of Emergency Medicine, University of Virginia School of Medicine Jonathon Truwit, Pulmonary and Critical Care Medicine, University of Virginia Health Systems

• Section Editors viiContributors viiiPreface xiForewords xiiPart 1 The ECG in Clinical Practice 11 What are the clinical applications of the ECG in emergency and critical care? 32 What are the indications for the ECG in the pediatric emergency department? 123 What are the limitations of the ECG in clinical practice? 194 Is the ECG indicated in stable non-cardiac patients admitted to the hospital? 245 What is the use of the ECG in preoperative assessment and cardiovascular risk stratification? 286 Which patients benefit from continuous electrocardiographic monitoring during hospitalization? 33Part 2 The ECG in Cardinal Presentations 397 How should the ECG be used in the syncope patient? 418 How should the ECG be used in the chest pain patient? 499 How should the ECG be used in the dyspneic patient? 5810 How should the ECG be used in the patient with altered mentation? 6411 How should the ECG be used in the patient during and following cardiac arrest? 6912 What is the impact/proper role of the ECG in the undifferentiated cardiorespiratory failure patient? 75Part 3 The ECG in ACS 8313 What is the role of the ECG in ACS? 8514 What pseudoinfarction patterns mimic ST elevation myocardial infarction? 9215 What ECG changes might myocardial ischemia cause other than ST segment elevation or Q waves and what are the differential diagnoses of these changes? 10316 What is a hyperacute T Wave? 11517 What is the significance of Q waves? 12218 What are the ECG indications for additional electrocardiographic leads (including electrocardiographic body-surface mapping) in chest pain patients? 12819 What further diagnostic adjuncts to the standard 12-lead ECG may help to diagnose ACS? 13820 Is serial electrocardiography (serial ECGs and ST segment monitoring) of value in the ECG diagnosis of ACS? 14821 What QRS complex abnormalities result in ST segment elevation that may mimic or obscure AMI? 15522 What are the electrocardiographically silent areas of the heart? 16723 What is the value of the prehospital acquired 12-lead Ecg? 17624 What are the electrocardiographic indications for reperfusion therapy? 18225 What are the ECG manifestations of reperfusion and reocclusion? 19526 Does localization of the anatomic segment/identification of the infarct-related artery affect early care? 20427 Can the ECG be used to predict cardiovascular risk and acute complications in ACS? 216Part 4 The Dysrhythmic ECG 23128 Can the electrocardiogram determine the rhythm diagnosis in narrow complex tachycardia? 23329 Can the ECG guide treatment of narrow QRS tachycardia? 24430 How can the ECG guide the diagnosis and management of wide complex tachycardias? 25131 Can the ECG guide management in the patient with bradydysrhythmias? 26732 What are the electrocardiographic indications for temporary cardiac pacing? 27633 Can the ECG accurately diagnose pacemaker malfunction and/or complication? 28434 How can the ECG guide acute therapy in the Wolff Parkinson White (WPW) patient? 29535 What is the role of the ECG in PEA cardiac arrest scenarios? 303Part 5 The ECG in Critical Care 31536 What is the role of the ECG in the critically ill non-coronary patient? 31737 Can the ECG distinguish between coronary and non-coronary etiologies in the critically ill patient? 32638 What is the role of the ECG in therapeutic considerations/ medical management decisions in the critically ill patient? 33539 Can the ECG predict risk in the critically ill noncoronary patient? 34540 What is the proper role of the ECG in the evaluation of patients with suspected PE? 35441 What is the role and impact of the ECG in the patient with hyperkalemia? 36242 What is the role and impact of the ECG in the patient with electrolyte abnormalities other than hyperkalemia? 37143 What is the role of the ECG in the hypothermic patient? 37844 What are the non-ACS “deadly” ECG presentations? 384Part 6 The Toxicologic ECG 39545 How useful is the ECG in the evaluation of the poisoned patient? 39746 Can the ECG guide management in the critically ill poisoned patient? 40247 Do characteristics of the QRS complex in the poisoned patient correlate with outcome? 40748 What is the treatment for wide complex dysrhythmias in the poisoned patient? 412Part 7 Electrocardiogaphic Differential Diagnosis 417  49 What is the ECG differential diagnosis of ST segment elevation? 41950 What is the ECG differential diagnosis of ST segment depression? 42851 What is the ECG differential diagnosis of the abnormal T wave? 43652 What is the ECG differential diagnosis of narrow complex tachycardia? 44453 What is the ECG differential diagnosis of wide complex tachycardia? 45254 What is the ECG differential diagnosis of bradycardia? 46155 What is the ECG differential diagnosis of the abnormally wide or large QRS complex? 46956 What is the ECG differential diagnosis of a prolonged QT interval? 479

"This book is written by the emergency physician for the emergency physician and it would appeal to any avid, competitive ECG collector who will find it value for money." (Cardiology News, 1 October 2011) “I loved this book and excitedly read bits aloud as I scanned the chapters. It was the combination of a scholarly approach combined with a down-to-earth discussion of patient management that was so appealing.” (British Journal of Cardiac Nursing, September 2009)