Don't Miss These ECG's

My ECG content has been a bit lacking on the site, mainly because so many other sites do it so well, but alas you will get ECG’s in the exam, I got two in the VAQ and one in the SCE, and none of them were easy, so I’ve decided to beef up the ECG quota and get teaching.

As the ED Consultant you are the last bastion of ECG diagnosis in the ED, and if you don’t have a list of “if I miss it, no-one else will pick it & the patient may die” ECG’s then fear not, in this 2-part video whiteboard session I run through 6 of the most serious and subtle ECG’s that you can’t afford to miss, in the exam, or in real-life! Of course there’s ischemic ECG’s, electrolyte abnormalities and toxicologocal ECG’s, and I’d hope by now you can pick those, but here is a collection of rare but important ECG’s that frequently get missed (one of these cropped up in my written exam, and the pass rate was around 30% – go back to the 2009.1 writtens to see which one it was), so don’t be slack, watch & learn, & you may just save someone’s life one day with this knowledge!

Every time I see a patient with syncope, unexplained collapse or altered conscious state – I run through this list, it applies to children and adults.

NB: Videos best watched in Full Screen Mode (click on bottom right corner of video player)

Don’t Miss These ECG’s – Part 1

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Don’t Miss These ECG’s – Part 2

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3 Responses to Don't Miss These ECG's

  1. ambonsall March 27, 2012 at 6:50 am #

    Great site and lots of useful pearls.
    Liked the ECGs not to miss, but was wondering about the Mobitz II 2nd Deg Blk example. As it was 2:1 block how could you be sure it wasn’t Mobitz I? I thought with 2:1 they were indistinguishable. (I concede that both probably need treatment if there was syncope.)

  2. Andy B March 27, 2012 at 8:20 am #

    Cheers Adrian
    I guess technically 2:1 and Wenkebach are indistinguishable, as you can’t tell if the PR’s lengthening or not, however I’d always refer a 2:1 to Cardiology, especially if the history was suspicious (eg syncope, low BP, chest pain). I’d always encourage Registrars to err on the side of caution as well and not just send them home assuming its a Wenkebach (which is the point of including it in that series), as they are headed for a pacemaker if it’s Mobitz II.

  3. matgoebel April 4, 2012 at 1:24 am #

    For an ECG with 2:1 AV conduction, you cannot actually specify whether the patient is in a type 1 or type 2 second degree block. Because type 1 is a disease of the AV node, if the rhythm is narrow complex, it is more likely type 1. Because type 2 is a disease of the bundle branches, if the rhythm has a RBBB morphology it is more likely type 2 because the block itself exists in the left bundle. However, with only 2:1 conduction, you cannot actually discern between the two. A cardiologist reading an ECG with 2:1 AV conduction is most likely going to simply write “Second Degree AV Block, Type Undetermined” rather than getting pinned down to calling it type 1 or type 2.

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