It is a New Year and Justin is back on the podcast to discuss another series of papers that range from serious science to silly stuff.
We had a great time recording this podcast, so many things learned. Hope you enjoy it too.
The papers as ever are below in free PDF format and the audio is at the bottom. This episode does involve a lot of visual descriptions of ECGs, ECHOs and jujitsu manoeuvres – so you might want to check out the papers to understand what the heck we are talking about!
The ECGs that Justin describes in his case are here: Firstly, deep septal TWI….
When we repeated the ECG, it had changed. Now there was a left bundle branch block, with conchordant ST changes…
I was baffled, so I turned to Twitter for some help. It was Sam Ghali (@EM_RESUS) that ultimately came up with what I believe to be the right diagnosis: cardiac memory. I had never heard of “cardiac memory” before. (It is also sometimes called “Chatterjee phenomenon”.) Apparently after being in a ventricular rhythm, the T wave “remembers” or tends to persist along the same vector. The result is that you can get deep T wave inversions just like I saw. Apparently this is very common after pace-makers, but it can also happen after an intermittent left bundle branch block, like we saw in my case. It is generally considered benign.
Bottom line: I think we are likely to see much higher rates of extravasation in the ED, but because true harms are rare, the overall message is still correct: if monitored carefully, it is perfectly reasonable to give norepinephrine through a well functioning peripheral IV.
Bottom line: Don’t redesign your hospital yet, but conversations between ICU and ED to ensure processes are in place so that patients get the best possible care no matter where they are physically situated sound like a good idea.
I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact