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Sam Ghali, M.D. Profile picture
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May 28 • 5 tweets • 2 min read
Here’s an important ECG of a 30 year old man who presented to the ER with chest pain. This tracing was recorded just minutes before he collapsed into cardiac arrest.

What’s the diagnosis? Image
If you’re a new follower I always post the answer with explanation the next day. If you’re new to my account, follow me if you want to learn about Emergency ECGs
Here’s a video I made breaking down this very important #ECG case of a 30 year old man who collapsed into cardiac arrest.

#FOAMed
Please take just 2 minutes to watch this video and share with others and I promise you will save lives
Thanks so much for all the kind comments and DMs on this one. 🙏 So happy to hear you guys found it helpful!

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More from @EM_RESUS

Sam Ghali, M.D. Profile picture
Aug 15, 2020
Here’s a great #ECG of a man who presented to the ER with crushing chest pain.

[thread] Image
Here’s the ECG Computer Read:

"Non-specific ST abnormality, consider anterior subendocardial ischemia."

[2/x]
Take a good look at Leads V1-V3 and burn these morphologies and this pattern into your mind.

THIS is what Posterior #STEMI looks like on a Standard 12-Lead ECG!

[3/x] Image
Read 11 tweets
Sam Ghali, M.D. Profile picture
Dec 17, 2019
Here’s a great #Echo of a young lady who suddenly collapsed to the ground in Cardiac Arrest. Bystander CPR was performed and 911 was called. Paramedics shock her once for pulseless VT and get ROSC on the scene. She’s intubated, in shock, on an Epi drip.

What’s the diagnosis?
The RV is very dilated with poor systolic function. The RA is also very big. The LV is Hyperdynamic with no obvious wall motion abnormality. This appearance of Severe Right Heart Strain is common during arrest, but when it persists AFTER ROSC, you must think Massive PE!

[2/x]
But the other caveat is that this Right Heart Strain could also be the result of *chronic* pulmonary hypertension.

So here’s what we did: We placed an Arterial Line & added a Norepi drip. We notified the CT techs that she needed to be next in line for an Emergent CTPA...

[3/x]
Read 6 tweets
Sam Ghali, M.D. Profile picture
Nov 10, 2019
A 17-year-old boy was rushed to the ER by his brothers struggling to breathe...

[thread]
He was in profound respiratory distress with deep retractions breathing 40 times per minute. It turns out he was a severe asthmatic in the midst of the worst asthma attack of his young life.

[2/x]
He was cyanotic and barely moving any air. His Pulse Ox registered 30% with a perfect waveform. His eyes rolled back and he lost consciousness right in front of us. He was on the brink of death...

[3/x]
Read 21 tweets
Sam Ghali, M.D. Profile picture
Oct 26, 2019
Watch this great video showing the Modified Valsalva Maneuver converting a patient in SVT to Normal Sinus Rhythm

If you’re not doing this, you’re not doing SVT right!

Video courtesy: @julesantosER
#FOAMed

In the REVERT Randomized Controlled Trial the success rate was 43% vs. 17% for the standard Valsalva Maneuver!

Read about it here: ncbi.nlm.nih.gov/m/pubmed/26314…
A lot people have asked about the physiologic explanation for why the Modified Valsalva Maneuver works. I’m gonna do my best to explain it as I understand it.

Let’s start by taking a look at the body’s physiologic response to valsalva...
Read 9 tweets
Sam Ghali, M.D. Profile picture
Jul 14, 2019
Hi, ER Doc here.

Opioids like Heroin and Fentanyl kill because they stop people from breathing.

[thread]
Narcan is the opioid antidote. It works by blocking the effects of these drugs at the receptors. So when you give it to people who have overdosed, they will typically wake up and resume breathing...

[2/x]
All commercial ✈️ should carry Narcan, but if you are ever in a situation where someone has overdosed and you don’t have Narcan, you can still save their life!

[3/x]
Read 10 tweets
Sam Ghali, M.D. Profile picture
Jul 3, 2019
I recently had a patient who presented in profound acute renal failure with a BUN of >200, creatinine of 13.5, and critical pH of 6.7, on the brink of death...

[thread]
The only reason he was still alive is because he still had a strong enough respiratory drive to blow his CO2 down to almost nothing!

[2/x]
When patients go into profound metabolic acidosis, their blood bicarbonate (a base) vanishes and they compensate by blowing off CO2 (an acid).

[3/x]
Read 21 tweets

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