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Sam Ghali, M.D.

@EM_RESUS

Oct 18, 2022

Here’s a very important #ECG of a 60-year-old lady who presented with chest pain and shortness of breath that began while walking her dog. She was also COVID+

What’s the diagnosis?

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 medical emergencies

Here’s a video I made breaking down this very important #ECG

#FOAMed

Read 4 tweets

Sam Ghali, M.D.

@EM_RESUS

Sep 4, 2022

Here’s the #ECG of a 68 year old man who was rushed to the ER by paramedics

BP: 80/40
HR: 150
RR: 35
SPO2: 95%

What’s the diagnosis?

Answer: HYPERKALEMIA

There’s a wide complex tachycardia with RBBB morphology. There are features here concerning for several life-threatening diagnoses including: V-Tach, Pulmonary Embolism, Acute Coronary Occlusion. But ALL these changes resolved with empiric ↑K+ treatment…

The QRS width narrowed right before our eyes. His vital signs improved dramatically. This was the repeat ECG recorded just 20 minutes later. Lead V1 is artifact but otherwise you can see that all the extreme changes have now resolved, and only a hint of peaked T waves remain…

Read 5 tweets

Sam Ghali, M.D.

@EM_RESUS

May 28, 2022

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?

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

Read 5 tweets

Sam Ghali, M.D.

@EM_RESUS

Aug 15, 2020

Here’s a great #ECG of a man who presented to the ER with crushing chest pain.

[thread]

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]

Read 11 tweets

Sam Ghali, M.D.

@EM_RESUS

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.

@EM_RESUS

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

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