Emergency medicine clinics of North America
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Emerg. Med. Clin. North Am. · Nov 2022
ReviewPacemaker Malfunction-Review of Permanent Pacemakers and Malfunctions Encountered in the Emergency Department.
Pacemaker malfunction refers to a failure of the pacemaker to perform the desired cardiac pacemaking function. These malfunctions can occur anywhere within the system from the pulse generator and leads to the electrode-myocardium interface. These failures of sensing, capture, and inadequate pacing can have severe hemodynamic consequences, so rapid identification of specific dysfunction is critical to intervention and stabilization. Emergency providers should be aware of pacemaker components, function, basic programming, and types of malfunctions to adequately assess, stabilize, and disposition patients.
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Wide complex tachycardias (WCT) are frequently encountered in the emergency department. Causes of WCT vary from benign (eg, supraventricular with rate-related aberrancy) to life threatening (eg, atrial fibrillation with WPW, or ventricular tachycardia). ⋯ Treatment of WCT depends on patient stability, regularity of the rhythm, and QRS morphology. When in doubt, monomorphic WCT should be presumed to be ventricular tachycardia and treated as such.
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The electrocardiogram (EKG) is a useful diagnostic tool that allows clinicians to rapidly evaluate patients for acute coronary syndrome. With the high prevalence of heart disease in society, the EKG is crucial in the evaluation of chest pain and diagnosis of ischemia. ⋯ Not all ischemic patterns requiring emergent management present within the classic definition of an STEMI. It is critical for clinicians to be able to accurately recognize these ischemic patterns to allow timely and appropriate cardiovascular care.
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Narrow-complex tachycardias are commonly seen on shift in the emergency department. Although a portion of patients present with hemodynamic instability because of arrhythmia, it is important to know that the tachycardia can be a result of an underlying condition. Rapid identification of the type and etiology of the arrhythmia is vital to directing appropriate management strategies and disposition decisions.
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Pharmacologic therapy is an integral component in the management of most cardiovascular emergencies. This article reviews the pharmacotherapy involved in the treatment of acute coronary syndromes, acute heart failure, and various arrhythmias. The focus will be to provide practical pearls that can be applied at the bedside in the Emergency Department.