The Lit Whisperers

As a blogger (first time I’ve ever called myself that, weird…), one of the best things about the EM/EMS/CC blog-o-sphere is that the opportunities for new projects and collaborations are endless. Given the theme of my past few posts to this blog, you’re right to assume I’m about to announce my involvement in yet another site…

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The EMS 12-Lead Blog

It seems like all I do these days on this, my personal emergency medicine and critical care blog, is announce other projects that I’m working on. It’s no different today as I’ve started a whole new adventure in the #FOAMed world. I’m now an Associate Editor at the blog that first got me excited about EM and EKG’s: the EMS 12-Lead blog!

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My Ultrasonic Hearing Beats Your X-Ray Vision

The official title for this is “Case Report of a Radiologically Occult Avulsion Fracture of the Fifth Metatarsal Diagnosed Using Bedside Ultrasound,” but that’s no fun and I think I just nodded-off while typing it.

The first vital piece of information for this story is that my girlfriend’s dog loves sticks. Here he is with one, certainly not running around like a crazy-person.

Gratuitous dog photo

I lied about it being vital info, but that gave me an excuse to post this picture.

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Examples of Rapid Atrial Flutter

My first post on 2:1 atrial flutter turned out to be one of my most popular and successful contributions to the FOAM world over the past few years, so I thought I’d go ahead and build on that a bit. Collected here are 50 different examples of rapid atrial flutter. Some are easy, most are a bit tricky, and a few a near-impossible; but they’re all atrial flutter. So, without further ado, get to it and start seeing atrial flutter.

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The Ultrasound+ Community

Hey there folks!

I’ve been away from this particular blog for a while, but I’ve been far from quiet in the #FOAMed and social media world. In fact, my electrocardiography discussion forum ECG+ has been so successful that I’m starting up a sister-group: Ultrasound+ (read as “Ultrasound Plus”).

Ultrasound Plus

If you’re interested in learning about bedside ultrasonography or sharing and discussing cases, click the link above to come on over and join. It should be a lot of fun.

The ECG+ Community

A couple of weeks ago Google+ introduced the concept of “communities,” where like-minded individuals can meet up to discuss their common interests. So, with great fanfare, I’d like to formally announce the creation of the ECG+ community!

Image - ECG+ - 01 - Logo

Click our logo to check out ECG+

We’re already a few posts deep, so check out the cases and comments and please share your own!

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Posterior MI Part I – The Abnormal V6 Sign

So here’s the case: You’ve just run an 12-lead on a patient experiencing chest pain and recognized ST-depression in leads V2-V4. Being some manner of an astute provider, your next move is to set up posterior electrodes for leads V7-V9 to confirm the hidden STEMI. You’re about to press the print button, but suddenly your monitor dies. How can you confirm that this patient is experiencing an isolated posterior STEMI and would benefit from immediate PCI as opposed to medical management?

Click image to enlarge. Click here for source. Courtesy of

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Seeking the Esoteric, Missing the Apparent

I was doing some light reading the other day and stumbled upon this article by R. Shinde et al, entitled Occurrence of “J Waves” in 12-Lead ECG as a Marker of Acute Ischemia and Their Cellular Basis. I don’t have access to Pacing and Clinical Electrophysiology, but the authors’ original manuscript is available for free here and can’t be too different from the finished product. In the end I wasn’t too intrigued by their whole J-wave hypothesis, but an ECG in their case study did catch my eye.

Serial 12-leads from a 28 year-old man experiencing chest pain. Click image for source.

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Don’t Let Your Bradycardic Patient D.I.E.

I’m not that great with mnemonics.

I can never remember all the terms involved, often I screw up the mnemonic itself, and I’m always scared that I’m going to substitute something that isn’t actually part of the differential. It’s as though one day I’m going to debate with myself whether hyperthyroidism falls under “H-for-hyper” or “T-for-thyroid” while reviewing the H’s-and-T’s during a cardiac arrest and miss the patient’s tamponade.

Still, there’s one mnemonic that I live and die by, and that is the DIE acronym for bradycardia.




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This Heart is Blocked Not

People still make Borat references, right?

Anyway, I’ve got a quick one for you today. This patient was being evaluated for possible pericarditis. What’s the rhythm?

Click to enlarge.

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