Cardiac Axis Deviation

right way wrong way sign

At some point or another, we have all heard someone mumble the terms “ECG axis”, “cardiac axis” or “cardiac axis deviation” when looking at a 12 lead ECG. But what does axis mean? I’ll let you in on a little secret, but you have to promise to tell EVERYONE! Here goes: cardiac axis is just a fancy way to discuss the flow of electrical conduction within the heart. And the kicker? It’s actually a relatively easy concept to understand.  Continue reading

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How to Diagnose ANY Cardiac Rhythm Systematically

ecg heart flatline

Narrow complex tachycardia…hmm, but isn’t that supraventricular tachycardia?

Broad complex tachycardia…VT…no wait, it’s VF…hang on, asystole (oh, oh!)

It’s atrial fibrillation…wait, what about atrial flutter?

Regular, no wait…is that irregular?

Let’s not forget all those different heart blocks…

What happened to a good ol’ run of straight forward sinus rhythm?

With so many cardiac rhythms to remember, wouldn’t it be nice to be able to get to the correct diagnosis each and every time? The beauty about cardiac rhythms are that they are all fairly predictable. If you ask the right questions in a systematic manner, it will get you to diagnosing the right cardiac rhythm pretty much every time! Don’t believe me? Why not give it a shot by using this flowchart I have designed to do just that:

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Understanding How Anticoagulants Work

warfarin anticoagulation stop the clot

As discussed in the article “The Clotting Cascade Made Easy”, a blood clot is formed when activated platelets are trapped in stabilised cross linked fibrin. The process of fibrin formation is controlled by procoagulation factors (factors that promote blood clotting) and anticoagulation factors (factors that inhibit blood clotting). If the ability of the body to maintain this equilibrium is disrupted, we could either bleed to death or become one big blood clot! Continue reading

Removing the Road Blocks: Understanding Heart Blocks

cardiac conduction pathway

Ever wondered about the differences between a first, second and third degree atrioventricular (AV) heart block? And not to mention that second degree AV blocks can be further differentiated into type 1 or type 2? You know, because it wasn’t confusing enough as it was! This article is going to explain it all to you! But before we start making heart blocks something that is easy to understand, we should start with a bit of normal electrophysiology through the heart. After all, we can’t understand what is abnormal until we truly understand what is normal! Continue reading

ST What?! Recognising Myocardial Ischaemic ECG Changes!

Acute Coronary Syndrome (ACS) does not refer to an adorable coronary artery too cute for it’s own good; it refers to a group of conditions that result in decreased coronary blood flow to the myocardial tissue. With a decreased coronary blood flow, there is a decreased supply of oxygen to the myocardial tissue. And nothing is as bad to the myocardial tissue than a lack of oxygen! If you are the superstitious type, you will believe that all bad things come in threes. No truer words have ever been spoken, with the 3 issues that result from a lack of oxygen to the myocardial tissue all starting with a capital “I”…
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Demystifying the 12 Lead ECG!

ecg dot application hair removal image

Whether you work within a coronary care unit or a general surgical unit, we have all performed a 12 lead electrocardiogram (ECG) on one of our patients at some point or another. We’ve prepped the chest of a patient that could rival some of the sheep shearing competitions that occur in New Zealand. We’ve tried untangling the mess of leads while secretly imagining the face of the colleague that left the ECG machine in such disarray on the dart board of our local bar. We’ve all had to deal with that ONE patient who cannot comprehend what it means to “lie still and quietly”. And after all of that effort to get that perfect print out of an ECG, wouldn’t it be nice to understand what those 12 leads are actually telling you?  Continue reading

Massive Blood Transfusions and Making the Blood Clot!

Blood Transfusion Negative

Ouch! I’ve just given myself a paper cut!

*Utters a string of expletives that would make a pirate blush*

As I apply pressure to my haemorrhaging war wound, I notice that the bleeding slows down to a stop. That is because my body is able to clot at the site of this small injury according to the physiology of the clotting cascade. However, it would be a different situation if I was in a horror movie and had my arm chewed off by zombies! I would now be experiencing a massive loss of blood that would result in the need for a massive blood transfusion. The internal processes of the body to clot may not be sufficient in the setting of a massive haemorrhage, and so it will need the help of some friends in the form of other blood products to help stop the bleeding.

*Cue the Rocky theme song as I battle through a horde of zombies with one arm to find an abandoned hospital, with a fully functional blood fridge, to initiate a massive blood transfusion protocol* Continue reading

The Clotting Cascade Made Easy!

At some point or another, there is a strong probability that we have all seen that dreaded flow chart. You know, the one with all the roman numerals that looks like it was created with the sole intent of confusing us. The one that we try to memorise but secretly hope that no one ever asks us about it. Do you know the one I’m talking about? That’s right; the dreaded coagulation or clotting cascade! And this article is going to simplify it to a point that you not only get it, but remember it as well! Continue reading

The No Kiss Zone: Hands Only CPR Saves More Lives

compression only cpr statistics

Most people who experience a cardiac arrest in the community die because they do not receive immediate cardiopulmonary resuscitation (CPR) from someone on the scene. As a bystander, do not be afraid to do something. Your actions can only help. If you are in the healthcare field, please advocate the importance of this to all the people in your life! After all, they may be the ones having to do CPR on you one day! Continue reading