Atrial fibrillation in the Wolff-Parkinson-White syndrome: ECG recognition and treatment in the ED.

Estimated to occur in 0.1% to 0.3% of the population, Wolff-Parkinson-White syndrome (WPW) is a condition where atrial impulses bypass the atrioventricular node and activate the ventricular myocardium directly via an accessory pathway. Clinical clues to the diagnosis include a young patient with previous episodes of palpitations, rapid heart rate, or syncope. Although several different rhythm presentations are possible, atrial fibrillation is a not infrequent dysrhythmia seen in the WPW patient. Electrocardiographic features suggestive of WPW atrial fibrillation include irregularity of the rhythm; a very rapid ventricular response; presence of a delta wave; and a wide, bizarre QRS complex. Stable patients suspected of having this condition should not receive agents that predominantly block atrioventricular conduction, but they may be treated with procainamide or ibutilide. If instability is present, electrical cardioversion is required.

A simulation course on lifesaving techniques for third-year medical students.

BACKGROUND: The University of Virginia School of Medicine discontinued animal vivisection in February 2004 for teaching lifesaving procedures to third-year medical students. Consequently, a 1-day course using simulation technology was developed to meet objectives previously covered in the animal laboratory. The authors sought to evaluate the course and hypothesized that the students' confidence in lifesaving procedures as well as their acceptance of simulation technology as a teaching tool would increase. METHODS: The course was designed in a two-session format. The first session (first half of the day) concentrated on individual procedure skills, utilizing part-task trainers. The second session (second half of the day) used a Medical Education Technologies Inc. (METI) Emergency Care Simulator (ECS) full-body patient simulator to present a major trauma scenario. The study design was a prospective, pretest-posttest study without a control group. A 10-question pre and post survey used a Likert scale to explore students' confidence in their skills as well as their acceptance of simulation technology. A course evaluation used a similar Likert scale for evaluation of the course substations, the trauma scenario, and students' self-assessment of their skill levels as well as a 100% point scale for an overall rating of the course. RESULTS: A total of eight 1-day courses were successfully held over 2 years with a total enrollment of 240 students utilizing 20 instructors inclusive of faculty, residents, and other emergency medicine health care providers. For the pre and post survey results, there was a significant increase in students' confidence in performing lifesaving procedures as well as their acceptance of simulation as a teaching tool (P < 0.05 for each question with pre n = 222 and post n = 226). For the course evaluation results (n = 190), all of the course substations were rated in the good to excellent range and the course received an overall score of 97.55 +/- 7.23% out of 100%. Furthermore, students reported a significant increase in their skill level (P < 0.05). CONCLUSION: This lifesaving techniques course utilizing simulation technology successfully covered objectives previously taught with animal vivisection, increased students' confidence levels in performing lifesaving procedures and was highly accepted by the medical students.

Electrocardiographic applications of lead aVR.

Lead aVR, 1 of 12 electrocardiographic leads, is frequently ignored in clinical medicine. In fact, many clinicians refer to the 12-lead electrocardiogram (ECG) as the 11-lead ECG, noting the commonly held belief that lead aVR rarely offers clinically useful information. In this report, we discuss the findings in lead aVR, which are potentially of value, including ST-segment elevation in the patient with acute coronary syndrome suggestive of left main coronary artery occlusion, PR-segment elevation in the patient with acute pericarditis, prominent R wave in the patient with significant tricyclic antidepressant poisoning, and ST-segment elevation in narrow complex tachycardia suggestive of Wolff-Parkinson-White syndrome.

Electrocardiographic ST-segment elevation in the trauma patient: acute myocardial infarction vs myocardial contusion.

The diagnosis of myocardial contusion in the setting of blunt trauma engenders much discussion and controversy-partly because of the lack of a gold standard for its identification other than histologic findings at autopsy. Furthermore, blunt cardiac trauma represents a spectrum of disorders ranging from transient electrocardiographic change to sudden death from myocardial rupture; hence, no single terminology exists to define such a wide range of scenarios. Here, we present 2 cases of electrocardiographic ST-segment elevation after high-speed motor vehicle crashes resulting in numerous injuries, including blunt chest trauma. Both patients demonstrated electrocardiographic ST-segment elevation, resulting from myocardial contusion and acute myocardial infarction.