Wednesday, 22 February 2017

ECG of the Week - 20th February 2017 - Interpretation

The following ECG is from a 20 yr old male who was brought to the Emergency Department following a motorbike accident in which he sustained a head injury. 
He has a GCS of 3, BP 160 systolic and divergent pupils.



Click to enlarge



Rate:
  • 96 bpm
Rhythm:
  • Regular
  • Sinus rhythm
Axis:
  • Right axis deviation
Intervals:
  • PR - Normal
  • QRS - Normal
Segments:
  • ST Depression leads II, III, aVL, V3-6
  • ST Elevation aVR & aVL
Additional:
  • Biphasic T wave in leads V3-4
Interpretation:

Remember the ECG is a test that must be taken to the bedside

In a young trauma patient with significant ST segment and T wave changes there are three main considerations:

  • Traumatic Brain Injury causing ECG changes
  • Blunt chest injury causing ECG changes
  • Cardiac event precipitating accident
    • ? Drug ingestion / vasospasm
    • ? Coronary dissection

In this patient there was no suspicion of a proceeding medical event precipitating the event and no evidence of blunt chest injury including clinical features, plain imaging and bedside USS assessment. The patient had sustained an isolated catastrophic head injury which was unfortunately unsurvivable.

Blunt Cardiac Injury

The American Association for the Surgery of Trauma has a very nice overview of blunt cardiac injury here:


ECG Changes Associated with Neurological Pathology

ECG changes are well described in the setting of neurological pathology, especially subarachnoid haemorrhage. but can occur in traumatic brain injury. There following is a nice overview of pathophysiology and outcome effects of cardiovascular abnormalities associated with brain injury:



References / Further Reading

Life in the Fast Lane

Textbook
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.