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Background The out-of-hospital cardiac arrest (OHCA) in the young may be associated with a genetic predisposition which is relevant even for genetic counseling of relatives. The identification of genetic variants depends on the availability of intact genomic DNA. DNA from autopsy may be not available due to low autopsy frequencies or not suitable for high-throughput DNA sequencing (NGS). The emergency medical service (EMS) plays an important role to save biomaterial for subsequent molecular autopsy. It is not known whether the DNA integrity of samples collected by the EMS is better suited for NGS than autopsy specimens. Material and methods DNA integrity was analyzed by standardized protocols. Fourteen blood samples collected by the EMS and biomaterials from autopsy were compared. We collected 172 autopsy samples from different tissues and blood with postmortem intervals of 14–168 h. For comparison, DNA integrity derived from blood stored under experimental conditions was checked against autopsy blood after different time intervals. Results DNA integrity and extraction yield were higher in EMS blood compared to any autopsy tissue. DNA stability in autopsy specimens was highly variable and had unpredictable quality. In contrast, collecting blood samples by the EMS is feasible and delivered comparably the highest DNA integrity. Conclusions Isolation yield and DNA integrity from blood samples collected by the EMS is superior in comparison to autopsy specimens. DNA from blood samples collected by the EMS on scene is stable at room temperature or even for days at 4 °C. We conclude that the EMS personnel should always save a blood sample of young fatal OHCA cases died on scene to enable subsequent genetic analysis.

BACKGROUND Genetics of sudden cardiac deaths (SCD) remains frequently undetected. Genetic analysis is recommended in undefined selected cases in the 2021 ERC-guideline. The emergency medical service and physicians (EMS) may play a pivotal role for unraveling SCD by saving biomaterial for later molecular autopsy. Since for high-throughput DNA-sequencing (NGS) high quality genomic DNA is needed. We investigated in a prospective proof-of-concept study the role of the EMS for the identification of genetic forms of SCDs in the young. METHODS We included patients aged 1-50 years with need for cardiopulmonary resuscitation attempts (CPR). Cases with non-natural deaths were excluded. In two German counties with 562,904 residents 39,506 services were analysed. Paired end panel-sequencing was performed, and variants were classified according to guidelines of the American College of Medical Genetics (ACMG). RESULTS 769 CPR-attempts were recorded (1.95% of all EMS-services; CPR-incidence 68/100,000). In 103 cases CPR were performed in patients

BACKGROUND The electrocardiogram (ECG) is an integral part of basic emergency medical diagnosis and preoperative evaluation. In cases of ST elevation myocardial infarction (STEMI) immediate treatment is mandatory after correlation of ischemic symptoms with the ECG pattern. However, there are also ECG patterns that can imitate STEMI, possibly resulting in the true underlying diagnosis being missed and inappropriate therapy being initiated. OBJECTIVES This paper provides an overview of the most important diagnoses that can imitate STEMI on ECG. MATERIAL AND METHODS A literature search was carried out to determine the most important differential diagnoses of ST elevation on ECG. These STEMI mimics are discussed in detail and their relevance for emergency medicine is explained. RESULTS This article provides an overview of differential diagnoses that should be known in emergency medicine when assessing an ECG with ST elevations. CONCLUSION Good knowledge of the ECG patterns presented here can support decision-making in emergency medicine.

INTRODUCTION: ST segment elevation myocardial infarction is a common reason for out-of-hospital cardiac arrest in adult patients. The surveillance of the ST segment in the electrocardiogram is limited to visual presentation. However, the ST segment can change during the course of treatment. If ST elevation is present immediate coronary revascularization is needed, therefore detecting ST elevation changes the treatment fundamentally. Sonification of the ST segment is a new method which enables the emergency team to detect intermediate changes of the ST segment.; MATERIAL AND METHODS: We have chosen two sonification designs which were introduced to two groups, medical students and computer science students. Twenty-one participants took part in the study. The sonification was designed for evaluation of the ST segment. The user was supposed to become empowered to distinguish between no, medium-low, medium-high or extreme ST elevation by listening to the sonification. The two groups were asked to evaluate the sounds for possible ST elevation as well as for aesthetics and usability. In a second study twenty-five medical students were taking part in a medical scenario in which sonification was played during a simulated case. The patient was suffering from a myocardial infarction, ST elevation was transient and sonification sounds were changing appropriately. The students were supposed to detect these changes and act accordingly by modifying the treatment.; RESULTS: Both groups were able to classify ST segment elevation by listening to the sonification samples. The higher the ST segment, the better was the detection rate overall. In all of the three categories (pleasantness, informativeness and long-term listening) the Water Ambience sonification was rated higher compared to the Polarity sonification. Moreover, in the two groups that took part in the study, we found a significant difference when comparing classification performance using both sonification designs. For the group of medical students as t(20) = 4.31, p = 3.44 * 10-4, p < 0.01 and for the computer science students as t(19) = 3.40, p = 9.39 * 10-6, p < 0.01. In the simulated medical scenario participants indicated that 96% detected the ST elevation. 60% stated that sonification played a role whereas for 32% it did not play a role for the detection of ST elevation.; CONCLUSIONS: Sonification has the potential to play an important role as a new supporting tool for the surveillance of the ST segment during the care of patients with suspicion of myocardial infarction. It can be helpful to differentiate between ST segment elevation myocardial infarction and non-ST segment myocardial infarction especially if ST elevation is transient. Furthermore, sonification is viewed as pleasant to listen to and might not contribute to alarm fatigue. Copyright © 2022 Elsevier Inc. All rights reserved.

The treatment situation in intensive care is characterised by a specific asymmetry in the relationship between patients and the team: Patients are particularly dependent on their environment and often show impaired consciousness and capacity to consent. This facilitates the use of coercion or enables and/or provokes it. The aim of this recommendation is to show ways to recognise patients with their wishes and needs and to integrate them into treatment concepts in the intensive care unit in order to reduce and avoid coercion whenever possible. The recommendation shows the variety of possible forms of coercion and discusses the moral standards to be considered in the ethical weighing process as well as legal conditions for justifying its use. It becomes obvious that treatment measures which may involve the use of coercion always require a careful and self-critical review of the measures in relation to the indication and the therapeutic goal. The recommendation's intention therefore is not to disapprove the use of coercion by interprofessional teams. Instead, it aims to contribute to a sensitive perception of coercion and to a critical and caring approach to formal and especially informal (indirect) coercion.Die Behandlungssituation in der Intensivmedizin ist durch eine starke Asymmetrie in der Begegnung gekennzeichnet: Patient:innen sind in besonderer Weise auf ihr Umfeld angewiesen, weisen häufig Beeinträchtigungen des Bewusstseins und der Willensbildung auf. Dies erleichtert die Anwendung von Zwang bzw. ermöglicht diesen und/oder ruft ihn hervor. Ziel dieser Handlungsempfehlung ist es, Wege aufzuzeigen, um Patient:innen mit ihren Wünschen und Bedürfnissen wahrzunehmen und sie in Behandlungskonzepte auf der Intensivstation einzubinden, um Zwang zu reduzieren und wann immer möglich zu vermeiden. Der Beitrag zeigt die Vielfalt möglicher Formen von Zwang auf und diskutiert die im ethischen Abwägungsprozess zu berücksichtigenden moralischen Maßstäben sowie rechtliche Bedingungen zur Rechtfertigung seiner Anwendung. Es wird deutlich, dass Behandlungsmaßnahmen, die die Anwendung von Zwang beinhalten können, immer einer sorgfältigen und auch selbstkritischen Überprüfung der Maßnahmen im Verhältnis zur Indikation und zum Therapieziel bedürfen. Die Handlungsempfehlung möchte daher nicht prinzipiell die Anwendung von Zwang durch die interprofessionellen Teams missbilligen, sondern sie soll vielmehr zu einer sensiblen Wahrnehmung von Zwang und zu einem kritischen und fürsorglichen Umgang mit formellem und insbesondere informellem (indirektem) Zwang beitragen.

Erkennung und Behandlung von Hyperkaliamien konnen bei Notfallen lebenswichtig sein. Obwohl der Laborwert praklinisch in der Regel nicht zur Verfugung steht und auch in der Klinik Blutwerte nicht direkt bei Aufnahme vorliegen, sollte fruhzeitig die Verdachtsdiagnose einer Hyperkaliamie gestellt werden konnen. Eine zentrale Rolle kommt neben Anamnese und Klinik dem Elektrokardiogramm (EKG) zu. Die Hyperkaliamie kann sich im EKG durch ein breites Spektrum an Veranderungen zeigen. Eine sichere Diagnose ist damit nicht moglich, die Kenntnis typischer EKG-Anomalien jedoch wichtig. Durch die fruhzeitige Verdachtsdiagnose einer Hyperkaliamie kann ein entscheidender Vorteil bei der Behandlung dieses zeitkritischen Notfalls entstehen.

The electrocardiogram (ECG) is an integral part of basic emergency medical diagnosis and preoperative evaluation. In cases of ST elevation myocardial infarction (STEMI) immediate treatment is mandatory after correlation of ischemic symptoms with the ECG pattern. However, there are also ECG patterns that can imitate STEMI, possibly resulting in the true underlying diagnosis being missed and inappropriate therapy being initiated.This paper provides an overview of the most important diagnoses that can imitate STEMI on ECG.A literature search was carried out to determine the most important differential diagnoses of ST elevation on ECG. These STEMI mimics are discussed in detail and their relevance for emergency medicine is explained.This article provides an overview of differential diagnoses that should be known in emergency medicine when assessing an ECG with ST elevations.Good knowledge of the ECG patterns presented here can support decision-making in emergency medicine.HINTERGRUND: Das Elektrokardiogramm (EKG) ist fester Bestandteil der notfallmedizinischen Basisdiagnostik und präoperativen Evaluation. Aus einem ST-Hebungs-Infarkt (STEMI) folgt eine unmittelbare Behandlungskonsequenz, er muss aus Zusammenschau von typischer Klinik und entsprechendem EKG immer erkannt werden. Es gibt allerdings auch EKG-Bilder, die einen STEMI imitieren können. Dadurch kann ggf. die eigentlich zugrunde liegende Diagnose nicht gestellt und eine falsche Therapie initiiert werden.Erstellung einer Übersicht der wichtigsten Diagnosen, die einen STEMI im EKG imitieren können.Es wurde eine Literaturrecherche durchgeführt, um die wichtigsten Differenzialdiagnosen des STEMI im EKG zu ermitteln. Hieraus wurden in Abstufungen die notfallmedizinisch wichtigsten Bilder aufgeführt und deren Relevanz erklärt.Dieser Artikel ergibt eine Übersicht über die relevanten Differenzialdiagnosen, die notfallmedizinisch gekannt werden sollten, wenn ein EKG mit ST-Hebungen beurteilt wird.Eine gute Kenntnis der in diesem Beitrag vorgestellten EKG-Bilder kann helfen, schneller und präziser notfallmedizinisch relevante Diagnosen zu stellen.

Genetics of sudden cardiac deaths (SCD) remains frequently undetected. Genetic analysis is recommended in undefined selected cases in the 2021 ERC-guideline. The emergency medical service and physicians (EMS) may play a pivotal role for unraveling SCD by saving biomaterial for later molecular autopsy. Since for high-throughput DNA-sequencing (NGS) high quality genomic DNA is needed. We investigated in a prospective proof-of-concept study the role of the EMS for the identification of genetic forms of SCDs in the young.We included patients aged 1-50 years with need for cardiopulmonary resuscitation attempts (CPR). Cases with non-natural deaths were excluded. In two German counties with 562,904 residents 39,506 services were analysed. Paired end panel-sequencing was performed, and variants were classified according to guidelines of the American College of Medical Genetics (ACMG).769 CPR-attempts were recorded (1.95% of all EMS-services; CPR-incidence 68/100,000). In 103 cases CPR were performed in patients 50y. 58% died on scene, 26% were discharged from hospital. 24 subjects were included for genotyping. Of these 33% died on scene, 37.5% were discharged from hospital. 25% of the genotyped patients were carriers of (likely) pathogenic (ACMG-4/-5) variants. 67% carried variants with unknown significance (ACMG-3). 2 of them had familial history for arrhythmogenic cardiomyopathy or had to be re-classified as ACMG-4 carriers due to whole exome sequencing.The EMS contributes especially in fatal OHCA-cases to increase the yield of identified genetic conditions by collecting a blood sample on scene. Thus, the EMS can contribute significantly to primary and secondary prophylaxis in affected families.

The 12 lead ECG is difficult to evaluate if there is a persistent right or even left bundle block or a pace maker continually stimulating the right ventricle. Despite these pre-existing or new ECG changes it might still be possible to detect variations which can hint to an ST-elevation myocardial infarction (STEMI). Diagnosing significant ST elevations in a case of right bundle block is not very challenging. If the ECG shows a left bundle block the modified Sgarbossa criteria should be used for evaluation. These criteria can also be used in a pace maker ECG. If a patient is not pacemaker-dependent the stimulation can be paused transiently to reveal changes of the ST segment. At first medical contact it can be very important to assess these changes correctly in order to classify the ECG as a STEMI.

CardioScope is a sonification/auditory augmentation tool intendedto support cardiac diagnosis and monitoring. It allows usersto record and visualize synchronized Electrocardiogram (ECG)and Phonocardiogram (PCG) signals, to sonify the electrical activityof the heart or to augment the sound produced by its mechanicalbehaviour. As first step towards a realtime-interactive auditoryaugmentation, we here propose an auditory augmentation methodusing amplitude modulation that allows users to accentuate specificsegments of the heart sound in order to make pathologicalsignals from the heart sound more salient. We present a set ofsound examples illustrating the proposed method, and discuss resultsof a preliminary qualitative test with two physicians who aredoing their residency in cardiology.

This paper is a continuation and extension of our previous work [1]. CardioSounds is a portable system that allows users to measure and sonify their electrocardiogram signal in real-time. The ECG signal is acquired using the hardware platform BITalino and subsequently analyzed and sonified using a Raspberry Pi. Users can control basic features from the system (start recording, stop recording) using their smartphone. The system is meant to be used for diagnostic and monitoring of cardiac pathologies, providing users with the possibility to monitor a signal without occupying their visual attention. In this paper, we introduce a novel method, anticipatory mapping, to sonify rhythm disturbances such as Atrial Fibrillation, Atrial flutter and Ventricular Fibrillation. Anticipatory mapping enhances perception of rhythmic details without disrupting the direct perception of the actual heart beat rhythm. We test the method on selected pathological data involving three of the most known rhythm disturbances. A preliminary perception test to assess aesthetics of the sonifications and its possible use in medical scenarios shows that the anticipatory mapping method is regarded as informative discerning healthy and pathological states, however there is no agreement about a preferred sonification type.

The 12 lead ECG is difficult to evaluate if there is a persistent right or even left bundle block or a pace maker continually stimulating the right ventricle. Despite these pre-existing or new ECG changes it might still be possible to detect variations which can hint to an ST-elevation myocardial infarction (STEMI). Diagnosing significant ST elevations in a case of right bundle block is not very challenging. If the ECG shows a left bundle block the modified Sgarbossa criteria should be used for evaluation. These criteria can also be used in a pace maker ECG. If a patient is not pacemaker-dependent the stimulation can be paused transiently to reveal changes of the ST segment. At first medical contact it can be very important to assess these changes correctly in order to classify the ECG as a STEMI.

Diagnosing acute myocardial infarction (AMI) in left bundle branch block (LBBB) is challenging. Modified Sgarbossa criteria are known to help detect AMI in LBBB. This is a report about an electrocardiogram (ECG) with Wellens' signs in combination with a pre-existing LBBB. The ECG of a patient with fluctuating chest pain showed very subtle and one day later more obvious Wellens'signs. A left anterior descending artery (LAD) stenosis was diagnosed and successfully treated. Wellens' syndrome can be diagnosed in a case of LBBB and help detect a high-grade LAD stenosis even if modified Sgarbossa criteria are not met.

This paper presents two novel sonification designs for Electrocardiography (ECG) data: (a) Water Ambience soundscapes aim at turning heart activity into an ambience which exhibits salient patterns as specific ECG properties deviate from a normal heartbeat, (b) Timbre Morphing sonification aims at supporting analysts to quickly assess if an abnormality in terms of the frequency, rhythm or amplitude in the signal occurs. Both methods are embedded into an interactive setting where the users can upload a dataset and interactively adjust sonification parameters, for instance in search of settings that optimize the contrast between a baseline (regular) and abnormal (ST deviated) case, based on pre-recorded real ECG data sets. In result, we qualitatively analyze how a small group of users interacts with the system and what their overview regarding the proposed methods is. Also, we conduct a study with eight participants in which they are asked to classify a set of sonifications according to two categories; healthy or unhealthy. The study results suggest that the proposed sonification designs allow users to correctly classify the datasets without having prior knowledge about ECG signals.

We present a case of a 54-year-old male patient who was admitted to our Emergency Department (ED) with localized epigastric pain. Inflammation markers, ultrasound, and CT scan were inconsistent with an initial diagnosis of cholecystitis. However, there was additional evidence of cholecystolithiasis. The ECG showed new anterior biphasic T waves typical for a Wellens' type A ECG. Additionally, the patient had an intermittent left bundle branch block (LBBB). The diagnostic challenges in differentiating possible diagnoses will be described, to which in this case, were either acute cholecystitis or acute coronary syndrome (ACS). A laparoscopic study confirmed acute cholecystitis. Coronary angiography showed no pathological processes associated with ACS. ECG abnormalities were initially ongoing, but were no longer detectable during an 8month follow up assessment.

This paper presents a real-time sonification system for Electrocardiography (ECG) monitoring and diagnostic. We introduce two novel sonification designs: (a) Auditory magnification loupe, a method to sonify important beat-to-beat variations when doing sports activities, and (b) ST-segment water ambience sonification, which aims to assist clinicians in the diagnostic process by building a soundscape that exhibits ECG signal abnormalities as the analysed signal deviates from a healthy ECG. The proposed methods were designed to assist users to unobtrusively monitor their own (or their patients') heart signal in situations when a visual-only representation is not convenient for the proper fulfilment of a given task.Using CardioSounds users receive auditory feedback in order to monitor important heart rhythm disturbances (e.g. Arrhythmia) or pathologies due to a blocking of the heart's vessels.