Welcome to The Pearl Log — where post-shift wisdom surfaces, one shiny clinical take at a time. Some pearls are fresh, some are rough, all are found under pressure.
Find a Pearl
A Scary EKG
You are handed a triage EKG on a young patient with chest pain. The ST elevations are obvious, diffuse, and immediately uncomfortable to look at. Nothing about it feels subtle. The patient is stable, the story is incomplete, and the ECG demands a decision before the labs can help you. Is this an infarct hiding in plain sight, or inflammation pretending to be one? Before you decide, take a closer look at the tracing.
Aslanger Pattern
The Aslanger pattern is an ECG finding in inferior occlusion MI with multivessel disease where competing injury and ischemia vectors prevent classic contiguous ST-elevation. It typically shows isolated ST elevation in lead III, V1 greater than V2, and reciprocal lateral ST depression, and is associated with delayed cath and worse outcomes if missed.
A case of palpitations
A 37-year-old with a heart rate just over 200, narrow complexes, and a rhythm so regular it could keep time—no flutter waves in sight. He’s talking, perfusing, and looking at you expectantly. The next move? Something simple, safe, and maybe a little gravity-assisted.