Case Report| Volume 57, P203-206, January 2023

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“The Spiked Helmet sign”: A harbinger of impending barotrauma

Published:October 13, 2022DOI:


      • Timely recognition of the spiked helmet sign and its role in preventing unnecessary coronary imaging.
      • Identification of lung recruitment ventilation with high pressures in critically ill patients as one of the potential causes of SHS.
      • To understand the pathophysiologic mechanisms associated with the spiked helmet sign.


      The 'spiked helmet sign' (SHS) is an electrocardiographic finding associated with critical illness and a high risk of death; It is likened to ST-elevation, leading to harmful coronary imaging despite lack of apparent myocardial infarction.
      We describe the case of SHS secondary to high ventilation pressures in the setting of Acute Respiratory Distress Syndrome (ARDS) in a critically ill patient who subsequently developed barotrauma.


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