2005 and EKG/ECG - Emergency Care Today

ECG Blog #448 — A Young Man with Chest Pain.

Ken Grauer, MD

SEPTEMBER 21, 2024

The ECG in Figure-1 was obtained from a previously healthy man in his early 20s — who initially presented with GI symptoms, that then evolved into CP ( C hest P ain ). QUESTIONS: Given the above history — How would YOU interpret the initial ECG that is shown in Figure-1 ? Figure-1: The initial ECG in today's case. (

EKG/ECG

EKG/ECG Resuscitation Outcomes Hospitals

Chest Pain in Children: ReBaked Morsel

Pediatric EM Morsels

MAY 10, 2024

EKG Reasonable screen for cardiac etiology [ Kane, 2010 ]: Chest Pain with Exertion? 2005 Jun;33(6):1231-8. Is there a family history of sudden death, hypertrophic cardiomyopathy, long QT syndrome, or tachyarrhythmias? Chest Pain in Children: A Reasonable Work-up The goal is to balance risk of the rare with risk of over-testing.

EKG/ECG

EKG/ECG Pediatrics Ultrasounds Seizures

Texted from a former EM resident: 70 yo with syncope and hypotension, but no chest pain. Make their eyes roll!

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Here is the ED ECG (a photo of the paper printout) What do you think? American Journal of Emergency Medicine 2005; 23(3):279-287. The "good news" — is that a cardiac-related cause of syncope is unlikely if the initial ECG is normal, and cardiac monitoring in the ED fails to reveal significant arrhythmia.

EMS

EMS CPR EKG/ECG Wellness

Webinars

Bridging Innovation & Patient Care: The Growing Role of AI

MORE WEBINARS

46 year old with chest pain develops a wide complex rhythm -- see many examples

Dr. Smith's ECG Blog

AUGUST 9, 2024

These diagnoses were not found in his medical records nor even a baseline ECG. An ECG was obtained shortly after arrival: What do you think? There is no evidence of WPW on this ECG, but it is diagnostic for OMI. If the LAD is completely occluded, then why does the ECG show reperfusion? What are we seeing here?

EKG/ECG

EKG/ECG EMS Emergency Department Wellness

Patient with severe DKA, look at the ECG

Dr. Smith's ECG Blog

FEBRUARY 2, 2017

Here is the ECG: Sinus tachycardia. This is an extremely dangerous ECG. When the ECG shows the effects of hypokalemia, it is particularly dangerous. Here are the American Heart Association Guidelines: 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Part 10.1:

EKG/ECG

EKG/ECG Resuscitation Administration CPR

Classic LV aneurysm (persistent ST elevation after previous MI)

Dr. Smith's ECG Blog

NOVEMBER 10, 2008

What are the worrisome EKG findings, and what is the differential diagnosis? If you want a rule, I derived one a few years ago (AJEM 23(3):279-287; May 2005). I cannot tell from this ECG if it is 12 hours or 12 years since the MI. 70 yo with h/o MI, recent CABG, has acute onset of chest pain. What is the most likely diagnosis?

EKG/ECG

Severe shock, obtunded, and a diagnostic prehospital ECG. Also: How did this happen?

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

A prehospital ECG was recorded: Limb leads: Precordial Leads What is the therapy? What does a heart look like on ultrasound when the EKG looks like that? The followup ECG is here: Now the QRS is only slightly prolonged. A middle-aged woman was found down in her apartment unconscious. She was in shock with thready pulses.

Shock

Shock EKG/ECG Resuscitation Ultrasounds

What will you do for this patient transferred to you who is now asymptomatic?

Dr. Smith's ECG Blog

MARCH 6, 2019

This ECG was recorded on arrival: What do you think? Proof that all STE and hyperacute T-waves in the presentation ECG are new. They collected several repeat ECGs at the outside hospital before transport: None of these three ECGs meet STEMI criteria. This ECG shows persistent Occlusion MI but does not meet STEMI criteria.

EKG/ECG

EKG/ECG Outcomes Hospitals Wellness

LVH with anterior ST Elevation. When is it anterior STEMI?

Dr. Smith's ECG Blog

DECEMBER 29, 2015

What do you think of this ECG in a patient with chest pain? An ECG was obtained at triage: ECG #1 at 0000 hours. The ST depression in V6, and T wave flattening/inversion in V6 and aVL, also support LVH The ECG was repeated to get a clearer tracing and because her pain increased to 10/10 at that moment.

EKG/ECG

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Dr. Smith's ECG Blog

JANUARY 9, 2023

Meyers ECG Interpretation: Easily diagnostic of LAD occlusion. The ECG easily meets STEMI criteria in all leads V2-V6, as well. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chest pain. The ECG was interpreted as "benign early repolarization." This gets drilled into them.

EKG/ECG

EKG/ECG Wellness Ultrasounds Outcomes

Prehospital Traumatic Cardiac Arrest: A Systematic Review and Meta-analysis

RebelEM

MARCH 13, 2023

The only statistically significant factor intra-arrest was the first ECG rhythm, which only had an odds ratio of 1.12, which is relatively low. Many studies suggest that increased time spent on scene correlates with worse outcomes for trauma (Stiell 2008) and all-cause incidence (Isenberg 2005) across all levels of prehospital care.

Basic Life Support

Basic Life Support EMS Outcomes Resuscitation

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. This subsequent ECG was recorded after the K was up to 2.2 The QT is much shorter There are now clear U-waves in V2 and V3 2 days later, this ECG was recorded with a K of 3.5: These two rhythms are often indistinguishable on the monitor or ECG. This was stented.

Resuscitation

Resuscitation EKG/ECG Hospitals Administration

MI in Children

Pediatric Emergency Playbook

JUNE 1, 2017

Electrocardiography (ECG) should be performed on any patient with significant blunt chest injury. A negative ECG is highly consistent with no significant blunt myocardial injury. Any patient with a new abnormality on ECG (dysrhythmia, heart block, or signs of ischemia) should be admitted for continuous ECG monitoring.

Pediatrics

Pediatrics EKG/ECG Wellness Seizures

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

Dr. Smith's ECG Blog

APRIL 8, 2015

Abnormal ECG – looks for cardiac syncope. Abnormal Electrocardiogram (ECG): Defined (San Fran syncope rule) as any new changes when compared to the last ECG or presence of non-sinus rhythm. If no previous ECG was available, ECG was classified as abnormal if any abnormality was present. orthostatic vitals b.

Emergency Department

Emergency Department EKG/ECG Outcomes Seizures

EM@3AM: Hyperthermia

EMDocs

DECEMBER 16, 2023

A 12-lead EKG shows sinus tachycardia but is otherwise normal. 2005 Oct 5;9(5):R498-501. Triage vital signs include BP 80/40 mm Hg, HR 154 bpm, T 41C rectal, RR 28 breaths per minute, saturation 94% on room air. The patient is agitated, not oriented, and becoming combative with ED staff. Temps greater than 41.5C doi: 10.1186/cc3771.

Hyperthermia / Hypothermia

Hyperthermia / Hypothermia EMS Stroke Seizures

Pain Management of Common Chief Complaints in the ED

EMDocs

NOVEMBER 4, 2024

Pain can be associated with a friction rub on cardiac auscultation, a pericardial effusion on a bedside echocardiogram, or diffuse ST elevations on an EKG. 2005 Jul-Aug 2005;12(4):311-9. Up to two-thirds of rib fractures are missed on initial chest radiographs. Jan 23 2008;(1):CD000396. doi:10.1002/14651858.CD000396.pub3

Emergency Department

Emergency Department Fractures Burns EMS

When ACS care is very delayed, "STEMI metrics" can be perfect. And how specific is Queen of Hearts?

Dr. Smith's ECG Blog

MARCH 23, 2025

EMS arrived and recorded this ECG: What do you think? Here is the PMcardio Queen of Hearts interpretation of the ECG: STEMI equivalent detected. About an hour later another ECG was obtained: Barely meets STEMI criteria in inferior leads, but obvious inferior and posterior OMI. Inferior and posterior OMI without STEMI criteria.

EKG/ECG

EKG/ECG EMS Outcomes Wellness

Emergency Care Today

ECG Blog #448 — A Young Man with Chest Pain.

Chest Pain in Children: ReBaked Morsel

Webinars

Trending Sources

Texted from a former EM resident: 70 yo with syncope and hypotension, but no chest pain. Make their eyes roll!

Webinars

46 year old with chest pain develops a wide complex rhythm -- see many examples

Patient with severe DKA, look at the ECG

Classic LV aneurysm (persistent ST elevation after previous MI)

Severe shock, obtunded, and a diagnostic prehospital ECG. Also: How did this happen?

What will you do for this patient transferred to you who is now asymptomatic?

LVH with anterior ST Elevation. When is it anterior STEMI?

A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Prehospital Traumatic Cardiac Arrest: A Systematic Review and Meta-analysis

STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes

MI in Children

Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.

EM@3AM: Hyperthermia

Pain Management of Common Chief Complaints in the ED

When ACS care is very delayed, "STEMI metrics" can be perfect. And how specific is Queen of Hearts?

Stay Connected