Dr. Smith's ECG Blog

AUGUST 19, 2023

Below is the 15 lead ECG. The ECG above was only done an hour after arrival, when the first high sensitivity troponin I returned at 300ng/L (normal <26 in males and <16 in females). They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS. RR18 sat 99% HR 90 BP 90/60, afebrile.

EKG/ECG 98

EKG/ECG Wellness Outcomes Hospitals 98

Cook County EM Blog

MAY 15, 2023

Figure 1: Initial EKG The Case: 45-year-old Spanish speaking male with no known past medical history presented to the ED with 2-3 hours of severe back pain and throat pain. What does this EKG suggest? His EKG suggested a posterior MI as well as other signs of ischemia. Unfortunately, this EKG was not recorded in the EMR.

EKG/ECG 52

EKG/ECG Documentation/Coding Wellness 52

ALiEM

JUNE 15, 2023

An ECG may show signs similar to digoxin exposure Classic “scooping” of ST segments Heart blocks Dysrhythmias Hyperkalemia may be seen with severe cardiac glycoside poisoning. Serial ECGs and monitoring of serum potassium should be done in cases of severe poisoning. New York, NY: Springer; 2007. Elsevier; 2017. J Clin Lab Anal.

Poisoning 98

Poisoning EKG/ECG Hospitals 98

Dr. Smith's ECG Blog

DECEMBER 5, 2022

I received this ECG in a text message, with the message: "Hey, these look like hyperacute T waves to me, what do you think? Here is her old ECG:" What do you think? Here is my response: "There is something wrong with this ECG. Change the location of the limb Electrodes and repeat the EKG. What do you think? 2010.12.162.

EKG/ECG 52

EKG/ECG 52

Dr. Smith's ECG Blog

JULY 11, 2018

This prehospital ECG was recorded: Here are limb leads: Here are precordial leads: Diagnosis? Can you tell from this ECG? hint: no, you can't tell from this ECG) When this was shown to me, I said "Activate the Cath Lab." By the ECG, it should be a proximal occlusion, proximal to the RV marginal branch. She called 911.

EKG/ECG 52

EKG/ECG Hospitals Documentation/Coding 52

EMDocs

MAY 11, 2024

2007 Jan 27;369(9558):293-8. Chalela JA, Kidwell CS, Nentwich LM, et al. Magnetic resonance imaging and computed tomography in emergency assessment of patients with suspected acute stroke: a prospective comparison. doi: 10.1016/S0140-6736(07)60151-2. PMID: 17258669; PMCID: PMC1859855. Baig MU, Bodle J. Thrombolytic Therapy.

Stroke 111

Stroke EMS EKG/ECG Radiology 111

Dr. Smith's ECG Blog

OCTOBER 10, 2014

Here is his initial ED ECG: 1. Wellens' is a syndrome and not an ECG finding. If you only look at the ECG, there will be many false positives. Complete resolution of pain at the time of the ECG 3. The patient remained pain free, and this was recorded 27 minutes after the 2nd ECG (64 after the first): 3. QTc is 402.

EKG/ECG 52

EKG/ECG 52

RebelEM

MARCH 9, 2023

Wernicke’s Encephalopathy (WE) : WE is present in over 12% of patients with alcohol use disorder (AUD) (Donnino 2007) and is misdiagnosed in up to 80% of patients (Sechi 2007), and carries a mortality rate of 10-17%. 2007 Dec;50(6):715-21. Epub 2007 Aug 3. 2007 May;6(5):442-55. Work up appropriately.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

Dr. Smith's ECG Blog

JANUARY 17, 2023

Here is his first ECG: What do you think? Whenever you see a bizarre ECG, look at leads I, II, and III. So I asked the tech to record the ECG again, but move the left leg electrode. In the December 5, 2022 post of Dr. Smith's ECG Blog — We show 4 additional cases of this pulse-tap artifact. It looks bizarre, doesn't it?

EKG/ECG 52

EKG/ECG Wellness 52

Dr. Smith's ECG Blog

AUGUST 3, 2017

This is his 12-Lead ECG: What do you think?​ Firstly, subendocardial ischemia does not localize on 12-Lead ECG. The precordial ST-depression pattern on this ECG (and in this clinical setting) should immediately raise suspicion of Posterior STEMI! What's also interesting to note is that there is ST-elevation in V6 on the ECG.

EKG/ECG 52

EKG/ECG Outcomes Wellness 52

Dr. Smith's ECG Blog

JULY 22, 2023

An ECG was performed in the ED at 1554: Original image unavailable, this is the only recorded scanned ECG available. In a patient with syncope and fever, this ECG looks more like Brugada. Smith comment: the ECG in question could be due to Brugada, even though there is a change from baseline. PM Cardio digitized version.

EKG/ECG 92

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 92

Don't Forget the Bubbles

JULY 26, 2023

Add into this that the majority of children will be in normal sinus rhythm (NSR) by the time of assessment so to truly identify those who have something wrong we have to be confident in identifying arrhythmias where they are present and critical when analysing an ECG in NSR. All were examined and 98% had an ECG.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Dr. Smith's ECG Blog

NOVEMBER 2, 2015

Here was the first prehospital ECG with pain at 5/10: Computerized QTc is 418 ms. Medics were worried, and gave nitroglycerine, then repeated the ECG at 5 minutes with pain at 2/10: Less ST elevation And they repeated again with pain at 1/10 at 9 minutes: Near Normal Medics asked for physician interpretation on arrival. Hypothesis.

EKG/ECG 52

EKG/ECG Ambulance Services Administration 52

EMDocs

JANUARY 4, 2024

3 Always get an EKG to assess for cardiotoxicity, including widened QRS and prolonged QTc, although this may not be evident right away. 3 Cardiotoxicity 3 All patients need an EKG and cardiac monitoring. Her initial EKG showed sinus tachycardia with a QRS of 86 msec and QTc of 414 msec. Epub 2007 Sep 4. Ann Emerg Med.

Seizures 91

Seizures EKG/ECG Poisoning Shock 91

Mind The Bleep

NOVEMBER 12, 2023

12 lead ECG: variable findings but LVH, pathological Q waves, ST and T wave abnormalities are common. The following are possible ECG changes you may expect to see: Figure 3 : An ECG illustrating the changes in HCM. ECG example (3): Figure 4 : ECG illustrating the changes in non-ischaemic dilated cardiomyopathy.

EKG/ECG 96

EKG/ECG Research Outcomes 96

Dr. Smith's ECG Blog

JANUARY 30, 2019

An initial EKG was obtained: Computer read: sinus tachycardia, early acute anterior infarct. Here is her prior EKG: When compared to the old EKG – Q waves present before, TWI in aVR present before, but all other changes are new. What is the differential for this EKG? T wave inversion III, aVR, TWF in aVF. Is this an OMI?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

EMDocs

DECEMBER 16, 2023

A 12-lead EKG shows sinus tachycardia but is otherwise normal. 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 link] Gaudio, & Grissom, C. Becker, S. Siegler, J.,

Hyperthermia / Hypothermia 93

Hyperthermia / Hypothermia EMS Stroke Seizures 93

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 52

Pediatrics EKG/ECG Wellness Seizures 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Two prehospital 12-lead ECGs looked similar to this ED ECG: This shows diffuse ST depression (I, II, III, aVL, aVF, V3-V6) with reciprocal ST elevation in lead aVR. This ECG is diagnostic of diffuse subendocardial ischemia. Data collected included demographics, initial rhythm, EKG, emergency department (ED) CT and outcomes.

Resuscitation 52

Resuscitation EKG/ECG Hospitals Emergency Department 52

EMDocs

SEPTEMBER 25, 2023

2007): 748. Notable Physical Exam: General: Tripoding, severe respiratory distress. PMID: 33308912 Neilipovitz, David T., and Edward T. “No evidence for decreased incidence of aspiration after rapid sequence induction.” ” Canadian Journal of Anesthesia 54.9 Wallace C, McGuire B. Continuing Educ Anaesth Crit Care Pain.

Emergency Department 90

Emergency Department Soft Tissue Injuries Airway Management Operations 90

Northwestern EM Blog

JANUARY 24, 2022

Hypocalcemia can be hinted at through history or by hints such as a prolonged QTc on an ECG. 2007; 25: 309-331. Hypocalcemia Calcium homeostasis is necessary for the proper maintenance of myocardial contractility and vascular tone. may have greater severity of shock with increased mortality. Arch Surgery. 2004; 139(11):1199-1203.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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. Apart from the first monitored ECG rhythm, this study found no other prognostic factors available to differentiate between survivors and non-survivors.” 2007, 13: 691-6. 1.21; p=0.006).

Basic Life Support 52

Basic Life Support EMS Outcomes Resuscitation 52

EB Medicine

JUNE 6, 2019

Nachi: And finally let’s touch upon the ekg and ACS. In patients over 40 with upper abdominal pain, an EKG and troponin should always be considered. Nachi: A 2007 study suggests that using the Alvarado score along with bedside ultrasound might allow for rapid and inexpensive diagnosis of appendicitis.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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. 2007 Oct; 33(3): 233–239.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

RebelEM

FEBRUARY 3, 2025

While ECGs play a central role in detecting STEMI, misinterpretations often occur, leading to unnecessary catheterization or missed diagnoses. In this study, researchers developed and validated an AI model aimed at improving the diagnosis of STEMI based on 12-lead ECGs. Paper: Lee SH, Jeon KL, Lee YJ, Ko YG, Choi D, Hong MK, et al.

EKG/ECG 84

EKG/ECG Emergency Department Outcomes Hospitals 84

Dr. Smith's ECG Blog

JANUARY 21, 2023

ECG met STEMI criteria and was labeled STEMI by computer interpretation. What is your ECG interpretation, and would you activate the cath lab? This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. What do you think?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52