Dr. Smith's ECG Blog

DECEMBER 27, 2023

The following ECG was obtained. Note that the machine read is "normal sinus rhythm, normal ECG." ECG 1 What do you think? I sent this ECG to Dr. Smith and Dr. Meyers with no clinical context. Smith comment: this troponin alone should be enough data to activate the cath lab, regardless of the ECG. <0.049 ng/mL).

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EKG/ECG Documentation/Coding Wellness Emergency Department 131

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.

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EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 92

The Skeptics' Guide to EM

JANUARY 27, 2024

You provide her with two tablets of ASA to chew while your partner acquires an ECG, which ultimately shows clear ST elevation in the inferior leads and some ST changes in V1-V2 that make you wonder if your patient is having an acute myocardial infarction (MI) with right-sided ventricular involvement (RVI). It’s not 50-50.

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Administration Academics EKG/ECG EMS 127

Dr. Smith's ECG Blog

OCTOBER 6, 2023

This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion Nevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery: An elderly patient had onset of chest pain one hour prior. Here is the prehospital ECG. He called 911. What do you think?

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Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The baseline ECG is basically normal with no ischemia. Here is what the Queen of Hearts says about the Baseline ECG: Active chest pain triage ECG also read as not OMI: She says "not OMI", but she does not have access to the baseline ECG. In the future, we will be able to have her compare with previous and serial ECGs.

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Dr. Smith's ECG Blog

FEBRUARY 14, 2009

Interestingly, they found that this was not a transient feature that later progressed to ST elevation, but that it remained static until angiography up to 50 minutes after the initial ECG. This is the EKG of a previously healthy 40 year old man with one hour of chest pain and profound weakness and sense of "doom". K levels were normal.

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Dr. Smith's ECG Blog

APRIL 17, 2023

Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve Smith Take a look at these two ECGs below from two patients in the ED, first without any clinical context. The Queen of Hearts correctly says: Smith : Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)?

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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?

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Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 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. 2008 Apr;51(4):412-5, 415.e1.

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Seizures EKG/ECG Poisoning Shock 92

Dr. Smith's ECG Blog

OCTOBER 6, 2018

At 3:55 AM during that kind of a night shift, this ECG (among many others) was brought from triage for review by my team. We knew only that the ECG belonged to a man in his 50s with chest pain and normal vitals. Here is the computer interpretation: So we have a triage-computer-normal ECG. No prior available.

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EKG/ECG Seizures Documentation/Coding Outcomes 40

Dr. Smith's ECG Blog

MAY 2, 2019

Written by Pendell Meyers I received this prehospital ECG (we receive prehospital ECGs by telemetry from EMS in a large area around our hospital) and was told that there was a patient in her 50s with chest pain who was headed to an outside hospital (which happens to be a catheterization center). Here is the ECG: What do you think?

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Hospitals EKG/ECG Wellness EMS 52

Dr. Smith's ECG Blog

AUGUST 26, 2009

He called 911 and paramedics recorded a prehospital 12 lead ECG which showed a clear inferior STEMI (not shown, tracing could not be found). On arrival, the following ECG was recorded. In this case the diagnosis was clear due to the prehospital ECG. But suppose there had been no prehospital ECG? There is 0.5

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EMDocs

APRIL 22, 2024

During a short period of ROSC an ECG was performed. The findings of RV strain on the ECG also supported the POCUS echo findings in this case. EKG RV strain. Rockville (MD): Office of the Surgeon General (US); 2008. 2008 Mar;28(3):370-2. DVT Left Saphenofemoral Junction. Under perfused femoral artery. Am J Prev Med.

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Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

Dr. Smith's ECG Blog

MARCH 13, 2013

Here is a 15 lead ECG: Sinus rhythm. In my early repolarization/anterior STEMI study, I excluded any ECG with any precordial ST depression, considering this to be diagnostic of STEMI because normal variant precordial ST elevation does not coexist with simultaneous precordial ST depression. There is ST elevation in V1 (of 3.0

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EKG/ECG Hospitals Outcomes Wellness 52

EMDocs

MAY 11, 2024

Risk factors : 10% of ischemic strokes occur in the brainstem 2 Risk factors for ischemic brainstem stroke 3 : Atherosclerosis Hypertension Diabetes Smoking Atrial fibrillation Hyperlipidemia Ischemic heart disease Embolism Dissection Risk variables for hemorrhagic brainstem strokes 3 : Hypertension Anticoagulant use AV malformations Amyloid angiopathy (..)

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Stroke EMS EKG/ECG Radiology 110

The Skeptics' Guide to EM

JULY 2, 2022

His symptoms are moderately suspicious, he has a normal EKG, and a history of hypertension. The HEART score was originally developed in 122 patients in the Netherlands and published in 2008. Case: You are working a shift in your local community emergency department (ED) when a 47-year-old male presents with chest pain. AEM June 2022.

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Dr. Smith's ECG Blog

FEBRUARY 14, 2020

Here was his triage ECG (sorry for the quality, unable to obtain better images from sender): Last ECG on file is below for comparison. First try this ECG without the baseline, then with. Previous ECG on file (never just assume its the baseline, but I think this one looks consistent with a baseline). What do you think?

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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.

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EKG/ECG Outcomes Hospitals Wellness 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

The medics recorded the following initial ECG at time 0: The computer read (see below) gives no further comment beyond ventricular pacemaker. He refused to listen to the medic and was convinced that the ECG was due to hyperkalemia and that acute MI cannot be diagnosed in the presence of paced rhythm. What do you think?

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ACEP Now

DECEMBER 10, 2023

3 You order toxicology labs, an EKG, and a sitter to observe. 2008 Sep;34(9):e4. The initial QTc is normal, but on repeat becomes prolonged. CMP reveals hypokalemia. You order IV potassium and magnesium. The patient’s respiratory rate decreases and he becomes more somnolent. Am J Emerg Med. 2020;38(3):571-581. Sontheimer, D.

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Resuscitation EKG/ECG Documentation/Coding Hospitals 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

Suggestions on management: First , examine the ECG very closely for P-waves. The one exception ADDIN EN.CITE McCord 2008 1774 1774 17 McCord, J. style='mso-element:field-begin'> ADDIN EN.CITE McCord 2008 1774 1774 17 McCord, J. I know this is true for me, and I have to always be aware of it in order to avoid it! Wells, P.J.

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Seizures Administration Outcomes Hospitals 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. 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.

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Urgent Care Ultrasounds

JANUARY 17, 2019

Her ECG did not show any concerning features. HH has been associated with post-prandial syncope, chest pain, and ECG changes suggestive of ischaemia. 2008; 6:46. She was brought down to the urgent care clinic for assessment. A Focused TTE was performed. The following PSLA view was obtained. The American journal of cardiology.

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Pediatric Emergency Playbook

DECEMBER 1, 2015

Regardless of the exposure, obtain an ECG and look for bundle branch block, heart block, and dysrhythmias , since those will change disposition. Discharge patients with low-voltage injury, no symptoms, and a normal ECG. 2008; 15:988-994. Plan to re-examine either during observation in the ED, or in close outpatient follow-up.

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Burns Emergency Department EKG/ECG Shock 40

ACEP Now

JANUARY 9, 2024

Blood type and screen, COVID-19 tests, and ECG were all within normal limits. Baltimore: Lippincott Williams & Wilkins ;2008:307-9. FIGURE 1: Abdominal X-ray showing particulate radiopaque foreign bodies involving the stool. Click to enlarge.) An abdominal X-ray revealed particulate radiopaque foreign bodies involving the stool.

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Poisoning Pediatrics Emergency Department Wellness 52

EB Medicine

JULY 8, 2019

From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled! Nachi: Check an EKG immediately after arrival for any patient that may be concerning for ACS. A normal ekg of course does not rule out a cardiac cause of their presentation. From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled!

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EMDocs

FEBRUARY 29, 2024

Answer: This EKG shows Ashman’s phenomenon, which was first identified in 1947 by Drs. 6th edn Philadelphia: Saunders Elsevier, 2008: chapter 17, ventricular arrhythmias; 405–39. The post ECG Pointers: Ashman’s Phenomenon appeared first on emDOCs.net - Emergency Medicine Education. Wandering atrial pacemaker?

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EKG/ECG EMS Hospitals 104

EMDocs

JANUARY 20, 2024

ECG shows ST-segment elevation in V3-V6 only with depression in aVR. The most common findings on ECG are ST elevation , most often in the anterior precordial leads, as well as sinus tachycardia and QT interval prolongation. Initial vital signs include BP of 157/80, HR of 96, RR 14, SpO2 of 97% on RA, T 37.5.

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EMS Fluid Resuscitation Shock EKG/ECG 101

Dr. Smith's ECG Blog

MAY 23, 2022

Written by Jesse McLaren, with comments by Smith and Grauer Four patients presented with cardiorespiratory symptoms, with inferior ST elevation and reciprocal change on their ECG. Note: according to the STEMI paradigm these ECGs are easy, but in reality they are difficult. First lets start with each ECG without clinical context.

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EKG/ECG Documentation/Coding Hyperthermia / Hypothermia Research 52

Dr. Smith's ECG Blog

MARCH 6, 2020

Here was his ED ECG: There is sinus tachycardia (rate about 114) with nonspecific ST-T abnormalities. An ECG was recorded: This shows a regular narrow complex tachycardia at a rate of about 160. The post tach ECG is similar to the first one: Sinus rhythm The tachycardia recurred and resolved. BP:143/99, Pulse 109, Temp 37.2 °C

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EKG/ECG Ultrasounds Hospitals 52

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?

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Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

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. Jan 23 2008;(1):CD000396. Up to two-thirds of rib fractures are missed on initial chest radiographs. Epub 2017 Feb 14. PMID: 28192789. Cochrane Database Syst Rev.

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EMDocs

JULY 19, 2023

doi: 10.1186/2008-2231-22-46. Mercury, in all forms, reacts with sulfhydryl groups in intracellular sites ultimately interfering with multiple enzymatic processes. Rafati-Rahimzadeh M, Rafati-Rahimzadeh M, Kazemi S, Moghadamnia AA. Current approaches of the management of mercury poisoning: need of the hour. 2014 Jun 2;22(1):46.

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Dr. Smith's ECG Blog

JANUARY 31, 2025

Written by Magnus Nossen The ECG below was obtained from 50-something male with a history of hypertension and tobacco use. The ECG below ECG was recorded on the scene. What is the cause of the ECG changes here? ECG #1 The ECG shows sinus rhythm with a narrow QRS complex. How will you manage this patient?

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EKG/ECG Ambulance Services Outcomes Resuscitation 114