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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EKG/ECG Documentation/Coding Emergency Department Psychiatric 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

I remember Allie well from her days in the Research volunteer program at Hennepin. 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.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

EMDocs

JANUARY 4, 2024

3 Bupropion blocks the reuptake of dopamine and norepinephrine, as well as antagonizes acetylcholine at nicotinic receptors. 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.

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Seizures EKG/ECG Poisoning Shock 92

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?

Hospitals 52

Hospitals EKG/ECG Wellness EMS 52

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

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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EKG/ECG Documentation/Coding Research Academics 52

EMDocs

APRIL 22, 2024

If RV pressure is extreme, it can exceed LV pressure causing paradoxical septal wall motion toward the LV as well. When RV pressures elevate, RA pressures increase as well given forward blood flow is obstructed. During a short period of ROSC an ECG was performed. EKG RV strain. 2008 Mar;28(3):370-2. 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

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

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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EKG/ECG 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. The medic was very worried about the concordant STE and T-wave in aVR, and the downsloping concordant ST depression in II, III, aVF, as well as V5 and V6. What do you think? What happened?"

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EKG/ECG Emergency Department Research Outcomes 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

Suggestions on management: First , examine the ECG very closely for P-waves. Wells, P.J. Wells, P.J. 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. Try Lewis Leads!! Cigarroa, R.G. Flores, E.D. McBride, W.

Seizures 52

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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Basic Life Support EMS Outcomes Resuscitation 52

Pediatric Emergency Playbook

DECEMBER 1, 2015

Victims of electrical injuries present either in extremis or as the seeming well patient with insidious, developing disease. Most patients do well, and the burn heals by secondary intention. Taser dispo: People who have been tased do remarkably well and complications are rare. 2008; 15:988-994. J Pediatr Surg.

Burns 40

Burns Emergency Department EKG/ECG Shock 40

ACEP Now

JANUARY 9, 2024

On physical examination, the child was non-toxic, well-nourished, alert, awake, and not in acute distress. Blood type and screen, COVID-19 tests, and ECG were all within normal limits. Baltimore: Lippincott Williams & Wilkins ;2008:307-9. A review of systems revealed no abnormal findings. Click to enlarge.) Adv Pediatr.

Poisoning 52

Poisoning Pediatrics Emergency Department Wellness 52

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. From the 80’s to 2008, the worldwide prevalence of obesity nearly doubled! Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications.

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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

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. She denies any trauma, swelling, or redness in the joints, as well as fever or weight loss. Jan 23 2008;(1):CD000396. The pain is worse with activity but improves with rest.

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Emergency Department Fractures Burns EMS 105

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