Dr. Smith's ECG Blog

FEBRUARY 10, 2022

The ECG was labeled ‘normal’ by the computer (Marqette 12SL), later confirmed by the cardiologist. Smith : this proves my impression that the inferior T-waves on the first ECG are hyperacute. Six hours later a repeat ECG was done, with a repeat troponin downtrending at 1,000 ng/L. What do you think?

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RebelEM

MARCH 22, 2023

Differential to Consider (for Regular, Narrow Complex Tachydysrhythmias) Sinus Tachycardia AVNRT Orthodromic Atrioventricular Reentrant Tachycardia (AVRT) Atrial Flutter with 2:1 block Common EKG Findings Narrow-complex, regular rhythm with a rate that often exceeds the theoretical maximal heart rate (220 – age) for that patient.

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Dr. Smith's ECG Blog

JUNE 1, 2020

== MY Comment by K EN G RAUER, MD ( 6/1 /2020 ): == YOU are asked to interpret the ECG shown in Figure-1. Figure-1: The initial ECG in the ED. MY THOUGHTS on ECG #1: My initial impression on looking at the ECG in Figure-1 — was that the rhythm was either rapid AFib in a patient with WPW — or — PMVT ( P oly M orphic VT ).

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Dr. Smith's ECG Blog

OCTOBER 28, 2013

The following 12-lead ECG was recorded at 11 minutes after ROSC. at the time of the ECG. Here is the annotated ECG from above, with lines drawn. Here is an article I wrote: Updates on the ECG in ACS. The patient was resuscitated for 50 minutes, and then this ECG was recorded: Sinus rhythm. Mg was 1.6.

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PHEM Cast

APRIL 10, 2016

This was the same principle as in the Rivers trial: the standard care group is the ‘control’ group against which changes in outcome for the ‘intervention’ group are compared. Think about ECG as an example, So, where the box is green, the test has given us the correct result for the patient. 2013 Jun;44(6):1116–25. Elsevier B.V;

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Dr. Smith's ECG Blog

DECEMBER 16, 2019

This case was texted to me by one of our residency graduates, and with the outcome, so I don't know how I would have interpreted it blindly. Here is his ECG (there was no previous ECG available): What do you think? There was an ECG recorded the next AM: It does not appear much different! The LAD was 100% occluded.

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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.

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Dr. Smith's ECG Blog

NOVEMBER 4, 2022

What is your ECG interpretation and what would you do next? This ECG shows a normal sinus rhythm with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, late R wave progression (and misplaced V2), normal voltages, ST-elevation in aVR and global ST-depressions. BP was 110 and oxygen saturation was normal.

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EB Medicine

JULY 8, 2019

Jeff: Do note, however that 2013 guidelines do not recommend one procedure over another and leave that decision up to local surgical expertise, patient specific risk factors, and treatment goals. Nachi: Check an EKG immediately after arrival for any patient that may be concerning for ACS. Obesity (Silver Spring).

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EMDocs

DECEMBER 18, 2024

2013; 88(9): 589-595. Alcohol withdrawal syndrome: improving outcomes through early identification and aggressive treatment strategies. fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold Alcohol withdrawal syndrome in medical patients. Cleve Clin J Med. 2016; 83(1): 67-79.

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RebelEM

SEPTEMBER 28, 2023

ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% The upper range of this time was 120 minutes from diagnostic ECG in the majority of patients.

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ACEP Now

APRIL 9, 2025

When I was an inpatient pharmacy manager in 2013, my hospital was visited by the California Department of Public Health (CDPH), concerned about droperidol and ECG monitoring, or rather, lack thereof. outcome of this is the removal of droperidol from the hospital formulary. Despite all the buzzwords (Evidence-based medicine!

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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.

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Dr. Smith's ECG Blog

MAY 8, 2023

Triage ECG: What do you think? Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. Queen of Hearts interpretation: The cardiologist initially was not convinced, stating the ECG was not diagnostic or could not be diagnostic because it was paced. No labs were performed.

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Dr. Smith's ECG Blog

AUGUST 9, 2019

Some total LAD occlusion manifest on the ECG similarly to some left main occlusions. Depending on where the STE vector of the LM occlusion shows up on the ECG, there may be either STE, or STD, or neither in aVR, and lead aVR will not be the important part of the ECG interpretation in these cases.

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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.

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EMDocs

SEPTEMBER 25, 2023

Still, there are those that believe that FPS is more of a physician-centered endpoint that does not fully reflect important patient-centric outcomes (16). Resuscitation 2013; 84(11): 1500 – 4. 2013): 71-78. Notable Physical Exam: General: Tripoding, severe respiratory distress. References: Heffner AC et al. Sakles, John C.,

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Dr. Smith's ECG Blog

NOVEMBER 24, 2017

However, none of the formulas have proven to be definitively better than another and none are well correlated with outcomes or events! Example ECG: The heart rate is 167; the RR interval is 0.36 Answer : you must treat the patient's underlying condition causing sinus tachycardia, and repeat the ECG at the lower heart rate.

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The Skeptics' Guide to EM

SEPTEMBER 19, 2020

The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. TXA also seems to improve patient-oriented outcomes in epistaxis ( SGEM#53 and SGEM#210 ). The Lancet 2020 This was an SGEM Journal Club episode recorded live at McGill University Grand Rounds.

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Downeast Emergency Medicine

MARCH 13, 2022

rebound tenderness), getting an EKG if you have a high suspicion for cardiac involvement, or using ultrasound to assess for free fluid. He has a past medical history significant for nephrolithiasis and cholecystitis and a past surgical history significant for a cholecystectomy in 2013. , ruptured ectopic pregnancy, etc.

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Rural Doctors Net

AUGUST 30, 2013

Flooding him with crystalloid is going to dilute his clotting factors, make him hypothermic and potentially worsen outcomes. Whilst we’ve ‘re-discovered’ balanced resuscitation (first described by Cannon back after WWI), there remains some limited controversy – listen to this 2013 take from Simon Carley at St.

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ACEP Now

MARCH 11, 2025

It is important that we identify eating disorders in the ED, as the earlier treatment is started, the better the long-term outcomes (similar to schizophrenia), the lower the mortality rate, and the less likely they are to develop serious medical complications. Comorbidity and outcome in eating disorders. Int J Eat Disorder.,

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ACEP Now

JUNE 14, 2024

ECG evaluates for dysrhythmias, acute coronary syndrome, or signs of right heart strain. A therapeutic outcomes model. Antibiotic treatment and factors influencing short and long term outcomes of acute exacerbations of chronic bronchitis. Complete blood count evaluates for leukocytosis or anemia. J Antimicrob Chemother.

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Dr. Smith's ECG Blog

APRIL 9, 2025

This was her prehospital ECG: What do you think? ECG many months later: RBBB with well-formed Q-waves in V1-V6, also I, aVL. But it does show a strong association of better outcome with lidocaine vs. amiodarone. We used propensity score matching (PSM) to investigate the association between antiarrhythmic and outcomes.

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Dr. Smith's ECG Blog

FEBRUARY 26, 2025

Below is his presentation ECG. The above ECG was originally recorded with a paper speed of 50mm/sec. Interpretation: The ECG shows sinus rhythm at 94 beats per minute. This ECG shows a lot of "acuity". The ECG findings in isolation must be assumed to be acute MI until proven otherwise. What do you think?

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Dr. Smith's ECG Blog

MARCH 8, 2025

Her first ECG is shown. After this ECG was obtained, the ER physician received word that the patient's husband had died in the crash. Repeat ECG was obtained immediately, just 24 minutes after the prior ECG: Given the context, my top differential diagnosis would be stress cardiomyopathy AKA takotsubo. Overall bland.

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