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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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

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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Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? 2013 Sep;26(9):965-1012.e15. The beat-to-beat variation in the QRS complexes (electrical alternans) is a classic ECG finding of a large pericardial effusion or pericardial tamponade. J Am Soc Echocardiogr.

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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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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. Fast forward to now, and it seems droperidol is still a favorite punching bag for CDPH. Guideline directed!) The realistic (or preferred?)

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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. Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI.

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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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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.

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The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Audrey’s academic interests include trauma and resuscitation. Audrey’s academic interests include trauma and resuscitation. The first visit was back in 2013 for SGEM#50 : Under Pressure – Vasopressin, Steroids and Epinephrine in Cardiac Arrest. Robert’s academic interests include research and evidence-based medicine.

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Dr. Smith's ECG Blog

MAY 5, 2022

Fluid resuscitation was initiated. Here is the initial ED ECG: What do you think? The ECG shows peaked T waves, QRS widening, a coved-type ST segment with inverted T waves most prominent in V1 and V2 consistent with Brugada pattern. They opined that the ECG could instead be "metabolic." Creatinine elevated at 3.09

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Cook County EM Blog

MAY 29, 2023

As resuscitation measures are underway, you obtain collateral from EMS and parents. If a wide complex rhythm is present on ECG, sodium bicarbonate boluses (to overcome sodium channel blockade) should be administered. 2013 Jan;33(1):38-43. The Case: A 4-year-old boy born with no past medical history presents in cardiac arrest.

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EMDocs

SEPTEMBER 25, 2023

Resuscitation 2013; 84(11): 1500 – 4. 2013): 71-78. Notable Physical Exam: General: Tripoding, severe respiratory distress. References: Heffner AC et al. Incidence and factors associated with cardiac arrest complicating emergency airway management. PMID: 23911630 Kim WY et al. Sakles, John C., 2021 Jun;60(6):816-817.

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Downeast Emergency Medicine

MARCH 13, 2022

Key Concepts Quickly rule out life-threatening emergencies that require immediate resuscitation. rebound tenderness), getting an EKG if you have a high suspicion for cardiac involvement, or using ultrasound to assess for free fluid. Think aortic aneurysm dissection, bowel perforation, STEMI (especially in elderly female patients!),

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Rural Doctors Net

AUGUST 30, 2013

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. An ideal resuscitation would allow parallel processing with a designated team leader and teams devoted to various tasks.

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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. A retrospective 'target trial emulation' comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. For clarity in Figure-1 I've reproduced and labeled this initial ED ECG.

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Dr. Smith's ECG Blog

DECEMBER 23, 2024

She was resuscitated and admitted to ICU for presumed sepsis. Hint: What does the arterial waveform correspond to on the ECG? And you can see a sharp deflection in the ECG from pacing artifact. adapted from Grauer K: ACLS-2013-ePub Section 15, KG/EKG Press ). Her family had not heard from her and called EMS.

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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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ACEP Now

OCTOBER 29, 2024

Initial echocardiogram (ECG) on arrival (see figure 2) to our emergency department revealed normal sinus rhythm, mild interventricular conduction delay (RSR’), and possible right ventricular hypertrophy. This ECG in combination with presenting symptom of cardiac arrest raised suspicion for Brugada syndrome. Figure 2: The initial ECG.

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