2019, EKG/ECG and Stroke - Emergency Care Today

EM@3AM: Brainstem Strokes

EMDocs

MAY 11, 2024

Answer : Brainstem stroke specifically in the pons resulting in locked in syndrome. CT head without contrast 1 is performed and reveals the following: Question: What is the diagnosis?

Stroke

Stroke EMS EKG/ECG Radiology

Answer : Cerebellar Stroke Epidemiology: 1-4% of cerebrovascular accidents occur in the cerebellum. 2 In the United States, approximately 795,000 people suffer from strokes every year. 3 Cerebellar strokes are associated with high morbidity and mortality. CT head without contrast 1 reveals the following: What is the diagnosis?

Stroke

Stroke EMS Pediatrics EKG/ECG

An elderly male with acute altered mental status and huge ST Elevation

Dr. Smith's ECG Blog

OCTOBER 12, 2024

CTA head and neck were obtained and showed no evidence of intracranial hemorrhage, large vessel occlusion stroke (what a helpful and apt name for an acute arterial occlusion paradigm, by the way.), EKG on arrival to the ED is shown below: What do you think? 2) There was no terminal QRS distortion on these ECGs. Any changes?

EKG/ECG

EKG/ECG Documentation/Coding Emergency Department COPD

How important are old ECGs in Non-obvious cases of potential OMI?

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

In the last post, we saw how important old ECGs are in assessing the current ECG in a patient without atypical presentation (in this previous case, the patient had no chest pain, and the apparent inferior OMI did not have reciprocal ST depression in lead aVL). Here is that last post: A 90-something with acute stroke.

EKG/ECG

EKG/ECG EMS Stroke Outcomes

SGEM#269: Pre-Hospital Nitroglycerin for Acute Stroke Patients?

The Skeptics' Guide to EM

OCTOBER 5, 2019

Date: September 25th, 2019 Reference: Bath PM et al. Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomized, sham-controlled, blinded, phase 3 trial. The Lancet March 2019. Date: September 25th, 2019 Reference: Bath PM et al.

Stroke

Stroke Hospitals EMS Outcomes

A man in his 60s with syncope and ST depression. What does the ECG mean?

Dr. Smith's ECG Blog

OCTOBER 25, 2023

Here is his triage ECG: What do you think? What is the most likely cause of the patient’s ECG findings, and what would be your first step in management? What does the ECG show? What does the ECG show? Figure-1: The initial ECG in this case — and a rapid method for estimating the QTc ( See text ). Is it STEMI?

EKG/ECG

EKG/ECG Seizures Hospitals Stroke

OMI in a pediatric patient? Teenagers do get acute coronary occlusion, so don't automatically dismiss the idea.

Dr. Smith's ECG Blog

DECEMBER 5, 2023

Written by Kirsten Morrissey, MD with edits by Bracey, Grauer, Meyers, and Smith An older teen was transferred from an outside hospital with elevated serum troponin and and ECG demonstrating ST elevations. Acute coronary syndrome in a pediatric patient? He denied drug or alcohol use. He did have a family history notable for early CAD.

Pediatrics

Pediatrics EKG/ECG Hospitals Burns

Acute dyspnea in an older woman, is it OMI?

Dr. Smith's ECG Blog

FEBRUARY 18, 2024

ECG is shown below. Many ECG readers will not comment any further on rhythm once ventricular pacing has been identified, but it is still critical to determine the atrial rhythm. Cardiology felt that there was baseline artifact and recommended immediate repeat ECG which is shown below. What do you think?

EKG/ECG

EKG/ECG Stroke

Seizure in a 30 something

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

The ECG below was recorded by EMS. ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. At first glance, the ECG does not look too abnormal. In my experience, the pathologic finding in the above ECG is the easiest one to overlook — especially if you are in a rush and do not do a systematic review.

Seizures

Seizures EKG/ECG EMS Stroke

Diagnostics: Intractable Hiccups

Taming the SRU

NOVEMBER 18, 2024

Other causes include gastritis, gastric malignancy, pancreatitis, hiatal hernia, SBO, large meal, spicy foods, and carbonated drinks Neurologic Stroke, space occupying lesion, epilepsy, CNS infection, demyelinating and neurodegenerative disorders such as multiple sclerosis and Parkinson’s disease are causes of intractable hiccups.

Stroke

Stroke Administration Dehydration COPD

A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?

Dr. Smith's ECG Blog

DECEMBER 24, 2023

Here is her triage ECG: What do you think? And so was an appropriate anti-coagulant, since atrial flutter, like fibrillation, can result in thromboembolism and stroke. For clarity and ease of comparison, I've put together in Figure-1 — the 3 serial ECGs in today's case. Atrial flutter with 2:1 conduction.

EKG/ECG

EKG/ECG Stroke Administration Wellness

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

Dr. Smith's ECG Blog

JANUARY 9, 2024

The ECG below was recorded. The ECG was interpreted as showing atrial flutter with 2:1 conduction. Answer : The ECG above shows a regular wide complex tachycardia. Said differently, the ECG shows a rather slow ventricular tachycardia with a 2:1 VA conduction. How do you interpret the below ECG?

EKG/ECG

EKG/ECG Stroke Hospitals Documentation/Coding

A Pathognomonic ECG. What is it?

Dr. Smith's ECG Blog

MARCH 19, 2019

This patient presented with weakness, decreased urine output, and vomiting: What is the ECG diagnosis? Here was a repeat ECG: QTc 523. The value of recognizing this particular ECG pattern — is that it may expedite your clinical diagnosis even before laboratory results return. This is pathognomonic for hypocalcemia.

EKG/ECG

EKG/ECG Seizures Stroke Operations

Status epilepticus. What is this ECG pathognomonic of?

Dr. Smith's ECG Blog

NOVEMBER 18, 2019

Here is the ECG: The computer reads a long QT at 449 ms, and a Hodges QTc of 506 ms. From EMCrit: Taking control of severe hyponatremia with DDAVP An ECG recorded 2 days later with a K of 4.1: Figure-1: Both ECGs that were done in this case ( See text ). This patient presented with status epilepticus. What do you think?

EKG/ECG

EKG/ECG Seizures Stroke Wellness

What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

Dr. Smith's ECG Blog

MARCH 15, 2023

Here is her EKG: What is unusual about this? Here is the ECG after ibutilide: What do you notice? Here is the post-cardioversion ECG: Sinus rhythm, still with the longer QT interval. For more on SSS — See My Comment at the bottom of the page in the July 5, 2018 post in Dr. Smith’s ECG Blog. She was on no medications.

EKG/ECG

EKG/ECG Dehydration Stroke Wellness

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

She has no previous cardiac history of which she is aware 911 was called and here is her Prehospital ECG: What do you think? link] Case continued She arrived in the ED and here is the first ED ECG. In comparison with the first ECG, I would guess that the artery is reperfusing. Stroke-volume:50 ml. Normal wall thickness.

EKG/ECG

EKG/ECG Ultrasounds Wellness Stroke

SGEM#267: Afib of the Night – Chemical vs. Electrical First Cardioversion

The Skeptics' Guide to EM

SEPTEMBER 21, 2019

Date: September 18th, 2019 Reference: Scheuermeyer et al. AEM Sept 2019 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and clinical lecturer in Calgary. Date: September 18th, 2019 Reference: Scheuermeyer et al. His ECG shows atrial fibrillation with a rapid ventricular response.

Emergency Department

Emergency Department Stroke Academics Shock

A man in his late 30s with acute chest pain and ST elevation

Dr. Smith's ECG Blog

MAY 16, 2023

Here is his triage ECG: What do you think? No prior ECG was available. Pretest probability is crucial in ECG diagnosis of OMI or ECG diagnosis of OMI mimic. As Ken says below, tachycardia is not common in OMI and distorts the ST segment, so managing the tachycardia and repeating the ECG is a good strategy.

EKG/ECG

EKG/ECG Stroke Documentation/Coding Outcomes

What is the infarct artery????? And have you ever seen a troponin this high?

Dr. Smith's ECG Blog

JANUARY 16, 2020

An elderly woman with h/o stroke and aphasia seemed different to her daughter, and was pointing all over her body as if in pain. At 20 minutes, just before cath, another ECG was recorded: More (worsening) STE Her initial troponin I returned at 0.341 ng/mL (URL = 0.030 ng/mL) (not per L, not high sensitivity) Lactate was 3.7

EKG/ECG

EKG/ECG Stroke Wellness

What will you do for this patient transferred to you who is now asymptomatic?

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.

EKG/ECG

EKG/ECG Outcomes Hospitals Wellness

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

OCTOBER 7, 2019

When the paramedics arrived, they obtained a 12 lead ECG and confirmed the unstable vital signs. EKG is pictured below: What do you think? Although the shock is no doubt partly a result of poor pump function, with low stroke volume, especially of the RV, it should be compensated for by tachycardia. Why is the patient in shock?

Seizures

Seizures EKG/ECG Shock EMS

Atrial fibrillation? Multifocal Atrial Tachycardia? Don't look at computer read until AFTER you interpret!

Dr. Smith's ECG Blog

JANUARY 5, 2020

Here is the ECG: What do you think? IJC Heart and Vasculature 25(2019). A study of 2298 ECGs from 1085 patients which had a computerized interpretation of AF found that in 442 (19%) of these ECGs, from 382 patients (35%), the interpretation was incorrect, and that, in 92 of these 382 patients, the physician had failed to correct it.

EKG/ECG

EKG/ECG COPD Wellness Sepsis

EM@3AM: Hyperthermia

EMDocs

DECEMBER 16, 2023

A 12-lead EKG shows sinus tachycardia but is otherwise normal. Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C. Temps greater than 41.5C

Hyperthermia / Hypothermia

Hyperthermia / Hypothermia EMS Stroke Seizures

Episode 19 - Cannabinoids: Emerging Evidence in Use and Abuse

EB Medicine

AUGUST 1, 2018

First up is the link between cannabis use and stroke or TIA. times higher risk of stroke or TIA. Jeff: For any patient arriving with suspected cannabis or synthetic abuse, consider checking an EKG. An RCT is underway in Canada on the use of ondansetron versus haloperidol with an estimated completion of July 2019.

Seizures

Seizures Hyperthermia / Hypothermia Administration Dehydration

Emergency Care Today

EM@3AM: Brainstem Strokes

EM@3AM: Cerebellar Stroke

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An elderly male with acute altered mental status and huge ST Elevation

How important are old ECGs in Non-obvious cases of potential OMI?

SGEM#269: Pre-Hospital Nitroglycerin for Acute Stroke Patients?

A man in his 60s with syncope and ST depression. What does the ECG mean?

OMI in a pediatric patient? Teenagers do get acute coronary occlusion, so don't automatically dismiss the idea.

Acute dyspnea in an older woman, is it OMI?

Seizure in a 30 something

Diagnostics: Intractable Hiccups

A young woman with palpitations. What med is she on? With what medication is she non-compliant? What management?

A fascinating electrophysiology case. What is this wide complex tachycardia, and how best to manage it?

A Pathognomonic ECG. What is it?

Status epilepticus. What is this ECG pathognomonic of?

What is strange about this paroxysmal atrial fibrillation in an otherwise healthy patient? And what happened after giving ibutilide?

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

SGEM#267: Afib of the Night – Chemical vs. Electrical First Cardioversion

A man in his late 30s with acute chest pain and ST elevation

What is the infarct artery????? And have you ever seen a troponin this high?

What will you do for this patient transferred to you who is now asymptomatic?

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Atrial fibrillation? Multifocal Atrial Tachycardia? Don't look at computer read until AFTER you interpret!

EM@3AM: Hyperthermia

Episode 19 - Cannabinoids: Emerging Evidence in Use and Abuse

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