Dr. Smith's ECG Blog

APRIL 25, 2023

No pericardial effusion on ultrasound." ECG diffuse ST elevation, but lacking pericarditis features, and very concerning for acute injury." It peaked at 21,000 ng/L Post angiogram ECG: The fact that there is near normalization suggests that this may have been a thrombus with complete lysis. What do you think?

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EMDocs

APRIL 22, 2024

Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. Multiorgan POCUS The diagnostic power of POCUS often resides in combining multiple ultrasound exams. During a short period of ROSC an ECG was performed. EKG RV strain.

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Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 81

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. I don't know if her pain was getting better or not.

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EKG/ECG Ultrasounds Wellness Stroke 105

Dr. Smith's ECG Blog

JANUARY 10, 2020

He had this ECG at time 0 What do you think? There was an old ECG for comparison: Very normal Interpretation: There is serious widespread ST elevation that could easily by due to a wraparound LAD with anterior and inferior MI. Another ECG was recorded at 1.5 ng/mL Another ECG was recorded at 3.5 Learning Points: 1.

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EKG/ECG Ultrasounds Emergency Department Wellness 52

Dr. Smith's ECG Blog

MARCH 15, 2023

Here is her EKG: What is unusual about this? Her bedside cardiac ultrasound was normal We decided to cardiovert her since the time of onset was very recent. Here is the ECG after ibutilide: What do you notice? Here is the post-cardioversion ECG: Sinus rhythm, still with the longer QT interval. She was on no medications.

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EKG/ECG Dehydration Stroke Wellness 52

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. Am J Med 2019, 132(5):622-630.

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EKG/ECG Shock Sepsis Emergency Department 52

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. 2019 Mar 19;10:215. Epub 2019 Dec 9. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. Brainstem stroke: anatomy, clinical and radiological findings. doi: 10.1053/j.sult.2013.01.004. 2013.01.004. PMID: 23522778.]

Stroke 88

Stroke EMS EKG/ECG Radiology 88

EMDocs

OCTOBER 8, 2024

Glucose POC ECG: Is this actually sinus tachycardia? Looking at the initial or even repeating the ECG will be helpful here. Poor waveforms more often indicate decreased perfusion than hypoxia. Respiratory Rate Temperature Do we have a recent and accurate temperate? A core temperature may be indicated. Do they have edema?

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Shock Emergency Department Pediatrics EKG/ECG 94

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He had the following EKG recorded: Low voltage, suggests effusion. A bedside cardiac ultrasound was normal, with no effusion. He was started on Extracorporeal Life Support ("VA ECMO") Here is the ECG on ECMO: Very low voltage On Day 3, the EF recovered (that seems quick!) He was moderately hypoxic. Guo T, Fan Y, Chen M, et al.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

EMDocs

APRIL 10, 2024

1-3,5,7,9] All patients developing symptoms of LAST should be placed on a continuous cardiac monitor and have an ECG performed. [2] 3] If performing a nerve block with ultrasound guidance, always know where the tip of your needle is. [5] McGraw Hill Companies, Inc; 2019. per 10,000 cases of peripheral nerve blocks. [3]

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Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 92

Dr. Smith's ECG Blog

JUNE 2, 2023

She denied chest pain and denied feeling any palpitations, even during her triage ECG: What do you think? My bedside ultrasound was of insufficient quality, but showed somewhat reduced overall EF, distended IVC without respiratory variation, no pericardial effusion, and diffuse bilateral B lines. == What do you think of her ECG?

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EKG/ECG Wellness Ultrasounds EMS 83

Dr. Smith's ECG Blog

MAY 13, 2020

Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS. The ECG only tells you there is ischemia, not the etiology of it. This was a point of care ultrasound, not a bubble contrast echo.

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EKG/ECG EMS Shock Ultrasounds 52

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Here is his triage ECG: What do you think? mm has been described in normal subjects) Overall impression: In my opinion and experience, this ECG most likely represents a normal baseline ECG, but with a small chance of pericarditis instead. A repeat ECG was performed and cardiology was re-consulted: Roughly unchanged.

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EKG/ECG Operations Ultrasounds Wellness 52

Dr. Smith's ECG Blog

OCTOBER 24, 2019

The ECGs An initial ECG was obtained as the pain was rapidly resolving: Minimal upsloping ST Elevation in III, with a steeply biphasic T wave, and with reciprocal ST depression in leads I and aVL. Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis.

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EKG/ECG Wellness Shock Ultrasounds 52

Dr. Smith's ECG Blog

APRIL 24, 2020

Here was his ED ECG, which was identical to the prehospital ECG. ST vector In this ECG, the ST vector is both posterior (away from V3 and V4), upward, away from aVF, and rightward (away from I, II, V5, V6 and towards aVR. This is unfortunate in my view, as it complicates the retrospective analysis of the ECG!!

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EKG/ECG Shock Ultrasounds 52

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? They did not have an ultrasound on the ambulance (some local crews are starting to utilize POC limited US in our service areas). A right sided ECG was not recorded.

Seizures 52

Seizures EKG/ECG Shock EMS 52

Dr. Smith's ECG Blog

APRIL 3, 2019

Nevertheless, there is a lot to learn from the ECGs. I was shown this ECG without any information: QTc = 431 ms What was my response? The 4-variable formula can be used: [link] Also see free apps: iPhone: "SubtleSTEMI" Android: "ECG SMITH" www.mdcalc.com: [link] Here, the QTc = 431 STE60V3 = 1.5 RAV4 = 4 QRSV2 = 13.5.

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EKG/ECG Ultrasounds Outcomes 52

ACEP Now

MAY 10, 2024

His vital signs are normal and the ECG does not demonstrate a myocardial infarction. While waiting for laboratory investigations, including troponin and d-dimer, you wonder if a quick point-of-care ultrasound (POCUS) examination looking for three sonographic findings could help determine the likelihood of this being an AoD.

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Ultrasounds Outcomes Academics Documentation/Coding 52

EB Medicine

JULY 8, 2019

I’m Jeff Nusbaum and I’m back with Nachi Gupta for the 30 th episode of EMplify and the first Post-Ponte Vedra Episode of 2019. Consider performing a RUSH exam (that is rapid ultrasound for shock and hypotension) to identify the cause. Nachi: Check an EKG immediately after arrival for any patient that may be concerning for ACS.

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Emergency Department Sepsis Operations Dehydration 40

EMDocs

JANUARY 20, 2024

ECG shows ST-segment elevation in V3-V6 only with depression in aVR. Bedside ultrasound shows hypokinesis of the basal portion of the left ventricle with an apparent sigmoid-shaped septum and a dilated inferior vena cava. Initial vital signs include BP of 157/80, HR of 96, RR 14, SpO2 of 97% on RA, T 37.5. The oral mucosa is moist.

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EMS Fluid Resuscitation Shock EKG/ECG 74

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. Abdominal ultrasound: Complete a bedside abdominal aortic ultrasound if the patient has risk factors, or a FAST exam if a ruptured ectopic pregnancy is suspected. Silverio, Luz.

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Ultrasounds EKG/ECG Radiology Radiology 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

As part of the workup, she underwent an ECG. Thus, Brugada is the likely diagnosis _ A very nice explanation of this is given in the document quoted below on current ECG criteria for Brugada pattern. We repeated the ECG: Brugada pattern is mostly resolved. Is this Type 2 Brugada syndrome/ECG pattern?

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EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 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. A bedside POC cardiac ultrasound was done: Findings: Decreased left ventricular systolic function. An ECG was recorded: This shows a regular narrow complex tachycardia at a rate of about 160. BP:143/99, Pulse 109, Temp 37.2 °C

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EKG/ECG Ultrasounds Hospitals 52

ACEP Now

JUNE 14, 2024

In 2019, the global prevalence of COPD was estimated to be 10.3 Ultrasound evaluates for global heart function, right heart strain, pulmonary edema, and lung sliding. ECG evaluates for dysrhythmias, acute coronary syndrome, or signs of right heart strain. Complete blood count evaluates for leukocytosis or anemia. 2012;16(5):323.

COPD 52

COPD Hospitals Emergency Department Outcomes 52

EB Medicine

AUGUST 1, 2018

It was peer-reviewed by Joseph Habboushe, assistant professor at NYU and Nadia Maria Shaukat, director of the emergency and critical care ultrasound at Coney Island Hospital in Brooklyn, New York. Jeff: For any patient arriving with suspected cannabis or synthetic abuse, consider checking an EKG.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40