Dr. Smith's ECG Blog

AUGUST 2, 2024

His ECG is shown below. How does RCA occlusion fit with the ECG? The answer is that the ECG really shows right ventricular OMI. We've highlighted a considerable number of acute RV MI cases in Dr. Smith's ECG Blog ( See the October 7, 2019 and May 10, 2024 posts , to name just two ). There is non-obstructive disease here.

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EKG/ECG Fluid Resuscitation Academics Resuscitation 122

Dr. Smith's ECG Blog

OCTOBER 23, 2023

An Initial ECG was performed: Initial ECG: Sinus tachycardia with prolonged QT interval (QTc of 534 ms by Bazett). A repeat ECG was performed 2 hours after arrival: QTc prolongation ato 722 ms now with alternating T wave pattern (T wave alternans) I texted this to Smith who responded: “T wave alternans and long QT.

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EKG/ECG Documentation/Coding Psychiatric EMS 134

Don't Forget the Bubbles

JUNE 30, 2023

Elsa was found face down in the family pool 20 minutes after last visual contact and was picked up without resuscitation. She was intubated at the scene and transported to your ED, with cardiopulmonary resuscitation (CPR) performed en route. You request a 12 lead ECG and repeat a blood gas, asking for it to be run on the PICU analyser.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

ACEP Now

JULY 7, 2023

17,18 Given this, the advent of extracorporeal membrane oxygenation (ECMO) presents an opportunity to bridge care between traditional resuscitation of refractory VF patients in the ED and more definitive management in the catheterization lab. Resuscitation. Resuscitation. Resuscitation. Resuscitation. N Engl J Med.

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Resuscitation Shock Stroke Hospitals 98

The Skeptics' Guide to EM

FEBRUARY 11, 2024

She is received in the resuscitation room. The ECG shows sinus tachycardia with non-specific ST-T changes. Four studies with methodologic limitations were included in an SRMA of the ADD-RS and published in AEM 2020. [27] She complains of retrosternal chest pain radiating to her jaw. The chest x-ray is unremarkable.

Emergency Department 126

Emergency Department Resuscitation Hospitals Research 126

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

Below is the presentation ECG. The above ECG shows sinus rhythm. While on telemetry monitoring he suffered cardiac arrest and was resuscitated. What ECG finding may have contributed to (or precipitated) the cardiac arrest? After resuscitation and defibrillation , there were no more episodes of TdP.

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EKG/ECG Resuscitation Academics Operations 70

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Date: September 16th, 2020 Guest Skeptics: Dr. Robert Goulden and Dr. Audrey Marcotte are Chief Residents from the Royal College of Emergency Medicine Program at McGill University. Audrey’s academic interests include trauma and resuscitation. Audrey’s academic interests include trauma and resuscitation. Reference: Roberts et al.

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Academics Resuscitation EMS Stroke 52

EMDocs

MAY 15, 2024

ECG: Evaluate for ischemia, right heart strain. Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Published 2020 Feb 12. Overestimates arterial oxygen saturation. times maintenance.

Blood Transfusions 90

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 90

EMDocs

MAY 28, 2024

ECG: Evaluate for ischemia, right heart strain. Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. American Society of Hematology 2020 guidelines for sickle cell disease: transfusion support. Published 2020 Feb 12. Overestimates arterial oxygen saturation. times maintenance.

Blood Transfusions 88

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 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. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? 2020 Nov 21;41(44):4258]. A core temperature may be indicated. Ann Emerg Med. Eur Heart J.

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Shock Emergency Department Pediatrics EKG/ECG 103

RebelEM

MARCH 13, 2023

What They Did: Two researchers performed a systematic review and meta-analysis following the PRISMA and CHARMS guidelines They collected articles using Embase, Medline ALL via Ovid, Web of Science Core Collection, and Google Scholar published between 1995-2020. Discussion: Dead On Scene: The 96.2% mortality rate and 43.5% 1.21; p=0.006).

Basic Life Support 52

Basic Life Support EMS Outcomes Resuscitation 52

Dr. Smith's ECG Blog

MAY 19, 2020

A followup ECG was recorded 2 days later: No definite evidence of infarction. As per Dr. Smith — “ S hark F in” m orphology was noted on the initial monitoring strip, and initial 12-lead ECG. Smith’s ECG Blog ( For review — See the June 11, 2018 post and the January 24, 2020 post , to name just 2 instances ).

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CPR EKG/ECG Shock Ultrasounds 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

A 12 lead ECG was obtained by EMS and is shown below: What do you think? The ECG is diagnostic of LAD occlusion (or even left main occlusion possibly), with the classic pattern of RBBB and LAFB with huge concordant STE in V1-V2, I, and aVL, with reciprocal depression in most other leads (and/or a component of subendocardial ischemia pattern).

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EKG/ECG Shock EMS Documentation/Coding 52

Emergency Medicine Cases

APRIL 21, 2020

Anand Swaminathan on recognition and ED management of adrenal crisis, Maria Ivankovic on indications for antibiotics in strep throat from EM Cases Course 2020, Jesse McLaren on recognition of posterior MI from ECG Cases, Justin Yan & Hans Rosenberg on just the facts of approach to DKA, Brit Long on ovarian torsion imaging myths, Walter Himmel on (..)

EMS 52

EMS EKG/ECG Head Injuries Resuscitation 52

EMDocs

NOVEMBER 1, 2023

ECG – May show tachycardia or rate related ST depressions Laboratory evaluation: CBC w/ differential – may reveal leukocytosis with left shift CMP, Lipase – can reveal alternative intra-abdominal diagnoses as well as show findings of end-organ hypoperfusion (elevated serum creatinine, transaminitis, etc.) McGraw-Hill Education; 2020.

Operations 78

Operations Radiology Radiology Fluid Resuscitation 78

Dr. Smith's ECG Blog

JANUARY 21, 2023

In the resuscitation room, the patient had another seizure that stopped after IV Lorazepam. ECG met STEMI criteria and was labeled STEMI by computer interpretation. What is your ECG interpretation, and would you activate the cath lab? Could anything else produce this ECG pattern and clinical presentation?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

RebelEM

MARCH 30, 2023

However, there are no clear guidelines for management in post-cardiac arrest patients without ST-segment elevations on ECG. Clinical Question : In patients who suffer an OHCA without ST-segment elevation on the post-resuscitation ECG, will early coronary angiogram (CAG) vs. delayed CAG improve outcomes?

Hospitals 57

Hospitals Outcomes EKG/ECG Resuscitation 57

EMDocs

JULY 19, 2023

8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated. 2020 Aug 15;417:213343. Epub 2020 May 7. Mercury, in all forms, reacts with sulfhydryl groups in intracellular sites ultimately interfering with multiple enzymatic processes. Sulfhydryl groups as targets of mercury toxicity.

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Poisoning Fluid Resuscitation Administration Seizures 77

EMDocs

JANUARY 17, 2024

She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). Her electrocardiogram (ECG) showed atrial fibrillation which was cardioverted to sinus rhythm.

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Poisoning Seizures Pediatrics EMS 74

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. Retrieved 22 April 2020. The Case: A 4-year-old boy born with no past medical history presents in cardiac arrest.

Seizures 52

Seizures Administration Resuscitation Poisoning 52

Ken Grauer, MD

SEPTEMBER 21, 2024

The ECG in Figure-1 was obtained from a previously healthy man in his early 20s — who initially presented with GI symptoms, that then evolved into CP ( C hest P ain ). QUESTIONS: Given the above history — How would YOU interpret the initial ECG that is shown in Figure-1 ? Figure-1: The initial ECG in today's case. (

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EKG/ECG Resuscitation Outcomes Hospitals 297

Mind The Bleep

OCTOBER 29, 2024

Circulation Assess heart rate, blood pressure, peripheral and central CRT, pulses and 3 lead ECG. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% This includes adequate pain control, fluid resuscitation, and stabilization of any systemic complications. Acute Crit Care. 2019 Nov;34(4):276-281.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Ken Grauer, MD

AUGUST 8, 2024

I was sent the ECG shown in Figure-1 — told only that that this middle-aged woman noted chest tightness and nausea an hour earlier. QUESTIONS: How would YOU interpret the ECG in Figure-1 ? — IF told that this patient arrested shortly after ECG #1 — Does this change your interpretation? Intervals ( PR-QRS-QTc ) are normal.

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EKG/ECG Resuscitation Wellness 316

Dr. Smith's ECG Blog

OCTOBER 26, 2020

12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC. Here is his first ECG recorded after stable ROSC: Originally recorded in 50 mm/s (the standard in Norway), here converted to 25 mm/s. I suspect LAD or LM.

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EKG/ECG Hyperthermia / Hypothermia Wellness CPR 40

Ken Grauer, MD

APRIL 26, 2024

The ECG in Figure-1 — was obtained on the scene by EMS ( E mergency M edical S ervices ). He was hemodynamically stable — but clearly distressed with a sense of “impending doom” at the time ECG #1 was recorded. QUESTIONS: How would YOU interpret the initial ECG in Figure-1 ? Extra Credit: How many beats are seen on this ECG?

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EKG/ECG Resuscitation EMS Wellness 388

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? The beat-to-beat variation in the QRS complexes (electrical alternans) is a classic ECG finding of a large pericardial effusion or pericardial tamponade. For clarity in Figure-1 — I've reproduced her initial ECG.

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EKG/ECG Ultrasounds Documentation/Coding COPD 40

Dr. Smith's ECG Blog

JUNE 27, 2024

Here was his initial ED ECG: Formal interpretation by interventional cardiologist: There is "Non-diagnostic" ST Elevation in V2-V4 and aVL. These studies did not address OMI ECG findings!!! So if the patient is awake and has ECG OMI findings , there is no reason to believe that angiography should be withheld. 5% vs. 58%!!

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Resuscitation EKG/ECG Outcomes Hospitals 116

Dr. Smith's ECG Blog

JULY 14, 2023

A 40-something with persistent Ventricular Fibrillation presented after attempted prehospital resuscitation A 40-something with no previous cardiac history presented to the ED in persistent Ventricular Fibrillation after attempted prehospital resuscitation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

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Resuscitation EKG/ECG CPR Outcomes 98

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Our first 12 lead ECG was then recorded at 0926. Another ECG was recorded 5 minutes later just before arrival at the hospital: Similar The patient was transported to a nearby suburban hospital with PCI capabilities while my partner cared for her. She was defibrillated and resuscitated. What do you think? V1 has 0.5

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EKG/ECG Emergency Department Ultrasounds Hospitals 52

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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EKG/ECG Fluid Resuscitation EMS Shock 52

EMDocs

JANUARY 4, 2024

In 2020, bupropion was the 18 th most-prescribed medication in the USA. 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. Place on cardiac monitoring and get frequent EKGs.

Seizures 77

Seizures EKG/ECG Poisoning Shock 77

Dr. Smith's ECG Blog

JANUARY 19, 2020

Her family called EMS and EMS recorded hypotension and this ECG: What do you think? It is impossible to determine from this ECG if there is also a right ventricular MI, but there is a suggestion of RVMI: the STD in V2 is very deep and yet minimal in V1. This is an obvious inferoposterior OMI. There is reciprocal STD in I and aVL.

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EKG/ECG EMS Resuscitation Wellness 52

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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EKG/ECG Resuscitation Shock Outcomes 52

EMDocs

APRIL 22, 2024

During this resuscitation two different ultrasound machines were used to capture images due to a malfunction with the first machine after initial images were captured. During a short period of ROSC an ECG was performed. The findings of RV strain on the ECG also supported the POCUS echo findings in this case. EKG RV strain.

Ultrasounds 93

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 93

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 88

Psychiatric Seizures Emergency Department Pediatrics 88

EMDocs

SEPTEMBER 25, 2023

Resuscitation 2013; 84(11): 1500 – 4. Epub 2020 Dec 9. 2020 Jul;158(1):45-47. Epub 2020 Jul 2. ” Journal of the Medical Association of Thailand 103 (2020). Notable Physical Exam: General: Tripoding, severe respiratory distress. References: Heffner AC et al. PMID: 23911630 Kim WY et al. J Emerg Med.

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Emergency Department Soft Tissue Injuries Airway Management Operations 76

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He had the following EKG recorded: Low voltage, suggests 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!) This is the ECG on V-V ECMO: Very little STE He had a lot of troponins measured. He was moderately hypoxic.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52