Taming the SRU

JANUARY 10, 2024

R4 Case Follow-up: SCAD WITH dr. Martella Spontaneous Coronary Artery Dissection (SCAD) is a diagnosis confirmed via imaging: Coronary Angiography, Optical Coherence Tomography, Intravascular Ultrasound Therefore, treatment in the ED is the same as atherosclerotic ACS: ASA, heparin gtt and possible statin.

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Dr. Smith's ECG Blog

OCTOBER 28, 2023

Here is his ECG. See this articles: Heart Failure with Preserved Ejection Fraction (NEJM review) One etiology of LVH on the ECG is Hypertrophic Cardiolmyopathy (HOCM), and sometimes ECGs in patients with HOCM are specific for HOCM. But this ECG is NOT specific for HOCM. Figure-1: The ECG in today's case.

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EKG/ECG Stroke Ultrasounds Wellness 57

Dr. Smith's ECG Blog

JANUARY 15, 2024

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. An ECG was obtained shortly after arrival: ECG 1 What do you think? The ECG has a lot of artifact, and the amplitude is very small, making interpretation challenging.

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EKG/ECG Wellness Point-of-Care Testing Shock 64

EMDocs

MAY 15, 2024

ECG: Evaluate for ischemia, right heart strain. Ultrasound Sensitivity 88-100%, specificity 68-94% Positive likelihood ratio of 14.6 (95% Markers for severe disease include hypoxemia, increasing respiratory rate or work of breathing, decreasing platelet count and/or Hb, and multilobar involvement on chest radiograph or lung ultrasound.

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Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 103

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

This is a case written by Dan Lee (One of our fantastic Hennepin Residents, class of 2020 ) edits by Smith A 60 something-year-old man with a history of ESRD, LVH and prior CABG presented after an episode of hypotension during his hemodialysis, run followed by a syncopal episode which caused his run to be terminated early.

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EKG/ECG Wellness Operations Ultrasounds 52

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 98

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 109

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Salim Rezaie, “Thrombolysis in Acute Ischemic Stroke: Now We Have No Positive RCTs”, REBEL EM blog, July 27, 2020. 2020 Feb;19(2):115-122. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. 2013.01.004.

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Stroke EMS EKG/ECG Radiology 110

Dr. Smith's ECG Blog

OCTOBER 23, 2022

The ECG told the story. EMS recorded these prehospital ECGs: Time 0: In V2-V4, there is ST elevation that does not meet STEMI "criteria," of 1.5 Time = 24 min S-wave depth is diminishing These prehospital ECGs were lost and not seen. This patient has a non-diagnostic ECG by most rules. She called 911. STE 60 V3 = 1.5

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EMDocs

MAY 28, 2024

ECG: Evaluate for ischemia, right heart strain. Ultrasound Sensitivity 88-100%, specificity 68-94% LR+ of 14.6 (95% Markers for severe disease include hypoxemia, increasing respiratory rate or work of breathing, decreasing platelet count and/or Hb, and multilobar involvement on chest radiograph or lung ultrasound.

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Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Our first 12 lead ECG was then recorded at 0926. What do you think?

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EKG/ECG Emergency Department Ultrasounds Hospitals 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Past medical history included RBBB without other cardiac history, but old ECG was not available. As for the ECG, it could represent OMI, but RBBB is also a clue that it may be PE. But with prehospital and ED ECGs being ‘STEMI negative’, the ECG was signed off and the patient waited to be seen.

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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.

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Shock EKG/ECG Outcomes Hospitals 52

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

ALiEM

FEBRUARY 28, 2024

We also must recognize the important contributions of media such as clinical photographs, radiology images, and ECGs. The American Medical Association (AMA) Manual of Style released its 11th edition in 2020. Trick of the trade: getting the last bit of ultrasound gel from the bottle. Oxford University Press, 2020.

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Radiology Radiology Academics Fractures 52

Dr. Smith's ECG Blog

MARCH 6, 2023

If you saw this ECG only knowing that it is an acute chest pain patient, what would be your interpretation? But you can make a diagnosis here, and Pendell and I do this all the time when reading ECGs from databases. The patient had this ECG recorded at 7 minutes after registration at triage as a walk-in (not by EMS): What do you think?

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Dr. Smith's ECG Blog

APRIL 12, 2023

Prehospital Conventional algorithm interpretation: ANTERIOR INFARCT, STEMI Transformed ECG by PM Cardio: PM Cardio AI Bot interpretation: OMI with High Confidence What do you think? On arrival, lung ultrasound confirmed pulmonary edema (B lines). The ECG findings are focal to the anterior and high lateral wall.

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EKG/ECG COPD Ultrasounds Outcomes 52

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. 2020 Nov 21;41(44):4258]. 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.

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Shock Emergency Department Pediatrics EKG/ECG 105

Dr. Smith's ECG Blog

MAY 19, 2020

A followup ECG was recorded 2 days later: No definite evidence of infarction. The ways to tell for certain include intravascular ultrasound (to look for extra-luminal plaque with rupture) or "optical coherence tomography," something I am entirely unfamiliar with. For clarity — I’ll again show the initial ECG done in the ED in Figure-1.

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CPR EKG/ECG Shock Ultrasounds 52

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 40

Dr. Smith's ECG Blog

FEBRUARY 12, 2023

I was reading EKGs on the system before a shift, and saw this one: What do you think? So I thought it probably is not posterior OMI and I just moved on and kept reading EKGs. So I thought it probably is not posterior OMI and I just moved on and kept reading EKGs. So we did a bedside cardiac ultrasound.

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Dr. Smith's ECG Blog

FEBRUARY 23, 2023

It is unclear whether he had active pain at the time of the first ECG: What do you think? 0.20 (above which, the ECG likely represents OMI). The team was concerned about possibly ischemic ST elevations on the ECG above, so they took it to Dr. Nossen for consultation. Vitals were within normal limits.

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EKG/ECG Ultrasounds Outcomes Hospitals 52

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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EKG/ECG Ultrasounds 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

F Triage ECG: ECG Interpretation: Sinus rhythm with normal QRS. I do not think this ECG is by itself diagnostic of OMI (full thickness, subepicardial ischemia ), b ut comparison to a previous might reveal this ECG as diagnostic of OMI. Cardiology interpretation of the initial ECG: “ST depressions laterally.”

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EKG/ECG Wellness Academics 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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Dr. Smith's ECG Blog

JANUARY 9, 2023

Meyers ECG Interpretation: Easily diagnostic of LAD occlusion. The ECG easily meets STEMI criteria in all leads V2-V6, as well. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chest pain. The ECG was interpreted as "benign early repolarization." Beware a negative Bedside ultrasound.

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EKG/ECG Wellness Ultrasounds Outcomes 52

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? A bedside cardiac ultrasound was performed with a parasternal long axis view demonstrated below: There is a large pericardial effusion with collapse of the right ventricle during systole. This patient is only pseudo-stable.

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Dr. Smith's ECG Blog

JULY 12, 2020

So I immediately left the room to get an ultrasound machine. While calling for some help and arranging to have her transported to our critical care zone, I got this quick ultrasound which confirmed my suspicion: This quick view was all I was able to obtain in the circumstances. Below you will see serial ECGs from that hospitalization.

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EKG/ECG Hospitals Ultrasounds Wellness 40

Dr. Smith's ECG Blog

FEBRUARY 6, 2020

They recorded a prehospital ECG and diagnosed STEMI and activated the cath lab prehospital. I always try to go and see these prehospital activations right when they arrive whether he will be my patient or not, in order to view the prehospital ECGs, because they are so often false positives. Scary looking, but all STE is due to LVH.

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EKG/ECG Wellness Ultrasounds 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 101

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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ACEP Now

JUNE 14, 2024

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. McGraw-Hill Education; 2020. An S3 on cardiac auscultation, jugular venous distension, or lower extremity edema suggests heart failure.

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COPD Hospitals Emergency Department Outcomes 52

EMDocs

NOVEMBER 4, 2024

Pain can be associated with a friction rub on cardiac auscultation, a pericardial effusion on a bedside echocardiogram, or diffuse ST elevations on an EKG. Evaluation by ultrasound of traumatic rib fractures missed by radiography. Epub 2020 Oct 31. Epub 2020 Oct 31. 2020 Apr/Jun;42(2):96-102. Epub 2020 May 1.

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Taming the SRU

JANUARY 22, 2025

2,3] In 2020, the CDC estimates that asthma exacerbations accounted for almost 1,000,000 ED visits and almost 100,000 inpatient hospitalizations. [4] 2020 Oct 17;396(10258):1204-1222. 2020 Nov 14;396(10262):1562. 2020 Sep;41(3):315-327. doi: 10.1016/S0140-6736(20)30925-9. Erratum in: Lancet. Am J Respir Crit Care Med.

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