EMDocs

OCTOBER 14, 2024

When you are presented with a tachycardic ECG, we want you to focus on two major factors right away. This ECG comes from a 75-year-old female presenting with palpitations. Take a look at her ECG: Figure 3: ECG from a 75-year-old female with palpitations. Take a look at this ECG. Take a look at this ECG.

EKG/ECG 90

EKG/ECG EMS Resuscitation Emergency Department 90

Dr. Smith's ECG Blog

JULY 9, 2024

His family started CPR and called EMS, who arrived to find him in ventricular fibrillation. 15 minutes after EMS arrival, after at least 6 defibrillations, the patient achieved sustained ROSC. Here is his ECG after stabilization of vitals (at least 30 minutes since sustained ROSC). What do you think?

EKG/ECG 119

EKG/ECG Resuscitation Shock CPR 119

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" Serial ECGs remained unchanged. Both were awake and alert with normal vital signs.

EKG/ECG 128

EKG/ECG EMS Outcomes Wellness 128

EMDocs

DECEMBER 11, 2023

The most common diagnostic test to identify patients who might require percutaneous intervention is the electrocardiogram (ECG). Emergency physicians have recognized for some time that there are many occlusions of the coronary arteries that do not present with classic STEMI criteria on the ECG.

EKG/ECG 118

EKG/ECG Emergency Department Academics Operations 118

Dr. Smith's ECG Blog

JUNE 23, 2024

His daughter immediately started CPR and another family member called EMS. When EMS arrived the patient was in ventricular fibrillation. Here is his presenting ECG: ECG 1, t = 0 What do you think? His transfer packet included notes, labs, cath report, and ECG reports, but no actual ECG images.

EKG/ECG 121

EKG/ECG CPR EMS Hospitals 121

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 his first prehospital ECG: 1st Prehospital ECG What do you think?

EKG/ECG 119

EKG/ECG EMS Stroke Outcomes 119

EMDocs

FEBRUARY 6, 2025

This week, we feature a post from Dr. Tannenbaum’s ECG Teaching Cases , a free ECG resource. Without further ado, let’s look at some ECGs! Take a look at this ECG. Before we get too far, I promise, this is an ECG from a human, not my toddler drawing squiggles on ECG paper: Yikes. Not good right?

EKG/ECG 73

EKG/ECG EMS Wellness 73

Dr. Smith's ECG Blog

AUGUST 6, 2024

Written by Magnus Nossen with Edits by Grauer and Smith The ECGs in today’s case are from 3 different patients all presenting with new-onset CP ( Chest Pain ). All ECGs were recorded by EMS, and transferred to a PCI capable center for evaluation. For 2 of the 3 patients — the cath lab was activated based on the ECG.

EKG/ECG 106

EKG/ECG Wellness Hospitals EMS 106

EMDocs

JUNE 3, 2023

We’ll keep it short, while you keep that EM brain sharp. ECG and laboratory analysis (glucose, CBC, electrolytes, renal/liver function, troponin, PT/PTT) also recommended. Updated 2022 May 8]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Updated 2022 Jul 25]. Updated 2022 Jul 4]. Epub 2017 Dec 12.

Stroke 86

Stroke EMS Pediatrics EKG/ECG 86

Dr. Smith's ECG Blog

MAY 23, 2023

EMS arrived and recorded this ECG: What do you think? See same ECG below with computer automated interpretation, using the Glasgow ECG algorithm which apparently is used by many different providers and devices Amazing that the computer calls this normal. Next day ECG. And yet it still says "normal".

EKG/ECG 98

EKG/ECG Wellness Emergency Department EMS 98

RebelEM

SEPTEMBER 21, 2023

ECG shows a regular, narrow-complex, tachycardia at 190 bpm consistent with SVT. Up to 80% of patients will have at least one troponin sent ( Gabrielli 2022 ). The available literature shows that SVT is not associated with ACO, Type I MI or serious outcomes either in the short term or after prolonged follow up ( Gabrielli 2022 ).

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. 2022 Jul;27(4):e12939. Epub 2022 Feb 11. No ischemic ST changes. Ann Noninvasive Electrocardiol.

EKG/ECG 134

EKG/ECG Documentation/Coding Psychiatric EMS 134

Dr. Smith's ECG Blog

OCTOBER 10, 2024

EMS arrived and recorded vital signs within normal limits and the following ECG during active pain: EMS1 @ 0157: What do you think? During EMS transport, the pain suddenly resolved. For review on how I apply the Mirror Test I devised — See My Comment in the September 21, 2022 post in Dr.

EKG/ECG 110

EKG/ECG EMS 110

EMergucate

DECEMBER 13, 2022

ECG of the week 7th December 2022 – Interpretation: There is a regular narrow complex tachycardia (QRS < 120ms, rate … Continue reading →

EKG/ECG 52

EKG/ECG EMS 52

Dr. Smith's ECG Blog

JANUARY 8, 2024

I was reviewing ECGs for a study, and came across this one, and was able to get all the clinical information: What do you think? I do not have the EKG, but it was described as "non-diagnostic" (that probably means that the physician did not know how to diagnose it). Medics recorded the above ECG and called a STEMI alert.

EKG/ECG 74

EKG/ECG Resuscitation Hospitals EMS 74

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

When EMS found her, she was dyspneic and diaphoretic. Her ECG is shown below: What do you think? The conventional machine algorithm interpreted this ECG as STEMI. Alternatively, with STE in V1 and III, and STD in I and aVL, this ECG could represent proximal RCA OMI with right ventricular involvement.

EKG/ECG 131

EKG/ECG Ultrasounds Shock EMS 131

Emergency Medicine Journal

SEPTEMBER 25, 2024

Background Emergency Medical Services (EMS) studies have shown that prehospital risk stratification and triage decisions in patients with suspected non-ST-elevation acute coronary syndrome (NSTE-ACS) can be improved using clinical risk scores with point-of-care (POC) troponin. The primary end point was the hospital diagnosis of NSTE-ACS.

EMS 97

EMS EKG/ECG Operations Hospitals 97

Pediatric EM Morsels

MARCH 17, 2023

Ahmed 2008, Meyers 2022) Of course, treat any other systemic symptoms (like respiratory failure, hypotension) as you typically would. If you are managing a snake bite from a snake that does not typically reside in the U.S., please utilize other resources and local Toxicology experts for help with management protocols.

CDC 130

CDC Poisoning Pediatrics Shock 130

Dr. Smith's ECG Blog

JUNE 27, 2024

EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. This is her first ECG in the ED: What do you see? This ECG shows both a right bundle branch block and a posterior fascicular block. QRS complexes have similar RBBB morphology to the prior ECG.

EKG/ECG 123

EKG/ECG Documentation/Coding Emergency Department Wellness 123

Dr. Smith's ECG Blog

DECEMBER 12, 2022

Written by Pendell Meyers I was reading ECGs in a database (without any clinical information) when I came to this one: What do you think? Seeing only this ECG with no context, I thought this ECG was within normal limits. So, if I had to interpret this ECG with no other context, I would say I see no clear evidence of OMI.

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

JANUARY 4, 2022

The ECG below is from a 79 year old woman presenting with chest pain and shortness of breath. Questions: … Continue reading →

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

JUNE 26, 2022

Below is her ECG: A 24 year old Indigenous female P2 G3 31/40 pregnant presents to ED with left sided non pleuritic chest pain and shortness of breath.

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

NOVEMBER 15, 2022

The following ECG was obtained from an independent 78 year old woman at 11pm who complained of left sided shooting jaw ache that had commenced earlier that morning. She is adamant she has no chest …

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

DECEMBER 20, 2022

This ECG was obtained from a 22 year old man who had taken a polypharmacy overdose 24 hours ago. He had suffered a bradycardic / asystolic arrest and is currently in the intensive care unit.

EKG/ECG 52

EKG/ECG EMS 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The below ECG was recorded. The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. This ECG does not have the typical ST-vector of an LAD occlusion. This is lucky!

EKG/ECG 134

EKG/ECG Shock Hospitals Sepsis 134

EMergucate

MARCH 30, 2022

Describe and Interpret the ECG … Continue reading → 45 year old female with no prior history, presents with chest pain post Pfizer vaccine.

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

APRIL 27, 2022

Below is his ECG: Describe and Interpret the … Continue reading → A 53 year old male presents to ED complaining of chest pain.

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

JULY 13, 2022

An ECG is done and is presented to … Continue reading → A 53 year old male presents to ED complaining of chest pain.

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

JULY 20, 2022

Below is the patients ECG Describe and Interpret … Continue reading → A 83 year old male presents to ED after a syncopal episode.

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

JUNE 8, 2022

A 50 year old male presents to ED at 06h45 with chest pain radiating to his left arm which woke him up at 02h00 Below is the patients ECG

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

MARCH 16, 2022

The below ECG is from a 69 year old male who presented to ED with general malaise and fatigue. The patient is has a background of metastatic colon cancer and depression.

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

APRIL 20, 2022

The following ECG is from a 52 year old male with a history of bipolar mood disorder and cardiomyopathy. He presents to ED complaining of increasing shortness of breath and leg swelling. The patie…

EKG/ECG 52

EKG/ECG EMS 52

EMDocs

SEPTEMBER 26, 2024

EKG, labs, and a CXR are interpreted by the EP as normal. An attorney is consulted and a lawsuit filed against the hospital, the first ED physician, the EM group, and the PCP. Too much weight was given to the EKG, CXR, and labs. 3 : September 2022. Pay attention when a patient is being seen for exertional chest pain.

Radiology 87

Radiology Radiology EKG/ECG Documentation/Coding 87

Dr. Smith's ECG Blog

JULY 16, 2022

An EKG was reco rded and interpreted as normal by the computer, the clinician, and by the overreading cardiologist. He had an ECG recorded in triage (I am not certain whether the patient had active pain at this time; I believe he did not ): time 6 hours after EKG in clinic What do you think? There is zero ST Elevation.

EKG/ECG 52

EKG/ECG EMS 52

EMDocs

SEPTEMBER 19, 2023

Episode 86: Tricky Cases Part 2 Case 3: 56-year-old female with history of seizures, actively seizing, EMS called. Patient seized for approximately 20 minutes prior to EMS arrival. “The application of STEMI ECG criteria on a standard 12-lead ECG alone will miss a significant miry of patients who have acute coronary occlusion.”

Seizures 83

Seizures Documentation/Coding EKG/ECG Emergency Department 83

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The baseline ECG is basically normal with no ischemia. Here is what the Queen of Hearts says about the Baseline ECG: Active chest pain triage ECG also read as not OMI: She says "not OMI", but she does not have access to the baseline ECG. In the future, we will be able to have her compare with previous and serial ECGs.

EKG/ECG 86

EKG/ECG Shock Documentation/Coding Academics 86

Dr. Smith's ECG Blog

JUNE 28, 2023

EMS was dispatched for a 30-something male who feels his heart is racing. He arrived in the ED and had an immediate bedside cardiac ultrasound while this ECG was being recorded. Here is the ECG: What do you think? Here is the post cardioversion ECG: What do you think? Sudden onset. Is it definitely VT??

EKG/ECG 98

EKG/ECG Ultrasounds Administration EMS 98