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.

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EKG/ECG Resuscitation Hospitals EMS 75

Dr. Smith's ECG Blog

MARCH 4, 2024

I have often written about how an ECG interpreted as "normal" by a conventional algorithm may well be manifesting OMI, or even long QT or hyperkalemia. Shifa Karim and Gabe Keller helped with a project to assess all these ECGs with the Queen of Hearts. He did re-occlude and arrest but was resuscitated. 2 cases at once!

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EKG/ECG Documentation/Coding Wellness Resuscitation 106

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

A 50 yo was resuscitated from ventricular fibrillation. He had a prehospital ECG recorded after ROSC: What do you think? On arrival to the ED, this ECG was recorded: What do you think? But without seeing that first prehospital ECG, I would call this: "Posterior OMI until proven otherwise."

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EKG/ECG Wellness Academics Resuscitation 89

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 116

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. Heart disease and stroke statistics-2022 update: A report from the American Heart Association.

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Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Initial ROSC was obtained, during which this ECG was obtained: What do you think? I sent it to 2 of my ECG nerd colleagues with no clinical information whatsoever, who instantly said: "Looks like afib with subendocardial ischemia and right heart strain pattern." "I CPR was initiated immediately. The rhythm is atrial fibrillation.

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EKG/ECG Resuscitation Ultrasounds CPR 52

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 105

Broome Docs

MARCH 28, 2024

2022 Feb;52:85-91. Myth 3: The ECG changes from hyperkalemia are predictable and reliable. Resuscitation. Dispelling myths and misconceptions about the treatment of acute hyperkalemia. Am J Emerg Med. doi: 10.1016/j.ajem.2021.11.030. 2021.11.030. PMID: 34890894 Myth 1: Kayexalate is safe and useful. 2023 Dec;193:109991.

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PPE Ultrasounds Resuscitation Administration 107

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

EMDocs

NOVEMBER 29, 2023

2022 Aug;48(8):1009-1023. Resuscitation. Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia. Intensive Care Med. Question: In adult patients admitted to the ICU with severe CAP, does methylprednisolone compared to placebo reduce 60-day all-cause? Prospective, multi center RCT.

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Resuscitation Outcomes EKG/ECG 80

Mind The Bleep

DECEMBER 19, 2023

ECG: to monitor T wave changes due to hypokalaemia. ECG features of Hypokalaemia: Increased P wave amplitude (peaked P waves) Prolonged PR interval Widespread ST depression T wave flattening or inversion Prominent U waves (most noticeable in the precordial leads) Figure 2 : ECG of a patient with serum K+ of 1.9

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Dehydration Fluid Resuscitation Shock Resuscitation 98

EMDocs

SEPTEMBER 19, 2023

Airway plan discussed with resuscitation team. Reference: emDOCs – NCSE Journal of Emergency Medicine – Review Case 4: 52-year-0ld male brought in by EMS with “code STEMI” ECG demonstrates ST depressions with rocket like T waves in V2-V4. 2022 Nov 15;80(20):1925-1960. J Am Coll Cardiol.

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Seizures Documentation/Coding EKG/ECG Emergency Department 72

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

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

The patient was put on Extracorporeal Life Support in the ED 3 hours after initial resuscitation, the core temp was 30° C and the patient was defibrillated with a single attempt. A 12-lead ECG was recorded: There is sinus rhythm with RBBB and right axis deviation. The Osborn waves on ECGs #1 and #2 are huge!

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Hyperthermia / Hypothermia CPR EKG/ECG Resuscitation 40

ACEP Now

OCTOBER 9, 2024

However, the persistence of tachycardia despite fluid resuscitation and dosing with lorazepam to help with his panic disorder raised concerns that warranted further investigation. Our workup started with an ultrasound and EKG. EKGs will have abnormalities in about 90 percent, but they are typically nonspecific findings.

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EKG/ECG Fluid Resuscitation Ultrasounds Outcomes 52

EMDocs

MAY 15, 2024

ECG: Evaluate for ischemia, right heart strain. Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. 2022 Aug;58:235-244. Epub 2022 Jun 11. Overestimates arterial oxygen saturation. Up to 3x less accurate in black patients. When the clinical picture does not match the SpO 2 , get an ABG.

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Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 78

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.

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Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 82

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

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? Treasure Island (FL): StatPearls Publishing; April 30, 2022. Sinus Tachycardia.

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Shock Emergency Department Pediatrics EKG/ECG 95

RebelEM

MARCH 13, 2023

2022 Aug;48(4):3357-3372. Epub 2022 Mar 25. 2022 May 5. The only statistically significant factor intra-arrest was the first ECG rhythm, which only had an odds ratio of 1.12, which is relatively low. However, we might expect on-scene advanced trauma resuscitation to prolong prehospital time sizably. 1.21; p=0.006).

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Basic Life Support EMS Outcomes Resuscitation 52

EMDocs

MAY 28, 2024

ECG: Evaluate for ischemia, right heart strain. Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. 2022 Aug;58:235-244. Epub 2022 Jun 11. Overestimates arterial oxygen saturation. Up to 3x less accurate in black patients. When the clinical picture does not match the SpO 2 , get an ABG.

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Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 76

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

Here is his triage ECG: PM Cardio version: With no other information at all, I sent this ECG to Dr. Smith, who replied: "I think it is real. In other words, this ECG shows sinus rhythm, normal QRS complex, and: --Inferior OMI: STE in III, hyperacute T waves in lead III, reciprocal STD and TWI in aVL. STD in V4-5 too."

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EKG/ECG Shock CPR Outcomes 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] 2] Labs that may be useful after the initial resuscitation and for the admitting physician may include a basic metabolic panel and an arterial or venous blood gas analysis. [2] McGraw Hill; 2022.

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Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 94

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. BP was 110 and oxygen saturation was normal.

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EKG/ECG Shock Sepsis Emergency Department 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? JAMA Cardiol.

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Hospitals Outcomes EKG/ECG Resuscitation 60

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. 2022 Mar 2;83(3):1-12. Epub 2022 Mar 4.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Northwestern EM Blog

MAY 2, 2022

More modest lactic acid elevations are less likely to be related to cyanide poisoning and should not prompt intervention, especially in an asymptomatic patient, unless the level is persistently elevated despite adequate resuscitation. 2022, May 2). Wessling, E. Toxic House Fire Gases. Expert Commentary by Seltzer, J].

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Burns Poisoning EKG/ECG Operations 52

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 67

ACEP Now

MARCH 14, 2024

1,4-5 Thus, an electrocardiogram (ECG) and cardiac monitoring should be performed for unstable, electrical injury patients. Treatment for burns should focus on fluid resuscitation as appropriate based on your institution’s burn protocol per Brooke, Parkland, Rule of 10s etc. 7 Thus, an ECG is recommended for all electrical injuries.

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Burns Fluid Resuscitation EKG/ECG EMS 52

EMDocs

JULY 19, 2023

8 As always, remember to correct electrolyte abnormalities and provide fluid resuscitation as indicated. 2022, February 25). link] Accessed 21 November 2022 The post ToxCard: Organic Mercury Poisoning appeared first on emDOCs.net - Emergency Medicine Education. Whole blood mercury concentrations should be measured.

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Poisoning Fluid Resuscitation Administration Seizures 66

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. There is a subset of patients who, despite aggressive conventional resuscitation, have an inadequate hemodynamic response and develop refractory shock. due to inadequate access.

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Anaphylaxis Shock Sepsis Resuscitation 52

Taming the SRU

APRIL 13, 2023

stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e. EtOH, amphetamines, or cocaine) Prescription drugs (i.e. cuffed ETT) preloaded and intubate through the stoma if PPV needed Infection (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 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? 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

ACEP Now

FEBRUARY 11, 2024

This patient’s syncope is most likely due to metabolic disruptions and fluid-status physiology; nevertheless, assessment of cardiogenic etiologies through an EKG, troponin, and cardiac risk factors should be considered as appropriate. Updated December 11, 2022. Bansal AB, Al Khalili Y. In: StatPearls [Internet]. Published January 2023.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 52

EMDocs

JANUARY 4, 2024

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. Her initial EKG showed sinus tachycardia with a QRS of 86 msec and QTc of 414 msec. Accessed 12/18/2022. 2022; 55:232.e3-232.e4

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Seizures EKG/ECG Poisoning Shock 66

EMDocs

JANUARY 20, 2024

ECG shows ST-segment elevation in V3-V6 only with depression in aVR. Initial vital signs include BP of 157/80, HR of 96, RR 14, SpO2 of 97% on RA, T 37.5. On exam, she is clutching her chest and is in acute distress due to pain with no other remarkable findings. Initial troponin is mildly elevated.

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EMS Fluid Resuscitation Shock EKG/ECG 74

ACEP Now

DECEMBER 10, 2023

You want to respect patient autonomy, but is it legal to let him die without any emergency resuscitation? The answer is no, you cannot allow this patient to die by withholding resuscitative efforts. 3 You order toxicology labs, an EKG, and a sitter to observe. 2022 Jun;34(3):473-474. CMP reveals hypokalemia. J Med Ethics.

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