Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

The ECG below was recorded by EMS. ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. At first glance, the ECG does not look too abnormal. In my experience, the pathologic finding in the above ECG is the easiest one to overlook — especially if you are in a rush and do not do a systematic review.

Seizures 113

Seizures EKG/ECG EMS Stroke 113

Dr. Smith's ECG Blog

DECEMBER 24, 2023

Here is her triage ECG: What do you think? And so was an appropriate anti-coagulant, since atrial flutter, like fibrillation, can result in thromboembolism and stroke. For clarity and ease of comparison, I've put together in Figure-1 — the 3 serial ECGs in today's case. Atrial flutter with 2:1 conduction.

EKG/ECG 127

EKG/ECG Stroke Administration Wellness 127

EMDocs

SEPTEMBER 19, 2023

Also think about NCSE in patients with prior cerebral pathology (ie, ischemic stroke); a patient who was seizing, was treated, and is not coming out of their post ictal state; and in patients with unexplained altered mental status with no other cause. 2022 Nov 15;80(20):1925-1960. J Am Coll Cardiol.

Seizures 98

Seizures Documentation/Coding EKG/ECG Emergency Department 98

ALiEM

MARCH 22, 2024

Laboratory Data CBC , CMP , EKG , and Troponins were normal. The two main causes of internuclear ophthalmoplegia are demyelination of the medial longitudinal fasciculus (MLF) from multiple sclerosis (MS) and ischemic cranial nerve damage from stroke. 2022 Oct 24;18(2):329-334. 2022 Nov 7;18(1):152-158. doi: 10.13004/kjnt.2022.18.e64.

Stroke 67

Stroke Urgent Care Head Injuries Emergency Department 67

ACEP Now

JULY 7, 2023

Post-resuscitation ECGs demonstrating ST segment elevation are significant in delineating which patients might benefit most from advanced reperfusion techniques. Heart disease and stroke statistics-2022 update: A report from the American Heart Association. Published December 19, 2022. References Tsao CW, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

NOVEMBER 19, 2022

Written by Bobby Nicholson MD, with edits by Meyers A woman in her 50s with past medical history of heart failure, prior stroke, atrial fibrillation on Eliquis, lung cancer in remission, and CKD, presented to the emergency department for evaluation of cough and shortness of breath. EKG was obtained in triage and read as ventricular bigeminy.

EKG/ECG 52

EKG/ECG Stroke Emergency Department Wellness 52

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. Stroke-volume:50 ml. Normal wall thickness.

EKG/ECG 109

EKG/ECG Ultrasounds Wellness Stroke 109

EMDocs

MAY 15, 2024

ECG: Evaluate for ischemia, right heart strain. 2022 Aug;58:235-244. Epub 2022 Jun 11. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS) Underestimates alveolar hypoxemia. Overestimates arterial oxygen saturation. Am J Emerg Med.

Blood Transfusions 103

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 103

EMDocs

SEPTEMBER 24, 2024

Maternal mortality rate is 5-14%; condition associated with ischemic and hemorrhagic stroke, coma, heart failure, venous thrombosis, renal failure or liver damage, disseminated intravascular coagulation, and fetal demise. Obtain ECG for dysrhythmia. 2022 Aug;58:223-228. Up to 25% of mothers develop long term problems.

Seizures 105

Seizures Stroke EKG/ECG 105

EMDocs

MAY 28, 2024

ECG: Evaluate for ischemia, right heart strain. 2022 Aug;58:235-244. Epub 2022 Jun 11. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS). Underestimates alveolar hypoxemia. Overestimates arterial oxygen saturation. Am J Emerg Med.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

Dr. Smith's ECG Blog

MARCH 15, 2023

Here is her EKG: What is unusual about this? Here is the ECG after ibutilide: What do you notice? Here is the post-cardioversion ECG: Sinus rhythm, still with the longer QT interval. For more on SSS — See My Comment at the bottom of the page in the July 5, 2018 post in Dr. Smith’s ECG Blog. 25, 2022 ).

EKG/ECG 52

EKG/ECG Dehydration Stroke Shock 52

Mind The Bleep

JUNE 18, 2023

It is important to complete an ECG prior to initiating pharmacological therapy as drugs, such as antipsychotics can prolong the QT interval, increasing the risk of arrhythmias. – One stroke is prevented for every 37 patients with dementia who avoid 2-3 months of antipsychotic symptoms for their BPSD.

Psychiatric 52

Psychiatric Documentation/Coding Stroke Fractures 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. Vaishnav Hyperthermia: abnormally high body temperature due to thermoregulatory failure Severe hyperthermia: temp greater than 40.5C

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

ACEP Now

APRIL 5, 2024

1 However, many clinical features are common: more than 60 percent of patients present with a degree of neurological involvement, ranging from confusion to stroke and coma. 1 25 percent of patients may present with evidence of myocardial ischemia, including abnormal ECGs and elevated troponin levels. Am J Obstet Gynecol.

Domestic Violence 40

Domestic Violence Emergency Department Outcomes EKG/ECG 40

ACEP Now

JULY 6, 2023

Now, for selected patients, emergency physicians can leverage low and non-rising high sensitivity troponin values and a low HEART score (composed of history, ECG, age, risk factors, and troponin level) to implement outpatient follow-up plans safely, within a few hours. Updated September 21, 2022. February 22, 2022.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

EMDocs

DECEMBER 16, 2023

A 12-lead EKG shows sinus tachycardia but is otherwise normal. Both can result in heat exhaustion and heat stroke and have many overlapping symptoms. Patients with heat stroke have hot, dry skin and altered mental status (e.g., C, and heat stroke occurs at a core temperature > 40°C. Temps greater than 41.5C

Hyperthermia / Hypothermia 94

Hyperthermia / Hypothermia EMS Stroke Seizures 94

EMDocs

OCTOBER 27, 2023

On the monitors and subsequent ECG, you note he is in atrial fibrillation with rapid ventricular response. Further review reveals the patient was unable to afford his refill of Eliquis and abruptly stopped taking it, leading to his acute stroke. 2022 [cited 2022 Sep 22];Available from: [link] Cubanski J, Neuman T, Freed M, Damico A.

Research 96

Research Stroke EMS EKG/ECG 96

The Skeptics' Guide to EM

APRIL 9, 2022

Date: April 7th, 2022 Reference: Wong et al. AEM April 2022 Guest Skeptic: Dr. Chris Bond is an emergency medicine physician and assistant Professor at the University of Calgary. Date: April 7th, 2022 Reference: Wong et al. The workup can include laboratory testing, EEGs, ECGs, echocardiogram and advanced neuroimaging.

Head Injuries 52

Head Injuries Emergency Department Seizures Stroke 52

Dr. Smith's ECG Blog

DECEMBER 5, 2023

Written by Kirsten Morrissey, MD with edits by Bracey, Grauer, Meyers, and Smith An older teen was transferred from an outside hospital with elevated serum troponin and and ECG demonstrating ST elevations. Acute coronary syndrome in a pediatric patient? He denied drug or alcohol use. He did have a family history notable for early CAD.

Pediatrics 121

Pediatrics EKG/ECG Hospitals Burns 121

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. 2022 May;33(2):307-333. Up to two-thirds of rib fractures are missed on initial chest radiographs. ORL J Otorhinolaryngol Relat Spec. 1996 Nov-Dec;58(6):306-10. PMID: 8958538.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

EMDocs

FEBRUARY 3, 2025

These complications affect both the central and peripheral nervous systems and encompass a wide range of conditions, including transient ischemic attacks (TIA), stroke, headaches, mood disorders, seizures, psychosis, neuropathy, and cognitive dysfunction (1,6,7). Published 2022 Feb 1. Li H, Zheng Y, Chen L, Lin S. 2022;12(1):1687.

Stroke 70

Stroke EMS Seizures Outcomes 70