Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

A 50 year old presented to the emergency department of a remote rural community (where the nearest cath lab is a plane ride away) with one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation. What do you think, and how would you manage the patient?

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EKG/ECG Emergency Department Wellness 130

Dr. Smith's ECG Blog

JANUARY 27, 2024

Below is the triage ECG, with a computer interpretation (Marquette 12 SL) of “normal” which was confirmed by the over-reading cardiologist. Should this patient continue to stay in the waiting room, without interruption of the physician to interpret the ECG, because the computer interpretation is normal? What do you think?

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EKG/ECG Emergency Department Outcomes Documentation/Coding 117

Dr. Smith's ECG Blog

MARCH 10, 2025

Written by Jesse McLaren A 50 year old presented to triage with one hour of chest pain, and the following ECG labeled normal by the computer (GE Marquette SL) algorithm. see reference below) Whats the gold standard for ECG interpretation: is it cardiologist interpretation? What do you think? The latest is Langlois-Carbonneau et al.

EKG/ECG 89

EKG/ECG Outcomes Documentation/Coding Emergency Department 89

PEMBlog

MAY 15, 2023

The majority of these are cardiac and so today we will review what to look for in your screening ECG. History and physical examination are critical components to any emergency department evaluation but are especially helpful in syncope patients. Therefore, what are we looking for with our ECG? 6% of pediatric syncope.

Pediatrics 97

Pediatrics EKG/ECG Emergency Department Burns 97

ACEP Now

AUGUST 12, 2024

A 35-year-old male presented to the emergency department complaining of chest pain that started 1.5 The patient had an EKG performed within 10 minutes of arrival while in triage (see Figure 1). In the absence of significant ST elevations, the EKG was signed and the patient was placed back in the queue to await a bed.

EKG/ECG 52

EKG/ECG Emergency Department Hospitals 52

Dr. Smith's ECG Blog

SEPTEMBER 5, 2023

Here is the ECG: Computer interpretation: Normal ECG Interventionalist after doing PCI: SUBTLE STT CHANGES IN LIMB LEADS To me, this first ECG is diagnostic of inferior OMI. I sent this ECG to the Queen of Hearts (PMcardio OMI), and here is the verdict: YOU TOO CAN HAVE THE PM Cardio AI BOT!! He walked in to triage.

EKG/ECG 98

EKG/ECG Documentation/Coding Emergency Department 98

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The ECG below was recorded about 20 minutes after he regained consciousness. ECG #1 The above ECG shows sinus rhythm at about 60 bpm. Figure A It now becomes apparent that there is ST segment depression in almost every lead of the ECG (V1-V6, I, II, aVL and aVF). In the initial ECG (ECG# 1) aVR had ST elevation.

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EKG/ECG Shock Emergency Department Ambulance Services 128

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. This ECG was recorded in triage.

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EKG/ECG Resuscitation CPR Emergency Department 135

The Skeptics' Guide to EM

FEBRUARY 11, 2024

Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. EMJ Nov 2023. first appeared on The Skeptics Guide to Emergency Medicine. EMJ Nov 2023.

Emergency Department 132

Emergency Department Resuscitation Hospitals EKG/ECG 132

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergency department after an episode of syncope while standing in line at a grocery store. Here is his triage ECG: What do you think? What does the ECG show? What does the ECG show?

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EKG/ECG Seizures Hospitals Stroke 124

Dr. Smith's ECG Blog

JANUARY 1, 2024

AslangerE A 65-year-old gentleman presented to the emergency department after experiencing two recent ICD shocks in the preceding hours. An initial electrocardiogram (ECG) is provided below. A subsequent ECG was taken: There is persistent ST elevation, especially being concordant in inferolateral leads. What do you think?

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EKG/ECG Shock Emergency Department Administration 112

EMDocs

MAY 4, 2024

. #1: Emergent Cath Lab Activations with “Normal” Computer ECG Interpretations Spoon Feed A significant minority of code STEMI patients have an initial normal computer ECG interpretation. Consequently, emergency physicians must remain vigilant to identify signs of OMI regardless of the initial computer ECG interpretation.

Documentation/Coding 98

Documentation/Coding Stroke Emergency Department Pediatrics 98

EB Medicine

JULY 5, 2023

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2023 Emergency Medicine Practice article, Diagnosing and Treating Pericarditis and Myocarditis in the Emergency Department Epidemiology Nomenclature Etiology Differential diagnosis Prehospital care ED history and physical Diagnostics ECG Labs Imaging (X-ray, CT, US, MRI) Treatment (..)

Emergency Department 85

Emergency Department EKG/ECG 85

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". Learning Points: 1.

EKG/ECG 98

EKG/ECG Wellness Emergency Department EMS 98

EB Medicine

AUGUST 1, 2023

In this episode, Sam Ashoo, MD, and TR Eckler, MD, interview Al Sacchetti, MD, about the August 2023 Emergency Medicine Practice article, Evidence-Based Management of Pulmonary Embolism in the Emergency Department Etiology/pathophysiology Risk factors Differential diagnosis Prehospital care ED history and physical exam Diagnostic scoring systems (..)

Emergency Department 88

Emergency Department EKG/ECG 88

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

This ECG was recorded: What do you think? EKG showed sinus rhythm at 100 BPM with a normal axis and diffuse ST depressions. Another ECG was recorded: What do you think? Not knowing anything about the patient, I saw this ECG on our system just as I was leaving the dept. There is widespread ST depression.

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EKG/ECG Emergency Department Wellness Hospitals 119

Dr. Smith's ECG Blog

JANUARY 20, 2024

Written by Pendell Meyers A man in his late 30s with history of hypertension, tobacco use, and obesity presented to the Emergency Department for acute chest pain which started approximately 3 hours prior to arrival, in the setting of a very stressful situation. No repeat ECG was done at this time. Repeat ECG shows no changes."

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EKG/ECG Documentation/Coding Emergency Department Hospitals 121

JournalFeed

FEBRUARY 24, 2024

Monday Spoon Feed: This single-center prospective study found that in 2,275 ECGs with a computerized interpretation of “normal” and “otherwise normal,” there was a negative predictive value (NPV) of 100% for STEMI, with no final diagnoses of ACS or STEMI, and none required cardiac catheterization that visit. West J Emerg Med.

EKG/ECG 52

EKG/ECG Emergency Department 52

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. The following ECG was obtained.

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EKG/ECG Documentation/Coding Wellness Emergency Department 131

Taming the SRU

JANUARY 10, 2024

89% agree that violence in the emergency department has harmed patient care. Scrutinize but don’t overthink (interpret your EKGs with context) Know your splints Be comfortable with OMI EKGs Know your resources & know when to ask for help Be creative Current bills in progress: US H.R.2663 2663 & S.1176

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EKG/ECG Shock Fractures Emergency Department 93

EMDocs

SEPTEMBER 14, 2024

Source Use of Glucagon-Like Peptide-1-Agonists and Increased Risk of Procedural Sedation and Endotracheal Intubation in the Emergency Department. Ann Emerg Med. 2023-064364. 2024 Aug;84(2):226-227. DOI: 10.1016/j.annemergmed.2024.03.007. 2024.03.007. PMID: 39032988. #2: Pediatrics. 2024 Jul 1;154(1):e2023064364.

Emergency Department 96

Emergency Department Resuscitation Pediatrics EKG/ECG 96

EMDocs

SEPTEMBER 15, 2023

1: How to Spot Ischemia in RBBB Patients Spoon Feed In non-ischemic right bundle branch block (RBBB) ECGs, we expect discordant ST depression and T wave inversions in leads V1-V3. Ann Emerg Med. 2023 Aug;82(2):219-221. 2023 Jul 20:S1538-7836(23)00573-1. 2023 Aug;189:109834. Epub 2023 May 16. 2022.12.006. #2:

Pediatrics 85

Pediatrics Emergency Department Resuscitation EMS 85

Dr. Smith's ECG Blog

DECEMBER 13, 2024

Written by Magnus Nossen and Ken Grauer ( with Comment by Smith ) The ECG in Figure-1 was electronically transmitted by the ambulance service for evaluation. He was hemodynamically stable at the time ECG #1 was recorded. QUESTIONS: How would you interpret this ECG? Figure-1: The initial ECG in today's case. ( in duration.

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EKG/ECG Ambulance Services Emergency Department EMS 103

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. A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness.

EKG/ECG 64

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

EMDocs

MAY 11, 2024

Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. Updated 2023 Jun 24]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Updated November 9, 2023. Accessed November 19, 2023. Accessed December 15, 2023. Updated 2023 Aug 28].

Stroke 110

Stroke EMS EKG/ECG Radiology 110

Broome Docs

MARCH 28, 2024

Emerg Med J. doi: 10.1136/emermed-2023-213285. 2023 Sep 21:ciad571. Ann Emerg Med. 2023 Sep 19:S0196-0644(23)00671-6. Am J Emerg Med. Myth 3: The ECG changes from hyperkalemia are predictable and reliable. 2023 Dec;193:109991. 2024 Jan 22;41(2):96-102. Is our PPE evidence-based? 2023.08.018.

PPE 96

PPE Ultrasounds Resuscitation Emergency Department 96

PEMBlog

OCTOBER 18, 2024

Duchenne Muscular Dystrophy (DMD) is a complex and progressive disease requiring highly specialized care, especially in emergency situations. When patients with DMD present in the Emergency Department (ED), an understanding of the nuanced aspects of their care is essential for optimal management. Updated 2023 Jul 10].

Emergency Department 52

Emergency Department Fractures Best Practices Documentation/Coding 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. The ECG below was recorded. The ECG was interpreted as showing atrial flutter with 2:1 conduction. Answer : The ECG above shows a regular wide complex tachycardia. How do you interpret the below ECG? This is very prolonged.

EKG/ECG 119

EKG/ECG Stroke Hospitals Documentation/Coding 119

Critical Care Now

JULY 21, 2024

Published 2023 Nov 28. In the “Occlusive Myocardial Infarction (OMI) Manifesto,” Dr. Patients with OMI have higher mortality and worse left ventricular function than those with NOMI, making detection crucial but challenging in busy emergency departments. The Queen of Hearts AI model can detect subtle OMI changes on ECG.

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EKG/ECG Emergency Department EMS Wellness 75

Dr. Smith's ECG Blog

JUNE 18, 2013

I want all to know that, with the right mind preparation, and the use of the early repol/LAD occlusion formula, extremely subtle coronary occlusion can be detected prospectively, with no other information than the ECG. His ECG was repeated at this point: This shows a well developed anterior STEMI. Ann Emerg Med 1998;31(1):3-11.

EKG/ECG 52

EKG/ECG Outcomes Emergency Department Hospitals 52

Dr. Smith's ECG Blog

JANUARY 13, 2024

The next morning, the following ECG was obtained. Repeat ECG from the emergency department is shown. The ECG read also says "Please have pacer interrogated to check atrial sensing." The following day, he had clear ECG evidence of pacemaker malfunction that went unrecognized. What do you think?

EKG/ECG 110

EKG/ECG Hospitals Fractures Emergency Department 110

Dr. Smith's ECG Blog

MARCH 17, 2023

Submitted by anonymous, written by Pendell Meyers A woman in her 50s presented to the Emergency Department with chest pain and shortness of breath that woke her from sleep, with diaphoresis. Here is her triage ECG: PM Cardio Version (see original screenshot I received below) Original image. Her vitals were within normal limits.

EKG/ECG 52

EKG/ECG Emergency Department 52

Dr. Smith's ECG Blog

APRIL 17, 2023

Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve Smith Take a look at these two ECGs below from two patients in the ED, first without any clinical context. The remainder of his Emergency Department stay was uneventful. His triage at 0127 is the ECG above. His triage at 0127 is the ECG above.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Psychiatric 52

AENJ: Current Issue

MAY 8, 2024

However, typical NSVT presentation in the emergency department (ED) includes palpitations, near-syncope, dizziness, skipped beats, chest pain, and/or dyspnea (Katritsis et al., NSVT is often asymptomatic depending on its burden percentage.

Emergency Department 50

Emergency Department EKG/ECG 50

Dr. Smith's ECG Blog

DECEMBER 29, 2023

It was ongoing on arrival in the emergency department. Below is the old ECG (on top) and then new ECG (on bottom). The old ECG has proportional ST elevation and T waves. So this STE cannot be considered normal even though there was STE on the previous ECG. But the ECG still doesn’t meet STEMI criteria.

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EKG/ECG Documentation/Coding Emergency Department 70

ALiEM

MARCH 22, 2024

A 53-year-old woman with no significant past medical history presented to the emergency department with a 3-day history of double vision on leftward gaze. Laboratory Data CBC , CMP , EKG , and Troponins were normal. Lipid panel : Cholesterol 241 (H) CSF : No oligoclonal bands, Protein 197 (H), Albumin 57 (H), IgG 16.3 (H)

Stroke 67

Stroke Urgent Care Head Injuries Emergency Department 67

EMDocs

NOVEMBER 27, 2023

A 55-year-old male, with a previous medical history of hypertension, hyperlipidemia, and gout, presents to the emergency department for four days of fever and progressive rash. Obtain EKG if patient is presenting with chest pain. McGraw-Hill Education; 2023. Adverse Cutaneous Drug Reactions. DRESS syndrome: Part I.

EMS 96

EMS Sepsis Burns EKG/ECG 96