Dr. Smith's ECG Blog

NOVEMBER 11, 2023

A 90-something year old woman presented with an acute mild stroke. She had a routine ECG as part of her workup: What do you think? Peak trop 62 ng/L (would be very low for acute OMI) Next AM ECG: Still with very ischemic looking T-waves. Always look at old ECGs, even if you think the diagnosis is obvious.

Stroke 70

Stroke EKG/ECG Wellness 70

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

FEBRUARY 18, 2024

ECG is shown below. Many ECG readers will not comment any further on rhythm once ventricular pacing has been identified, but it is still critical to determine the atrial rhythm. Cardiology felt that there was baseline artifact and recommended immediate repeat ECG which is shown below. What do you think?

EKG/ECG 109

EKG/ECG Stroke 109

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

Dr. Smith's ECG Blog

JANUARY 9, 2024

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. Said differently, the ECG shows a rather slow ventricular tachycardia with a 2:1 VA conduction. How do you interpret the below ECG?

EKG/ECG 119

EKG/ECG Stroke Hospitals Documentation/Coding 119

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. There were no oligoclonal bands. Br Ir Orthopt J. 2022 Nov 7;18(1):152-158.

Stroke 67

Stroke Urgent Care Head Injuries Emergency Department 67

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.

EKG/ECG 57

EKG/ECG Stroke Ultrasounds Wellness 57

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

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. Accessed June 16, 2023. References Tsao CW, et al. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

ACEP Now

DECEMBER 11, 2023

The Case FIGURE 1: Initial EKG were notable for a leukocytosis of 23.19 A repeat ECG completed shortly after epigastric pain was controlled showed dynamic STE in aVL, V1 and aVR with diffuse ST depressions (see Figure 2). During the initial work-up, her ECG revealed STE measuring approximately 1 mm in V1, V2.

EKG/ECG 52

EKG/ECG Hospitals Stroke Emergency Department 52

Dr. Smith's ECG Blog

MAY 5, 2023

= Case Presentation by K EN G RAUER, MD ( 5/5 /2023 ): — Edits by Drs. Dr. Smith was reading ECGs — and he sent myself and Dr. Meyers the tracing shown in Figure-1. Figure-1: The initial ECG in today's case. The CASE Continues: A little while later — a 2nd ECG was done. Figure-3: The repeat ECG in today's case.

EKG/ECG 52

EKG/ECG Stroke Operations 52

Taming the SRU

JUNE 3, 2024

Susan Wilcox Increasing regionalization due to: Growth of specialty centers Increasing development of healthcare systems Hub-and-spoke models Development of ECMO, trauma, transplant, and stroke centers The higher the acuity of the centers, the higher the acuity of the patient that needs to get there.

Shock 91

Shock Seizures Airway Management Stroke 91

Dr. Smith's ECG Blog

MAY 16, 2023

Here is his triage ECG: What do you think? No prior ECG was available. Pretest probability is crucial in ECG diagnosis of OMI or ECG diagnosis of OMI mimic. As Ken says below, tachycardia is not common in OMI and distorts the ST segment, so managing the tachycardia and repeating the ECG is a good strategy.

EKG/ECG 52

EKG/ECG Stroke Documentation/Coding Outcomes 52

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. She was on no medications.

EKG/ECG 52

EKG/ECG Dehydration Stroke Wellness 52

PEMBlog

SEPTEMBER 6, 2023

Life threatening non-psychiatric causes of acute psychosis include hypoglycemia, cerebral hypoxia, drug toxicity, CNS abnormalities (such as brain tumor, meningoencephalitis, injury, seizures, or stroke), metabolic conditions, electrolyte disturbances, hepatic failure, uremia, or thyrotoxicosis. Hosp Pediatr (2023) 13 (1): 66–71

Psychiatric 52

Psychiatric Pediatrics Emergency Department EKG/ECG 52

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. In 2023 we must move beyond that title. Accessed June 10, 2023.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 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. Updated April 7, 2023.

Domestic Violence 40

Domestic Violence Emergency Department Outcomes EKG/ECG 40

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. Exam shows an uncomfortable-appearing febrile gentleman with a mild cough.

Research 96

Research Stroke EMS EKG/ECG 96

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. 2023 Nov;82(5):615-623. Epub 2023 May 13. Up to two-thirds of rib fractures are missed on initial chest radiographs. Feb 2016;56(2):331-40. doi:10.1111/head.12767

Emergency Department 105

Emergency Department Fractures Burns EMS 105

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

She was brought to the ED in a deep coma with GCS of 3, with vital signs, and an ECG was recorded: What do you think? From the ECG alone, the diagnosis can only be suspected.) By ECG alone: it is suspicious for stress cardiomyopathy, or takotsubo, due to the diffuse ST Elevation: II, III, aVF AND I and aVL.

EKG/ECG 89

EKG/ECG Resuscitation EMS Seizures 89

Taming the SRU

NOVEMBER 18, 2024

Other causes include gastritis, gastric malignancy, pancreatitis, hiatal hernia, SBO, large meal, spicy foods, and carbonated drinks Neurologic Stroke, space occupying lesion, epilepsy, CNS infection, demyelinating and neurodegenerative disorders such as multiple sclerosis and Parkinson’s disease are causes of intractable hiccups.

Stroke 86

Stroke Administration COPD Dehydration 86

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). Type III Hypersensitivity Reaction.Published May 2023. doi:10.1001/jama.2024.2315.

Stroke 70

Stroke EMS Seizures Outcomes 70