Dr. Smith's ECG Blog

JUNE 13, 2024

Don't miss his analysis and assessment of the Queen of Hearts AI OMI ECG bot -- that assessment is at the very bottom of the post. Here is her ED EKG: What do you think? I would have very high suspicion for OMI on this ECG. Past medical history included Crohn’s disease, hyperlipidemia, hypothyroidism, and she smoked 1ppd.

EKG/ECG 93

EKG/ECG Documentation/Coding EMS Burns 93

Dr. Smith's ECG Blog

MARCH 14, 2024

Written by Jesse McLaren Three patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. It is well known that NOMI usually has a normal ECG or nonspecific ECG.

EKG/ECG 120

EKG/ECG Documentation/Coding Patient Safety Outcomes 120

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 119

EKG/ECG Emergency Department Academics Operations 119

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

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." See Discussion in the June 29, 2024 post of Dr. Smith' ECG Blog ).

EKG/ECG 111

EKG/ECG Wellness Academics Resuscitation 111

Dr. Smith's ECG Blog

MAY 31, 2023

I received the following text message with these 3 EKGs (providers text me ECGs all day every day; most are false positives; many are subtle true positives): "Hi Steve, here are 3 EKGs for you (my colleague's case). Academic Emergency Medicine 27(S1): S220; May 2020. A 67 yo f developed chest pain this morning."

EKG/ECG 96

EKG/ECG Outcomes Academics Wellness 96

ALiEM

NOVEMBER 6, 2023

Wolf-Parkison-White Syndrome (WPW) Case Question: What are the characteristic ECG findings of this condition and how is this condition managed? These particular EKG findings define a “Wolff-Parkinson-White Pattern.” WPW Syndrome consists of characteristic EKG findings as well as symptomatic arrhythmias. 2006 Oct;11(4):340-53.

EKG/ECG 78

EKG/ECG Academics Outcomes Wellness 78

Dr. Smith's ECG Blog

MAY 30, 2023

His prehospital ECG was diagnostic of inferior posterior OMI. Here is his ED ECG: There is bradycardia with a junctional escape. We recorded an ECG in which V1-V3 were put in the position of V4R-V6R, and V4-6 were placed in V7-9 to (academically) confirm posterior OMI. He appeared gray in color, with cool skin.

Shock 97

Shock EKG/ECG Academics Stroke 97

Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

Triage ECG: What do you think? It's a very "fun" ECG, with initial ectopic atrial tachycardia (negative P waves in inferior leads conducting 1:1 with the QRSs), followed by spontaneous resolution to sinus rhythm. In the available view of the sinus rhythm, we see normal variant STE which probably meets STEMI criteria in V4 and V5.

EKG/ECG 132

EKG/ECG Academics 132

Dr. Smith's ECG Blog

JULY 21, 2024

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. See below for Ken Grauer Comment on the initial ECG: == On arrival, another ECG was recorded: There appears to have been quite a bit of spontaneous reperfusion!

EKG/ECG 132

EKG/ECG Shock Hospitals Sepsis 132

Dr. Smith's ECG Blog

JUNE 12, 2017

Here was a comment on Facebook about this post: "I was hoping this post would let me off the hook for all those "normal ekg" reading and but no, they can't replace us yet." I am working with a company that writes deep neural network software for interpreting ECGs. An ECG is recorded and the computer reads it as "normal".

EKG/ECG 52

EKG/ECG Academics Hospitals 52

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Initial ED ECG: What do you think? Then we must consider clinical data other than the ECG, for a pretest probability : Of all wide complex tachydysrhythmias, the majority are VT. Pretest probability: Even before the ECG, a patient with a history of coronary stent has a 90% chance that his wide complex tachycardia is VT.

EKG/ECG 140

EKG/ECG Shock Academics Documentation/Coding 140

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.

EKG/ECG 121

EKG/ECG Fluid Resuscitation Academics Resuscitation 121

Sensible Medicine

JUNE 28, 2024

If I had it all to do again, there is no doubt that I would choose medicine in general and academic general internal medicine in particular, but occasionally we all have a bad week. She follows up at a “highly ranked” west coast academic medical center, near where she lives half the year. I love my job.

Stroke 105

Stroke Academics EKG/ECG Hospitals 105

Dr. Smith's ECG Blog

OCTOBER 18, 2023

A few days into her hospital stay she developed chest discomfort and the following ECG was recorded. Are these ECG changes related to the CNS infection perhaps? When I saw the ECG of this patient I saw that there was definitely something "off". I sent the top ECG to Dr Smith with no information and without the baseline ECG.

EKG/ECG 124

EKG/ECG Hospitals Academics Outcomes 124

Dr. Smith's ECG Blog

OCTOBER 6, 2023

This is one case where it made a difference: Right Ventricular MI seen on ECG helps Angiographer to find Culprit Lesion Nevertheless, it is sometimes a fun academic exercise to try to predict the infarct artery: An elderly patient had onset of chest pain one hour prior. Here is the prehospital ECG. He called 911.

EKG/ECG 67

EKG/ECG Academics Shock Outcomes 67

ALiEM

APRIL 10, 2023

In addition, an EKG is essential given that neonates can present with irreversible total atrioventricular heart block, which can present in utero or after birth. Any baby with findings concerning for neonatal lupus should have an EKG performed. Around 2% of infants present with heart block postnatally within the first month.

Pediatrics 98

Pediatrics EKG/ECG Academics Wellness 98

Sensible Medicine

FEBRUARY 12, 2024

Academic medicine sometimes gets it right. The AF episodes we see on an ECG were simply manifestations of atrial disease. They defined atrial cardiopathy using easy clinical criteria — the ECG appearance of p-waves in lead V1, an abnormally high biomarker called BNP, or a large left atrial diameter by echocardiogram.

Wellness 133

Wellness Stroke EKG/ECG Academics 133

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 84

EKG/ECG Shock Documentation/Coding Academics 84

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

He heads curriculum and conference for the academic year and is passionate about resident […] The post SGEM#344: We Will…We Will Cath You – But should We After An OHCA Without ST Elevations? The EKG shows sinus tachycardia with nonspecific changes and no ST segment elevations, Q waves, or hyperacute T waves.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Dr. Smith's ECG Blog

APRIL 29, 2020

I was texted this ECG in real time, but it turns out to actually be the 2nd one recorded in the ED. Just as interesting is EKG 1, 24 minutes before the first: What do you think here? Below, I post 4 more examples of ECGs that were recorded from patients who had Torsades. Smith showed a total of 10 ECGs in his comments above.

EKG/ECG 52

EKG/ECG CPR Wellness Academics 52

Dr. Smith's ECG Blog

APRIL 22, 2019

He asked: "Hey Steve, Wanted to get your thoughts on this EKG:" What do you think? The computer called it a normal ECG Algorithm unknown Aside : [There is some "sinus arrhythmia", which is indeed a normal finding. For clarity — I’ve reproduced the first 2 ECGs that were done in this case in Figure-1. A former resident sent this.

EKG/ECG 52

EKG/ECG Burns Academics 52

Dr. Smith's ECG Blog

DECEMBER 19, 2018

The pain had almost resolved by the time an ECG was obtained in the ED: Here is the computer diagnosis What do you think? But do you think the ECG is “normal?” Despite the computer interpretation, the ED physician was concerned about the ECG, and planned for serial troponins. Well, the computer thought so! It was not normal!

EKG/ECG 52

EKG/ECG Academics Hospitals EMS 52

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Triage ECG (no prior for comparison): Computer algorithm read: "Sinus rhythm, low voltage QRS, inferior myocardial infarction, probably old." I texted this ECG with no information to Dr. Smith, who immediately said: "If CP, then anterior OMI until proven otherwise." Every note says "no ischemic changes on ECG."

EKG/ECG 79

EKG/ECG Outcomes Academics Documentation/Coding 79

Sensible Medicine

JULY 5, 2023

” “… but you could have a stroke or heart failure if you don’t get to the right place, so let’s get an EKG to confirm.” I was ecstatic to tell her the good news, “You do not have a rheumatologic condition!”

EKG/ECG 97

EKG/ECG Stroke Academics 97

Northwestern EM Blog

MARCH 1, 2025

Remove ECG leads and patches. Reattach EKG leads to back. Academic Emergency Medicine. Place a new bed sheet on the side of the bed that the patient will face when in this lateral decubitus position. Leave most of the sheet hanging. Turn patient into lateral decubitus position. Suction as needed. Strayer, R.J., Levitan, R.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

Downeast Emergency Medicine

APRIL 5, 2021

This year we are very fortunate to have Dr. Amal Mattu, EKG Jedi, as teaching faculty for our 39th Maine Medical Center/Maine ACEP Winter Symposium. HR 137, BP 105/50, 36C, RR 26, 95% O2 saturation on room air As he is brought in by ambulance, the paramedic presents the prehospital ECG below… do you activate the cath lab?

EKG/ECG 40

EKG/ECG Shock Burns Academics 40

Dr. Smith's ECG Blog

APRIL 24, 2015

Here was his initial ED ECG: There is atrial fibrillation with a rapid ventricular response. Here is the post cardioversion ECG: ST depression, with ST elevation in aVR persists. and repeat the ECG, to see if the apparent ischemia persists. Academic Emergency Medicine 17(s1):S194; May 2010 The patient was cardioverted.

Resuscitation 52

Resuscitation EKG/ECG Academics Hospitals 52

ALiEM

FEBRUARY 28, 2024

We also must recognize the important contributions of media such as clinical photographs, radiology images, and ECGs. Photographs, ECGs, Radiology Images These fall into the category of “other multimedia” in the AMA Manual of Style, and here is my best attempt to interpret this to clinical media. Accessed February 20, 2024. 11th ed.

Radiology 52

Radiology Radiology Academics Fractures 52

The Skeptics' Guide to EM

JULY 2, 2022

He is also the CME editor for Academic Emergency Medicine. He is also the CME editor for Academic Emergency Medicine. His symptoms are moderately suspicious, he has a normal EKG, and a history of hypertension. Major adverse cardiac event rates in moderate-risk patients: Does prior coronary disease matter? AEM June 2022.

EKG/ECG 40

EKG/ECG Academics Emergency Department Hospitals 40

Dr. Smith's ECG Blog

AUGUST 26, 2009

He called 911 and paramedics recorded a prehospital 12 lead ECG which showed a clear inferior STEMI (not shown, tracing could not be found). On arrival, the following ECG was recorded. In this case the diagnosis was clear due to the prehospital ECG. But suppose there had been no prehospital ECG? There is 0.5

EKG/ECG 52

EKG/ECG Documentation/Coding Research Academics 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2024

Below is the presentation ECG. The above ECG shows sinus rhythm. What ECG finding may have contributed to (or precipitated) the cardiac arrest? Below is the patient’s 12 lead ECG following defibrillation. What does this ECG tell you? The ECG shows sinus rhythm. What do you think? There is a prolonged QTc.

EKG/ECG 69

EKG/ECG Resuscitation Academics Operations 69

The Skeptics' Guide to EM

APRIL 21, 2018

He is also the CME editor for Academic Emergency Medicine (AEM). He is also the CME editor for Academic Emergency Medicine (AEM). The EKG and laboratory tests are normal. Clinical Examination for Acute Aortic Dissection: A Systematic Review and Meta-analysis. Corey Heitz is an emergency physician in Roanoke, Virginia.

Emergency Department 52

Emergency Department Academics EKG/ECG Research 52

ALiEM

MARCH 22, 2024

Laboratory Data CBC , CMP , EKG , and Troponins were normal. Copyright Images and cases from the Society of Academic Emergency Medicine (SAEM) Clinical Images Exhibit at the 2023 SAEM Annual Meeting | Copyrighted by SAEM 2023 – all rights reserved. Br Ir Orthopt J. 2022 Nov 7;18(1):152-158. doi: 10.22599/bioj.280.

Stroke 67

Stroke Urgent Care Head Injuries Emergency Department 67

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Robert’s academic interests include research and evidence-based medicine. Audrey’s academic interests include trauma and resuscitation. Robert’s academic interests include research and evidence-based medicine. Audrey’s academic interests include trauma and resuscitation. Reference: Roberts et al.

Academics 52

Academics Resuscitation EMS Stroke 52

Dr. Smith's ECG Blog

MARCH 31, 2023

Here is the result: Next, it interprets the digital data: A perfect interpretation Unfortunately, this ECG was not interpreted as OMI and the patient did not get another ECG recorded until 2 hours later. I tell them that it is not the ECG that is nonspecific, but the interpreter who is nonspecific.

EKG/ECG 52

EKG/ECG Academics Wellness Documentation/Coding 52

Cook County EM Blog

APRIL 27, 2022

2019.09.007 What : Retrospective cohort study of all droperidol administrations between January 2012 and April 2018 at an academic and pediatric emergency department in the US with 77,000 annual visits. of patients had an ECG in the prior 6 months, 4% had a QTc >500 msec 26.4% Am J Emerg Med. 2020;38(7):1310-1314.

Administration 52

Administration EKG/ECG Emergency Department EMS 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

F Triage ECG: ECG Interpretation: Sinus rhythm with normal QRS. I do not think this ECG is by itself diagnostic of OMI (full thickness, subepicardial ischemia ), b ut comparison to a previous might reveal this ECG as diagnostic of OMI. Cardiology interpretation of the initial ECG: “ST depressions laterally.”

EKG/ECG 52

EKG/ECG Wellness Academics Ultrasounds 52