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 ).

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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). It is one of the few OMI patterns that is really well described: de Winter’s T-waves. Abstract 556.

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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. doi: 10.1111/j.1542-474X.2006.00127.x.

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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.

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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.

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ALiEM

APRIL 10, 2023

Additional Images Physical Exam General: Well appearing, no distress. Skin: Large, serpiginous rash on the left forehead and scalp with central clearing and peripheral erythema as well as areas of erythematous plaques. Any baby with findings concerning for neonatal lupus should have an EKG performed. Updated 2021 Jun 30].

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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!

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Dr. Smith's ECG Blog

AUGUST 2, 2024

His ECG is shown below. The LCx and OM branches are not as well seen. How does RCA occlusion fit with the ECG? The answer is that the ECG really shows right ventricular OMI. Written by Willy Frick A 50 year old man with no medical history presented with acute onset substernal chest pain.

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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.

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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.

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Northwestern EM Blog

MARCH 1, 2025

In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Remove ECG leads and patches. Reattach EKG leads to back. The PROSEVA study is the most recent and famous randomized control trial. Leave most of the sheet hanging.

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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.

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Dr. Smith's ECG Blog

APRIL 29, 2020

Her husband stated that she had not been feeling well in the past 2 weeks and c/o dizziness as well as diarrhea. 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? What do you think?

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Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

It radiated to both shoulders and both upper extremities, and there was shortness of breath and diaphoresis as well. Triage ECG (no prior for comparison): Computer algorithm read: "Sinus rhythm, low voltage QRS, inferior myocardial infarction, probably old." Every note says "no ischemic changes on ECG." Day 2: No ECGs recorded.

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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?” Well, the computer thought so! Despite the computer interpretation, the ED physician was concerned about the ECG, and planned for serial troponins.

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Sensible Medicine

AUGUST 21, 2023

On yesterday’s podcast , I talked with Bobby Yeh, an academic cardiologist who made a compelling case for enhancing credibility of observational research. Next week I am going to show you what a well-done medical study looks like. Please do listen. Bobby is one of the smartest people in cardiology today. It is our goal.

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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

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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.

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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. Nevertheless, this suggests that the OMI involves the posterior wall as well.

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Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift.

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Dr. Smith's ECG Blog

NOVEMBER 26, 2018

Here is his initial ECG: What do you think? When the team saw this ECG, we obviously noticed the large STE in the inferior leads, with STD in V1-V5, I, and aVL, and STE in V6. Back to the interpretation of the ECG: Does the rhythm matter to you in this case? What will you do for this patient? How many problems does he have?

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Dr. Smith's ECG Blog

DECEMBER 16, 2018

This case is contributed by Brooks Walsh , an EM physician and ECG expert from Connecticut. The initial ECG: The rhythm is regular at 150, and the QRS is markedly wide. Flecainide is well-known to precipitate VT. The case An older woman presented to the ED with dyspnea, diaphoresis, and chest pressure. Note of Caution!

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Dr. Smith's ECG Blog

JANUARY 5, 2020

Here is the ECG: What do you think? A study of 2298 ECGs from 1085 patients which had a computerized interpretation of AF found that in 442 (19%) of these ECGs, from 382 patients (35%), the interpretation was incorrect, and that, in 92 of these 382 patients, the physician had failed to correct it. Among, 2447 ECGs, Mant et al.

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Dr. Smith's ECG Blog

JUNE 23, 2023

Here is the ED ECG: What do you think? The amiodarone was discontinued and the patient did well. == MY Comment , by K EN G RAUER, MD ( 6/23 /2023 ): == From an academic standpoint — I love WCT ( W ide- C omplex T achycardia ) rhythms. For clarity in Figure-1 — I've reproduced and labeled the 2 ECGs in today's case.

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Mind The Bleep

JULY 8, 2023

Therefore, I’m sharing the things that worked well and were time-effective, and those that didn’t. Many questions were repeated, and on some, the resources were not included (“look at this ECG” but no ECG was visible). Other resources Flashcards worked very well for me, but aren’t everyone’s cup of tea. Survivorship bias.

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EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). ” Academic Emergency Medicine 20.1 Notable Physical Exam: General: Tripoding, severe respiratory distress. 2013): 71-78.

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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.

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EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Jeff: And while it’s not exactly core EM, we’re going to briefly discuss indications for bariatric surgery, as this is something we don’t often review even in academic training programs. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in.

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The Skeptics' Guide to EM

FEBRUARY 9, 2019

He is also the CME editor for Academic Emergency Medicine. He is also the CME editor for Academic Emergency Medicine. His heart rate is 130-140 beats per minute, irregular, and his EKG shows atrial fibrillation with rapid ventricular response (RVR). AEM February 2019. Date: February 7th, 2019 Reference: Bouida et al.

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Dr. Smith's ECG Blog

APRIL 8, 2015

True Syncope: If, on the other hand, the patient is well, had no other serious symptoms , has a normal sinus rhythm, and normal physical exam , then you need to be certain the syncope was not due to a dangerous brady- or tachydysrhythmia that could recur. Abnormal ECG – looks for cardiac syncope. Vasovagal syncope is generally benign.

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Dr. Smith's ECG Blog

NOVEMBER 14, 2024

This ECG is so obvious to me that it is hard to imagine that there are doctors who do not recognized it. He saw the ECG and ordered an ED ECG." The initial ECG shows definite ST-T wave abnormalities in 11/12 leads — with marked hyperacute T waves in lead III ( within the 1st RED rectangle in Figure-1 ). But it is true.

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Dr. Smith's ECG Blog

MARCH 14, 2025

At the time of this initial ED ECG, his symptoms were improving ECG #1 on admission to the ED The patient was not seen quickly in the ED as it was a busy shift and the ECG did not meet STEMI criteria. The below ECG was recorded. Does this repeat ECG shed any light on what is going on? ECG #2 repeat in the ED.

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Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

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EMDocs

FEBRUARY 3, 2025

This mortality is multifactorial and thought to be related to more active disease as well as an association with biochemical abnormalities such as hyperglycemia, hypocalcemia, uremia, and elevated liver enzymes (19).Intestinal Protein-losing enteropathy in systemic lupus erythematosus: 12 years experience from a Chinese academic center.

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