Dr. Smith's ECG Blog

AUGUST 18, 2024

Here is his triage ECG with minimal symptoms: What do you think? The ECG shows pacemaker failure with inability to capture or sense, with either underlying atrial fibrillation or junctional escape rhythm. Today's CASE: For clarity in Figure-1 — I've reproduced today's ECG. That there is pacemaker malfunction is easy to diagnose.

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EKG/ECG Fractures Burns Wellness 111

Don't Forget the Bubbles

OCTOBER 7, 2024

Up to 5% of burns occur secondary to electrical injuries, and this rises to 27% in developing countries. Significant injuries can occur even in the absence of extensive burns or other signs of external injury. Children, especially toddlers, may insert objects into outlets, leading to shocks or burns.

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Burns Fluid Resuscitation Shock Resuscitation 80

ECG Guru

JULY 30, 2023

The Patient: This ECG is from a 63-year-old man who complained of epigastric pain for three hours. The pain was sudden in onset, burning in nature, and accompanied by nausea and palpitations. The ECG: The rhythm is normal sinus, a bit fast at 90 bpm. This is an ECG sign of GLOBAL ISCHEMIA.

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EKG/ECG Burns 52

ALiEM

FEBRUARY 20, 2024

What agent would most likely be responsible for these ECG findings? This EKG shows a wide complex (QRS 240 msec), irregular rhythm with left bundle branch block morphology at a rate slower than expected (90 bpm) for a ventricular arrhythmia such as ventricular tachycardia. Bruccoleri RE, Burns MM. Acute Card Care. J Med Toxicol.

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Shock EKG/ECG Poisoning Burns 73

Dr. Smith's ECG Blog

FEBRUARY 14, 2009

Interestingly, they found that this was not a transient feature that later progressed to ST elevation, but that it remained static until angiography up to 50 minutes after the initial ECG. This is the EKG of a previously healthy 40 year old man with one hour of chest pain and profound weakness and sense of "doom". K levels were normal.

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EKG/ECG Burns Ultrasounds 52

Northwestern EM Blog

MAY 2, 2022

EKG changes, elevated troponin, angina) Pregnancy (with some resources citing a level ≥20%) Carboxyhemoglobin level ≥25% Importantly, these are not hard and fast rules and there is no firm guideline mandating when HBOT should or should not be used.

Burns 52

Burns Poisoning EKG/ECG Operations 52

Dr. Smith's ECG Blog

DECEMBER 11, 2018

Prehospital EKG and strips (not shown) had "heart rate 156" (according to the computer interpretation) and "Bigeminal PVCs" The prehospital 12-lead looked just like the first ED ECG: What do you think? This ECG is pathognomonic for severe hyperK, and the long ST segment is all but pathognomonic for hypocalcemia.

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EKG/ECG Dehydration Burns Outcomes 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. Burning pain subxiphoid and into throat." A former resident sent this. Sounds like reflux, right?

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EKG/ECG Burns Academics 52

Taming the SRU

JUNE 7, 2023

Chhabria and Baez Case: Young patient presenting with R knee pain x5 days, progressing now with SOB and CP History notable for flu-like symptoms for past 2 weeks Physical exam notable for tachycardia, tachypnea, muffled heart sounds + murmur and gallop, R knee and elbow swelling Remarkable diagnostics: CXR - cardiomegaly, no PNA Labs - new anemia, (..)

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Poisoning EKG/ECG Pediatrics Burns 76

Medagadget

OCTOBER 31, 2023

This brings us to the burning question: does it work? Let’s also talk about the ECG features onboard the chest piece. The CORE 500 provides a 3-lead ECG (an improvement from the 1-lead ECG provided by the Eko DUO). In short, yes. It works pretty well, especially with the up-to-40X digital amplification.

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EKG/ECG Burns Wellness Telemedicine 90

ACEP Now

MARCH 14, 2024

Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm. FIGURE 1: Electrical burns of the patient’s bilateral feet. FIGURE 2: Traumatic amputation and electrical burn of the patient’s left arm. He was intubated by EMS due to the extent of his injuries.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Intensive Blog

AUGUST 21, 2024

Outline the initial assessment of severe burns injury, including how you will calculate fluid resuscitation requirements. cerebral ox, ECG, TOE, differential BPs) Bleeding? Discuss the advantages and disadvantages of using pulse oximetry to target oxygen therapy (50%) What SpO2 targets do you use in ICU patients and why? (50%)

Burns 52

Burns Hyperthermia / Hypothermia Fluid Resuscitation Operations 52

Dr. Smith's ECG Blog

JUNE 28, 2018

This ECG (ECG #3) was recorded immediately after the last episode of pain spontaneously resolved. Angiographic and clinical characteristics of patients with unstable angina showing and ECG pattern indicating critical narrowing of the proximal LAD coronary artery. Here is the first post-cath ECG (ECG #4).

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EKG/ECG Burns Research Outcomes 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? Pubmed ]

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EKG/ECG Shock Burns Academics 40

Dr. Smith's ECG Blog

APRIL 20, 2019

EMS showed us their ECG on arrival at her house: What do you think? The cardiologist arrived quickly and was skeptical about these findings on EMS ECG. So while they were trying to explain their interpretation I simply recorded another ECG: This ended the discussion. 100% mid-LAD occlusion. LAD now open after intervention.

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EKG/ECG EMS Burns 52

ALiEM

FEBRUARY 9, 2024

Applying the 2022 ACC guideline Before delving into the specifics of the hs-cTn pathways, start with the ECG. The ACC 2022 pathway has a section dedicated to ECGs in ischemia [1], and FOAMcast has a great visual summary. below limit of detection) AND the chest pain onset is >3 hours ago AND the ECG is non-ischemic.

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EKG/ECG Emergency Department Burns Wellness 110

RebelEM

OCTOBER 19, 2022

Treat moderate to severe symptoms and any EKG changes with IV calcium salts Always search for and treat the underlying cause of hypocalcemia REBEL Core Cast 88.0 – Hypocalcemia Click here for Direct Download of the Podcast Definition: A serum calcium level < 8.5

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EKG/ECG Blood Transfusions Burns EMS 52

EB Medicine

NOVEMBER 1, 2018

Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. You’re probably familiar with this concept when you see high voltages arcing through the air without direct contact with the actual electrical source, leading to diffuse burns. Most electrical injuries present with burns to the skin.

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Emergency Department Burns EKG/ECG Shock 40

EM Curious

AUGUST 26, 2015

Read more, here at Dr. Smith's ECG Blog. SHORTNESS OF BREATH AND ST SEGMENT ELEVATION [BLOG]: A middle aged man with history of MI presented by EMS for the sudden onset of difficulty breathing.

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Burns Dislocations EMS Ultrasounds 52

ACEP Now

OCTOBER 9, 2024

Our workup started with an ultrasound and EKG. EKGs will have abnormalities in about 90 percent, but they are typically nonspecific findings. In addition, we observed in his EKG high-voltage, LVH, left atrial enlargement, tall R-wave in V1, and Q waves that were like needles. Burns E, Buttner R. Eur J Cardiothorac Surg.

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EKG/ECG Fluid Resuscitation Ultrasounds Burns 52

ACEP Now

APRIL 4, 2024

A traditional, left-sided EKG was initially obtained, which demonstrated inverted P waves in lead I, deep Q waves in lead V1, negative QRS complex in V1, and RBBB. It was immediately discerned that the patient had dextrocardia from previous records, and an EKG for dextrocardia was obtained. Figure 1: EKG for Dextrocardia showing STEMI.

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EKG/ECG Burns Documentation/Coding Emergency Department 40

Dr. Smith's ECG Blog

DECEMBER 23, 2014

An otherwise health male in his early 40's presented with "burning" in his epigastrium that radiated to his throat and was relieved with Maalox and lidocaine. He had an ECG recorded: Sinus Rhythm. None of these findings are diagnostic of ischemia, but they should give you a high index of suspicion and prompt serial ECGs at a minimum.

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EKG/ECG Burns Resuscitation Outcomes 52

EMDocs

NOVEMBER 27, 2023

Obtain EKG if patient is presenting with chest pain. Burn center transfer for management of severe exfoliative dermatitis Predictive factors for serious cases have yet to be identified, however allopurinol associated DRESS has a higher associated progression to serious DRESS and death rate. and/or N-acetylcysteine (NAC).

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EMS Sepsis Burns EKG/ECG 91

Pediatric Emergency Playbook

DECEMBER 1, 2015

Case 1: Toddler with an oral commissure burn An electrical burn to the angle of the mouth cauterizes superficial bleeding vessels, and hours later the wound becomes covered with a white layer of fibrin, surrounded by erythema. Most patients do well, and the burn heals by secondary intention. Take Home Points 1.

Burns 40

Burns EKG/ECG Emergency Department Shock 40

Taming the SRU

AUGUST 4, 2024

Wound healing is faster with Dermabond compared to sutures, and can be useful as a less-painful technique to repair certain wounds Dermabond differs from non-medicinal superglue because it is sterile, is more flexible, and ultimately less brittle than standard superglue There have been care reports of non-medicinal glue (superglue, nail glue, etc.)

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Dislocations Emergency Department Documentation/Coding Burns 85

Dr. Smith's ECG Blog

OCTOBER 26, 2011

QS-waves and depth of T-wave inversion are very helpful in determining the duration of injury (the "acuteness" of the ECG) , the viability of the myocardium, and patency of the infarct-related artery. So all duration of injury must be estimated from the ECG. I will specifically discuss acuteness on the ECG in a future post.

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EKG/ECG Burns Administration Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 13, 2022

His vitals were normal and his first ECG was as shown below: There is obvious ST segment elevation (STE) in anterior leads. Is this a subtle ECG ? This was a clearly diagnostic ECG that makes me think of a proximal left anterior descending artery (LAD) occlusion. A second ECG was taken at 15:16. Wait for the angiogram.

EKG/ECG 52

EKG/ECG Burns Documentation/Coding Hospitals 52

EMDocs

OCTOBER 25, 2024

Obtain EKG if patient is presenting with chest pain. Burn center transfer for management of severe exfoliative dermatitis Predictive factors for serious cases have yet to be identified, however allopurinol associated DRESS has a higher associated progression to serious DRESS and death rate. and/or N-acetylcysteine (NAC).

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Sepsis Burns EKG/ECG EMS 91

Dr. Smith's ECG Blog

JULY 19, 2019

Written by Pendell Meyers, with edits by Steve Smith A man in his early 40s with history of MI s/p PCI presented with bilateral anterior chest pain described as burning and belching with no radiation since last night starting around 11pm (roughly 11 hours ago). Here is his triage ECG: What do you think? ng/mL (very elevated).

EKG/ECG 52

EKG/ECG Burns Documentation/Coding Hospitals 52

Ziqitza HealthCare Ltd

APRIL 29, 2024

People usually complain of a feeling of burn or heaviness in the chest. Diagnosis of cardiovascular disease involves medical history, physical exams, and tests such as ECG and angiograms. Cardiovascular disease is diagnosed through medical history, physical exams, and tests like ECG and angiograms.

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Stroke Ambulance Services Burns EKG/ECG 52

Taming the SRU

MARCH 17, 2023

mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2

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Seizures Fractures Burns Pediatrics 40

Sensible Medicine

MAY 31, 2023

Barely thirty years old, and she had just burned her last bridge and had nowhere to go. She had been admitted for worsening suicidal behavior, which was a recurring problem for her, along with her tendency toward wild and rapid swings of mood, reckless impulsivity, and overall difficulty getting along with people.

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Psychiatric Hospitals Wellness Military 95

Rural Doctors Net

AUGUST 30, 2013

The visual confrontation of a man in pain with an obvious amputation and airway burns will induce a catecholamine surge in all but the psychopathic. He may need large amounts of fluid down the track as part of his burns management – we’ll calculate this a bit later. Airway compromised by burns. Keep him warm and covered.

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Burns Hospitals Ambulance Services Wellness 52

Northwestern EM Blog

JANUARY 24, 2022

Hypocalcemia can be hinted at through history or by hints such as a prolonged QTc on an ECG. Those at higher risk of hypocalcemia (vitamin D deficiency, ESRD, hyperparathyroidism, burns, multiple blood transfusions, etc.) may have greater severity of shock with increased mortality.

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Anaphylaxis Shock Sepsis Resuscitation 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. Newburger JW, Takahashi M, Burns JC. Acute coronary syndrome in a pediatric patient? He denied drug or alcohol use. Circulation.

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Pediatrics EKG/ECG Hospitals Burns 122

Ken Grauer, MD

FEBRUARY 1, 2025

I was sent the ECG in Figure-1 obtained from a previously healthy man his 60s, who contacted EMS ( E mergency M edical S ervices ) for new-onset severe burning CP ( C hest P ain ) that radiated to the jaw and throat. On seeing the ECG in Figure-1 the EMS crew activated the cath lab. I've highlighted these in Figure-2.

EKG/ECG 411

EKG/ECG Burns EMS 411

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. 21 Case: A 40-year-old male presents to the ED with a burning epigastric pain that has been worsening over the past week. Pain can be improved or exacerbated with meals.

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Emergency Department Fractures Burns EMS 105