Don't Forget the Bubbles

JULY 26, 2023

Add into this that the majority of children will be in normal sinus rhythm (NSR) by the time of assessment so to truly identify those who have something wrong we have to be confident in identifying arrhythmias where they are present and critical when analysing an ECG in NSR. All were examined and 98% had an ECG.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Dr. Smith's ECG Blog

APRIL 2, 2024

There was no bystander CPR. Here is the initial ED ECG. Other thought this was due to hyperkalemia, but the ECG does not have the appearance of hyperkalemia but does have the appearance of severe cardiomyopathy -- LBBB with very wide QRS) 3. ECG with LBBB and QRS of > 210 ms. An elderly man collapsed.

EKG/ECG 134

EKG/ECG Shock CPR Stroke 134

Don't Forget the Bubbles

JUNE 30, 2023

She was intubated at the scene and transported to your ED, with cardiopulmonary resuscitation (CPR) performed en route. You request a 12 lead ECG and repeat a blood gas, asking for it to be run on the PICU analyser. Your trusted nurse hands you the ECG: Paediatric ECG interpretation has never been your strong suit.

Hyperthermia / Hypothermia 145

Hyperthermia / Hypothermia Military CPR EKG/ECG 145

Emergency Medicine Cases

DECEMBER 8, 2020

In this month's EM Quick Hits podcast: Anand Swaminathan on lateral canthotomy, Emily Austin on pediatric cannabis poisoning, Reuben Strayer on an approach to hyperthermia, Brit Long on diagnosis and management of malignant otitis externa, Jesse McLaren on ECG diagnosis of occlusion MI in patients with BBB and Peter Brindley on prone CPR.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia CPR Poisoning EMS 52

Dr. Smith's ECG Blog

APRIL 30, 2024

Bystander CPR. Here is the only prehospital 12-lead: Sinus tachycardia, somewhat wide QRS, Ischemia Here is the first ED ECG: What is the rhythm here? This ECG is pathognomonic of hyperkalemia , with wide QRS, very SHARPLY peaked T-waves, flat ST segments, RBBB pattern and large R-wave in aVR. Medics found patient in PEA arrest.

EKG/ECG 109

EKG/ECG CPR EMS Resuscitation 109

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

Resuscitation 98

Resuscitation EKG/ECG CPR Outcomes 98

Dr. Smith's ECG Blog

OCTOBER 3, 2017

He received aspirin en route via EMS, and no EMS ECGs are available. Here is his ECG on presentation to the ED, approximately 45 minutes after onset of pain, but with pain improving since onset: What is your interpretation? I sent this ECG with no clinical information to Dr. Smith.

EKG/ECG 52

EKG/ECG CPR Shock EMS 52

Dr. Smith's ECG Blog

MAY 19, 2020

ECMO Flow was achieved after approximately 1 hour of high quality CPR. A followup ECG was recorded 2 days later: No definite evidence of infarction. Smith — “ S hark F in” m orphology was noted on the initial monitoring strip, and initial 12-lead ECG. For clarity — I’ll again show the initial ECG done in the ED in Figure-1.

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

Taming the SRU

JUNE 26, 2024

Unresponsive patients with undetectable MAP or EtCO2 less than 20 should undergo CPR. Factors that improve survival rates include cardiac activity on ultrasound, initial shockable rhythm, witnessed arrest, extremity only trauma, and bystander CPR. One should ensure that the device is plugged in and an audible hum is heard.

Blood Transfusions 87

Blood Transfusions Sepsis CPR EKG/ECG 87

Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. Initial ROSC was obtained, during which this ECG was obtained: What do you think? I sent it to 2 of my ECG nerd colleagues with no clinical information whatsoever, who instantly said: "Looks like afib with subendocardial ischemia and right heart strain pattern." "I

EKG/ECG 52

EKG/ECG Resuscitation Ultrasounds CPR 52

ACEP Now

JANUARY 4, 2025

A closer look, though, also shows the technology of the daya bulky, two-way radio for communicating with EMS, metal gurneys, glass saline bottles, and portable ECG monitors the size of a small shopping cart. Notice the use of the medical anti-shock trousers and the ECG machine. Click to enlarge.) Click to enlarge.)

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

RebelEM

JUNE 1, 2023

Bystander CPR, a known predictor of good outcomes, was more common in the SDCT cohort than in the standard care cohort. Control: Standard approach to diagnosis post-arrest but would be eligible for SDCT. There is no discussion of how many of the diagnoses made by SDCT could have been made clinically instead.

Outcomes 144

Outcomes Resuscitation Hospitals CPR 144

Dr. Smith's ECG Blog

APRIL 29, 2020

CPR was started immediately. 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. Is this inferior MI?

EKG/ECG 52

EKG/ECG CPR Wellness Academics 52

ACEP Now

DECEMBER 6, 2024

During initial assessment, an ECG was obtained and revealed ST-segment elevation (STE) in the inferior leads with ST depression anteriorly. Initial ECG demonstrating inferolateral ST segment elevation and anteroseptal depression, just prior to cardiac arrest. The ECG showed ST-segment elevation without obstructive coronary disease.

Resuscitation 98

Resuscitation EKG/ECG Documentation/Coding COPD 98

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

On arrival, CPR was continued and core temperature was measured at 18° C (64.4° A 12-lead ECG was recorded: There is sinus rhythm with RBBB and right axis deviation. Guide to this image: 30 minutes later, at 31 C, this ECG was recorded: The RBBB has resolved. The Osborn waves on ECGs #1 and #2 are huge!

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia CPR EKG/ECG Resuscitation 40

AED Leader

JULY 10, 2024

The Powerheart G5 is a user-friendly AED that provides real-time CPR feedback and can be used for adult and pediatric patients. It offers advanced features such as ECG monitoring and multiple rescue capabilities. It offers advanced features such as ECG monitoring and multiple rescue capabilities.

CPR 52

CPR EKG/ECG Shock Pediatrics 52

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

The paramedics achieve return of spontaneous circulation (ROSC) after CPR, advanced cardiac life support (ALCS), and Intubation. The EKG shows sinus tachycardia with nonspecific changes and no ST segment elevations, Q waves, or hyperacute T waves. She has a history of hypertension and non-insulin dependent diabetes mellitus.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

AED Leader

MAY 5, 2024

Let’s take a closer look at some of the critical features of Zoll AEDs: Zoll AED 3 : The Zoll AED 3 is a compact, user-friendly defibrillator that provides real-time CPR feedback and guidance. Zoll AED Plus : Zoll AED Plus is another popular model because of its unique CPR feedback technology.

CPR 52

CPR EKG/ECG Wellness Operations 52

Taming the SRU

OCTOBER 5, 2023

morbidity and mortality - quality improvement - research grand rounds - r1 clinical knowledge: pres/rcvs - r4 case follow-up: compartment syndrome Morbidity and Mortality WITH dr. finney Takotsubo Cardiomyopathy with COVID-19 Increasing incidence of Takotsubo Cardiomyopathy with the COVID-19 pandemic Morbidity and mortality is similar to that of ACS (..)

Stroke 91

Stroke EKG/ECG Seizures CPR 91

Dr. Smith's ECG Blog

FEBRUARY 2, 2017

Here is the ECG: Sinus tachycardia. This is an extremely dangerous ECG. When the ECG shows the effects of hypokalemia, it is particularly dangerous. "Administration of potassium may be empirical in emergent conditions. This patient presented with severe DKA. What do you think? What else? The K returned at 1.9

EKG/ECG 52

EKG/ECG Resuscitation Administration CPR 52

Thinking Critical Care

MAY 20, 2023

There’s going to be a buffet of workshops to pick and choose from that we are still putting together, from airway management to bedside procedures, ekg workshops, neuro exam workshop, wound dressing, and of course all kinds of POCUS. If you’re not personalizing your CPR, here’s the place to learn! This is gold.

Airway Management 95

Airway Management Resuscitation EKG/ECG CPR 95

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

EMS recorded the following ECG: What do you see? In other words, the ST segment and T-wave should be discordant to (in the opposite direction of) the positive R' wave [ see the 2nd ECG of this post ]. A male in late middle age with a history of RCA stent 8 years prior complained of chest pain.

CPR 52

CPR Resuscitation EKG/ECG Outcomes 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

Some total LAD occlusion manifest on the ECG similarly to some left main occlusions. Depending on where the STE vector of the LM occlusion shows up on the ECG, there may be either STE, or STD, or neither in aVR, and lead aVR will not be the important part of the ECG interpretation in these cases.

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

Dr. Smith's ECG Blog

OCTOBER 24, 2013

The physician recorded this ECG, interpreted it as normal, and sent the patient home on an antacid. He underwent immediate CPR, was found to be in ventricular fibrillation, and was successfully resuscitated. I do not have the post-resuscitation ECG. Did the ECG offer unseen hints? See explanation below. Lesson : 1.

EKG/ECG 52

EKG/ECG Resuscitation CPR Ultrasounds 52

EMDocs

JANUARY 8, 2024

For patients with OHCA, use of steroids during CPR is of uncertain benefit. Extracorporeal CPR Use of ECPR for patients with cardiac arrest refractory to standard ACLS is reasonable in select patients when provided within an appropriately trained and equipped system of care. COR 2b, LOE B-R. COR 2b, LOE C-LD.

Seizures 97

Seizures Shock CPR Hyperthermia / Hypothermia 97

Dr. Smith's ECG Blog

OCTOBER 28, 2013

It was witnessed, and CPR was performed by trained individuals. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. The following 12-lead ECG was recorded at 11 minutes after ROSC. at the time of the ECG. at the time of the ECG. Here is the annotated ECG from above, with lines drawn.

EKG/ECG 52

EKG/ECG CPR Resuscitation Research 52

EM SIM Cases

MAY 9, 2023

The team should begin CPR and follow the PALS pediatric bradycardia algorithm. After one round of CPR, the patient’s heart rate will increase and the consulting team should arrive. Normal paediatric ECG Despite intubation, the child remains hypoxemic and the team works through an approach to post-intubation hypoxemia.

Pediatrics 52

Pediatrics CPR Radiology Radiology 52

Dr. Smith's ECG Blog

MARCH 9, 2017

This was her ECG (it is unclear if this was with or without pain): Computerized ECG Read: “Normal sinus rhythm. Normal ECG.” Overall this is a very quiet ECG. link] A repeat ECG was performed 1.5 hrs after the initial ECG) she develops severe, crushing chest pain. Don’t trust the computerized ECG reading.

EKG/ECG 52

EKG/ECG CPR Shock Hospitals 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

A prehospital ECG was recorded: Limb leads: Precordial Leads What is the therapy? What does a heart look like on ultrasound when the EKG looks like that? The followup ECG is here: Now the QRS is only slightly prolonged. A middle-aged woman was found down in her apartment unconscious. She was in shock with thready pulses.

Shock 40

Shock EKG/ECG Resuscitation Ultrasounds 40

AED Leader

JULY 19, 2023

Users are given audible instructions in English or Spanish that take them through the steps of CPR and shock delivery. This technology allows chest compressions to continue during an ECG, reducing pauses in CPR which may, in turn, improve survival rates. cprINSIGHT Analysis. cprINSIGHT Analysis. LIFELINKcentral.

CPR 52

CPR Shock EKG/ECG Hospitals 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. Two prehospital 12-lead ECGs looked similar to this ED ECG: This shows diffuse ST depression (I, II, III, aVL, aVF, V3-V6) with reciprocal ST elevation in lead aVR. This ECG is diagnostic of diffuse subendocardial ischemia.

Resuscitation 52

Resuscitation EKG/ECG Hospitals Emergency Department 52

Don't Forget the Bubbles

OCTOBER 7, 2024

Suspected low voltage injuries (<1000v) should still be approached with an A-E assessment, but if 12 lead ECG and urinalysis are normal, it’s reasonable to discharge the patient. If the ECG is abnormal, the patient should be managed as if exposed to a high voltage (>1000v).

Burns 80

Burns Fluid Resuscitation Shock Resuscitation 80

Dr. Smith's ECG Blog

JUNE 11, 2021

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. The paramedics found the patient with ROSC and a GCS 7, and an ECG showing LBBB with possible lateral ST elevation. So the RCA was stented.

EKG/ECG 52

EKG/ECG Documentation/Coding CPR Shock 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

Here is his triage ECG: PM Cardio version: With no other information at all, I sent this ECG to Dr. Smith, who replied: "I think it is real. In other words, this ECG shows sinus rhythm, normal QRS complex, and: --Inferior OMI: STE in III, hyperacute T waves in lead III, reciprocal STD and TWI in aVL. STD in V4-5 too."

EKG/ECG 52

EKG/ECG Shock CPR Outcomes 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He had the following EKG recorded: Low voltage, suggests effusion. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. This is the ECG on V-V ECMO: Very little STE He had a lot of troponins measured. He was moderately hypoxic.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

Dr. Smith's ECG Blog

MARCH 11, 2016

Her prehospital ECG was identical to her first ED ECG, and the cath lab was activated: There is massive ST elevation (greater than 15 mm) in V2 and V3, with ST elevation in I and aVL and reciprocal ST depression in II, III, aVF. This comes from chapter 28 of my book The ECG in Acute MI ). hours when she called 911. ng/mL time 1.5

EKG/ECG 52

EKG/ECG Outcomes CPR Shock 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

Here is his ECG: The resident was alarmed at the "ST elevation in III with reciprocal ST depression in aVL" Are you alarmed? An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." What do you think?

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EKG/ECG CPR Resuscitation Outcomes 40