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.

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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.

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CPR EKG/ECG Shock Ultrasounds 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.)

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Forensics Urgent Care Hospitals Emergency Department 52

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?

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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.

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Resuscitation EKG/ECG Documentation/Coding COPD 98

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.

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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.

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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.

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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 (..)

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Stroke EKG/ECG Seizures CPR 92

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

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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.

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Airway Management Resuscitation EKG/ECG CPR 95

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.

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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.

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Seizures Shock CPR Hyperthermia / Hypothermia 98

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.

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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.

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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.

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Shock EKG/ECG Resuscitation Ultrasounds 40

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.

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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."

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EKG/ECG Shock CPR Outcomes 52

AED Leader

DECEMBER 2, 2024

Furthermore, regular maintenance and training in cardiopulmonary resuscitation (CPR) techniques significantly enhance the potential effectiveness of AEDs in emergencies. CPR techniques and integration with AED use Combining CPR with AEDs can be lifesaving. Knowing when to apply CPR and when to use the AED is vital.

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Mind The Bleep

MAY 16, 2023

Other tests: At most, guidelines suggest that an ECG and pertussis test may be undertaken. Invasive tests & imaging: blood tests (including gas), lumbar punctures, neuroimaging are all generally unnecessary in low risk patients. Observation: a brief period of monitoring with continuous pulse oximetry and serial observations is reasonable.

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Basic Life Support Seizures CPR Wellness 52

The Skeptics' Guide to EM

FEBRUARY 3, 2023

The nurses started CPR immediately and place pads before you even arrived. A post-arrest ECG doesn’t show any signs of STEMI. A 50-year-old man who was admitted to the hospital with a non-ST elevated myocardial infarction (NSTEMI) overnight was found unconscious and without a pulse. The patient is still unconscious.

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Hyperthermia / Hypothermia Hospitals Documentation/Coding CPR 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts. Here is his first ECG recorded after stable ROSC: Originally recorded in 50 mm/s (the standard in Norway), here converted to 25 mm/s. While on telemetry the patient remained asymptomatic, however recurrent episodes of ECG abnormalities were recorded.

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EKG/ECG Hyperthermia / Hypothermia Wellness CPR 40

EMDocs

JANUARY 11, 2024

Data that do not establish neurological risk stratification in the first 6 hours after CA include the patient’s age, duration of CPR, seizure activity, serum lactate level or pH, Glasgow motor subscore in patients who received NMB or sedation, pupillary function in patients who received atropine, and optic nerve sheath diameter (95.3%, 20/21).

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Seizures Shock Infectious Diseases CPR 97

Dr. Smith's ECG Blog

JUNE 23, 2024

His daughter immediately started CPR and another family member called EMS. Here is his presenting ECG: ECG 1, t = 0 What do you think? His transfer packet included notes, labs, cath report, and ECG reports, but no actual ECG images. Smith's ECG Blog. He did not have access to ECG 1.

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EKG/ECG CPR EMS Hospitals 117

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This ECG was recorded in triage. The computer interpretation is: “Sinus Brady with moderate intraventricular conduction delay, nonspecific t wave abnormality, abnormal EKG” What do you think? Case Continued The ECG findings were not recognized. Therefore, no matter the initial ECG, record serial ECGs.

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EKG/ECG Resuscitation CPR Emergency Department 134

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.

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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.

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Hyperthermia / Hypothermia Military CPR EKG/ECG 145

RebelEM

SEPTEMBER 28, 2023

ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% The upper range of this time was 120 minutes from diagnostic ECG in the majority of patients.

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EKG/ECG Allergic Reactions Shock Stroke 138

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.

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EKG/ECG Hospitals Shock Documentation/Coding 98

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.

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Blood Transfusions Sepsis CPR EKG/ECG 88

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

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EKG/ECG Resuscitation Ultrasounds CPR 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.

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Outcomes Resuscitation CPR Hospitals 145

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.

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Shock EKG/ECG Outcomes Hospitals 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.

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EKG/ECG Shock Emergency Department Wellness 52

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!

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Hyperthermia / Hypothermia CPR EKG/ECG Resuscitation 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.

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CPR Shock EKG/ECG Hospitals 52

EB Medicine

NOVEMBER 1, 2018

Thankfully, that gentleman was successfully resuscitated despite no bystander CPR, and if you listen carefully, we hope to arm you with the tools to do so similarly. These aren’t your standard arrest patients though, they typically have many fewer comorbidities – so CPR tends to be more successful. Let’s move on to treatment.

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Emergency Department Burns EKG/ECG Shock 40