Dr. Smith's ECG Blog

APRIL 30, 2024

Bystander CPR. He was resuscitated into a perfusing rhythm. Here is the only prehospital 12-lead: Sinus tachycardia, somewhat wide QRS, Ischemia Here is the first ED ECG: What is the rhythm here? That said — I found this case highly insightful regarding a number of ECG manifestations of hyperkalemia.

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EKG/ECG CPR EMS Resuscitation 110

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.

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Resuscitation EKG/ECG Hospitals Emergency Department 52

Taming the SRU

JUNE 26, 2024

Unresponsive patients with undetectable MAP or EtCO2 less than 20 should undergo CPR. TEE can be helpful in guiding resuscitation if available. Factors that improve survival rates include cardiac activity on ultrasound, initial shockable rhythm, witnessed arrest, extremity only trauma, and bystander CPR.

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Blood Transfusions Sepsis CPR EKG/ECG 86

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. As per Dr. Smith — “ S hark F in” m orphology was noted on the initial monitoring strip, and initial 12-lead ECG. Figure-1: The initial 12-lead ECG in this case ( See text ).

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CPR EKG/ECG Shock Ultrasounds 52

Thinking Critical Care

MAY 20, 2023

Building on the energy and ethos that Philippe has curated in the Resuscitation side, I’m thrilled to bring a killer set of on-demand lectures and in-person content delivered by a top-notch, multi-disciplinary faculty. The Resuscitative TEE Course , run by none other than Felipe Teran is back again! This is gold.

Airway Management 95

Airway Management Resuscitation EKG/ECG CPR 95

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 90

Stroke EKG/ECG Seizures CPR 90

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

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.

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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. Circulation. 2023 Dec 18.

Seizures 93

Seizures Shock CPR Hyperthermia / Hypothermia 93

AED Leader

DECEMBER 2, 2024

Furthermore, regular maintenance and training in cardiopulmonary resuscitation (CPR) techniques significantly enhance the potential effectiveness of AEDs in emergencies. The American Heart Association and European Resuscitation Council emphasize the importance of early defibrillation.

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CPR Basic Life Support Resuscitation Hospitals 52

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.

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Pediatrics CPR Radiology Radiology 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."

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EKG/ECG Shock CPR Outcomes 52

EMDocs

JANUARY 17, 2024

She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED). Upon ED arrival, she had a heart rate (HR) of 160 and blood pressure (BP) of 80s/40s.

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Poisoning Seizures Pediatrics EMS 74

RebelEM

MARCH 30, 2023

However, there are no clear guidelines for management in post-cardiac arrest patients without ST-segment elevations on ECG. Clinical Question : In patients who suffer an OHCA without ST-segment elevation on the post-resuscitation ECG, will early coronary angiogram (CAG) vs. delayed CAG improve outcomes?

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Hospitals Outcomes EKG/ECG Resuscitation 57

Dr. Smith's ECG Blog

OCTOBER 26, 2020

12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC. In total, he received approximately 40 minutes of CPR and 7 defibrillation attempts. Coronary spasm causing massive current of injury with shark fin ECG.

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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 87

Dr. Smith's ECG Blog

JULY 14, 2023

A 40-something with persistent Ventricular Fibrillation presented after attempted prehospital resuscitation A 40-something with no previous cardiac history presented to the ED in persistent Ventricular Fibrillation after attempted prehospital resuscitation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

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Resuscitation EKG/ECG CPR Outcomes 98

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

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).

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Burns Fluid Resuscitation Shock Resuscitation 80

EB Medicine

MARCH 1, 2019

Again, no standard definition exists, with some diagnostic criteria including simply chest pain and increasing cardiac enzymes, and others including cardiac dysfunction, ecg abnormalities, wall motion abnormalities, and an elevation of cardiac enzymes. New EKG findings requires admission for monitoring. of those patients.

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Emergency Department EKG/ECG Operations Fractures 40

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

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

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

Critical Care Now

JUNE 21, 2022

His main areas of interest are Critical Care, Ultrasound, Prehospital Resuscitation, and Medical Education. CPR was started immediately after the coaching staff could not find a pulse and EMS arrived to find the patient in cardiac arrest. His coach and fellow players witnessed a seizure-like activity immediately after collapsing.

Seizures 52

Seizures EKG/ECG CPR Shock 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

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

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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Documentation/Coding Seizures Psychiatric Wellness 64

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

On arrival, CPR was continued and core temperature was measured at 18° C (64.4° The patient was put on Extracorporeal Life Support in the ED 3 hours after initial resuscitation, the core temp was 30° C and the patient was defibrillated with a single attempt. The Osborn waves on ECGs #1 and #2 are huge! Osborn waves are huge!

Hyperthermia / Hypothermia 40

Hyperthermia / Hypothermia CPR EKG/ECG Resuscitation 40