Dr. Smith's ECG Blog

MAY 19, 2020

ECMO Flow was achieved after approximately 1 hour of high quality CPR. In this case, profound shock for 1 hour would result in the same degree of infarction. A followup ECG was recorded 2 days later: No definite evidence of infarction. The Type 2 MI would then have been a result of the prolonged severe shock while in arrest.

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

She was in shock with thready pulses. A prehospital ECG was recorded: Limb leads: Precordial Leads What is the therapy? The rate is not fast enough to be causing shock, so if it is VT, the priority is still to treat hyperK and secondarily to cardiovert. They thought it was VT, but did not shock. The K returned at 7.4

Shock 52

Shock EKG/ECG Resuscitation Ultrasounds 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. She arrives in the emergency department (ED) with decreased level of consciousness and shock. She has a history of hypertension and non-insulin dependent diabetes mellitus.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

EMDocs

JANUARY 8, 2024

Emergent coronary angiography is not recommended over a delayed or selective strategy in patients with ROSC after cardiac arrest in the absence of ST-segment elevation, shock, electrical instability, signs of significant myocardial damage, and ongoing ischemia (Level 3: no benefit). o C recommended (Level 1: strong). COR 2b, LOE B-R.

Seizures 82

Seizures Shock CPR Hyperthermia / Hypothermia 82

Critical Care Now

JUNE 21, 2022

CPR was started immediately after the coaching staff could not find a pulse and EMS arrived to find the patient in cardiac arrest. Paramedics continued chest compressions, gave epinephrine via an intraosseous route, and delivered one shock. His coach and fellow players witnessed a seizure-like activity immediately after collapsing.

Seizures 52

Seizures EKG/ECG CPR Shock 52

Ziqitza HealthCare Ltd

MAY 14, 2024

Not only immediate care but emergency ambulance services provide a safe haven to the patients by offering continuous pre-hospital care like administering medications, managing airways, controlling bleeding, CPR and other interventions. This can make the difference between life and death.

Ambulance Services 52

Ambulance Services Hospitals CPR EKG/ECG 52

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

The Skeptics' Guide to EM

FEBRUARY 3, 2023

The nurses started CPR immediately and place pads before you even arrived. The patient is in ventricular fibrillation, and you achieve return of spontaneous circulation (ROSC) on the second shock. A post-arrest ECG doesn’t show any signs of STEMI. The patient is still unconscious.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Hospitals Outcomes Documentation/Coding 52

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

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

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. In those with severe injury, you may note refractory hypotension secondary to cardiogenic shock. New EKG findings requires admission for monitoring. of those patients.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 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).

Seizures 75

Seizures Shock Infectious Diseases CPR 75

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

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

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 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

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

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. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. Thankfully, fatalities are declining, with just 565 in 2015.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

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

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?

Hospitals 63

Hospitals Outcomes EKG/ECG Resuscitation 63

Taming the SRU

JUNE 6, 2023

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

Documentation/Coding 61

Documentation/Coding Seizures Wellness Psychiatric 61