Dr. Smith's ECG Blog

FEBRUARY 29, 2016

He is worried that he may be dehydrated. In accordance with the last case (in which the patient presented only with vomiting and diarrhea), an ECG was recorded : (Figure 1) Someone thought this was slow VT with a "northwest" axis (towards aVR, or -135 degrees), but there are definite P-waves (with a long PR interval).

EKG/ECG 52

EKG/ECG Dehydration Stroke Wellness 52

Dr. Smith's ECG Blog

MARCH 15, 2023

Here is her EKG: What is unusual about this? Here is the ECG after ibutilide: What do you notice? Here is the post-cardioversion ECG: Sinus rhythm, still with the longer QT interval. For more on SSS — See My Comment at the bottom of the page in the July 5, 2018 post in Dr. Smith’s ECG Blog. She was on no medications.

EKG/ECG 52

EKG/ECG Dehydration Stroke Wellness 52

RebelEM

OCTOBER 5, 2022

mg/dL 10.5 – 12.0 mg/dL 10.5 – 12.0

Dehydration 52

Dehydration Psychiatric Administration EKG/ECG 52

Taming the SRU

NOVEMBER 18, 2024

Prolonged hiccups can also cause a myriad of negative health consequences including sleep deprivation, exhaustion, malnutrition, dehydration, and depression. However, as hiccups become increasingly frequent or persistent, they can be distressing for patients and can be a sign of underlying disease.

Stroke 76

Stroke Administration Dehydration COPD 76

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He had this ECG recorded. He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. But, remember, we do not evaluate and treat ECGs, we evaluate and treat patients.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

EMDocs

MAY 15, 2024

Other causes of sickling: acidosis, dehydration, inflammation, infection, fever, and blood stasis Sickling leads to vascular occlusion, end-organ ischemia, and decreased RBC lifespan, which, in turn, leads to pain crisis, acute anemia, sequestration, infection, and acute chest syndrome (ACS.) ECG: Evaluate for ischemia, right heart strain.

Blood Transfusions 78

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 78

EMDocs

MAY 28, 2024

Other causes of sickling: acidosis, dehydration, inflammation, infection, fever, and blood stasis. ECG: Evaluate for ischemia, right heart strain. Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. HbS has reduced solubility in the setting of hypoxia, leading to sickling of the RBCs.

Blood Transfusions 76

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 76

EMDocs

OCTOBER 10, 2024

EKG shows atrial fibrillation with a rate of 169. She had no persistent vomiting, was not dehydrated and had no fever. Her R anterior thigh, knee and posterior calf are tender, swollen and ecchymotic. Lab shows WBC of 26,000, 59% polys plus 26% bands, and more immature cells. Glucose is 490, CO2 8, and pH 7.26 with 3+ urinary ketones.

Documentation/Coding 71

Documentation/Coding Hospitals Sepsis Infectious Diseases 71

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

An immediate 12-lead EKG was obtained: There is ST elevation in leads aVR and V1, with marked ST depression in I, II, III, aVF, V3-V6. DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR. What should be done?

EKG/ECG 52

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 52

Dr. Smith's ECG Blog

AUGUST 9, 2018

They gave him water with salt, as he thought he was dehydrated." Vitals were obtained, and placed on cardiac monitor, including a 12 lead EKG." There was no post cath ECG , which if unchanged would absolutely confirm that this is his baseline ECG. Learning point: Some patients have scary baseline ECGs.

EKG/ECG 52

EKG/ECG Dehydration EMS Hospitals 52

Dr. Smith's ECG Blog

JANUARY 29, 2013

What can you say about this ECG at a rate of 230 beats per minute? so it must be a pediatric ECG. The ECG was done because the heart rate was 230 and the differential included SVT vs. sinus tachycardia. This ECG, and the fact that the heart rate was variable (not constant) confirmed sinus tach.

Dehydration 52

Dehydration Pediatrics EKG/ECG 52

Dr. Smith's ECG Blog

JULY 24, 2018

We asked for the ECGs to be faxed over while they prepared to transfer him. We received 4 ECGs, including his baseline on file, and three from today, including triage, peri-arrest, and post-ROSC (sorry for the poor quality due to scanning). Prior ECG on file: Sinus tachycardia, imperfect baseline, otherwise unremarkable.

EKG/ECG 52

EKG/ECG Dehydration Resuscitation Documentation/Coding 52

Dr. Smith's ECG Blog

APRIL 26, 2017

Note 2 other similar cases at the bottom that come from my book, The ECG in Acute MI. Case While I was busy seeing patients, a resident brought me this ECG of a 60-something with a history of syncope only. There was no chest pain or SOB at the tim of the ECG: Computerized QTc is 464 ms A previous ECG from 8 years prior was normal.

EKG/ECG 52

EKG/ECG Ultrasounds Dehydration Stroke 52

Taming the SRU

APRIL 13, 2023

stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e. EtOH, amphetamines, or cocaine) Prescription drugs (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Dr. Smith's ECG Blog

NOVEMBER 9, 2012

On arrival, here is his initial ED ECG, and is identical to the prehospital ECG and at the same rate: There is a regular, wide complex. The patient ' s baseline ECG looks exactly the same, except that it is slower (93) and the p-waves are obvious. Maybe the patient has dehydration, sepsis, hemorrhage, or PE.

EKG/ECG 52

EKG/ECG Dehydration Sepsis Shock 52

Mind The Bleep

JUNE 18, 2023

environmental factors, pain, infection, dehydration, electrolyte disturbance, head injury, medication etc) Does the individual have capacity? It is important to complete an ECG prior to initiating pharmacological therapy as drugs, such as antipsychotics can prolong the QT interval, increasing the risk of arrhythmias.

Psychiatric 52

Psychiatric Documentation/Coding Stroke Fractures 52

PEMBlog

MARCH 27, 2024

GI symptoms are the second most common, and they include vomiting, food intolerance, food aversion, GERD, refractory to normal antireflux measures, diarrhea, and dehydration. So for instance, if they’re having cardiac issues, think about getting an EKG or an echocardiogram.

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

EB Medicine

JULY 8, 2019

Consider IV access and early IV fluids in those at risk for dehydration and intra-abdominal infections. Jeff: Tachycardic patients should make you concerned for hypovolemia 2/2 dehydration, sepsis, leaks, and blood loss. Nachi: Check an EKG immediately after arrival for any patient that may be concerning for ACS.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

OCTOBER 7, 2023

neurologic damage and thrombosis) 20,21 Resuscitation Lactated ringers > Normal saline due to reduced need for urinary alkalinization 22 Place foley and target urine output >300 mL/hr Electrolyte abnormalities Hyperkalemia: Obtain an ECG Stabilization: Calcium gluconate 2 g over 5-10 min.

EMS 74

EMS Fluid Resuscitation Fractures Resuscitation 74

EMDocs

DECEMBER 16, 2023

A 12-lead EKG shows sinus tachycardia but is otherwise normal. Triage vital signs include BP 80/40 mm Hg, HR 154 bpm, T 41C rectal, RR 28 breaths per minute, saturation 94% on room air. The patient is agitated, not oriented, and becoming combative with ED staff. Temps greater than 41.5C Temps greater than 41.5C

Hyperthermia / Hypothermia 69

Hyperthermia / Hypothermia EMS Stroke Seizures 69

Mind The Bleep

NOVEMBER 2, 2024

If the fontanelle is sunken then the baby may be dehydrated and if they are bulging then this can be a sign of birth injury or hydrocephalus. Request an ECG for the baby if ANY murmur is identified. The fontanelles ‘soft spots’ will be felt anteriorly and posteriorly on the head and are regions where the sutures will eventually join.

Documentation/Coding 52

Documentation/Coding Dislocations Ultrasounds Wellness 52

EB Medicine

AUGUST 1, 2018

Jeff: The hyperemetic phase lasts 24-48 hours and can lead to dehydration, electrolyte abnormalities, and weight loss. Jeff: For any patient arriving with suspected cannabis or synthetic abuse, consider checking an EKG. Be sure to look for and treat dehydration, acute renal failure, and rhabdo though.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Dr. Smith's ECG Blog

APRIL 8, 2015

Also consider non-hemorrhagic volume depletion, dehydration : orthostatic vitals may uncover this [see Mendu et al. (3)]. Abnormal ECG – looks for cardiac syncope. Abnormal Electrocardiogram (ECG): Defined (San Fran syncope rule) as any new changes when compared to the last ECG or presence of non-sinus rhythm.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

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. Effects of hydration and dehydration on blood rheology in sickle cell trait carriers during exercise. Up to two-thirds of rib fractures are missed on initial chest radiographs.

Emergency Department 99

Emergency Department Fractures Burns EMS 99