Don't Forget the Bubbles

JULY 26, 2023

Prioritise listening to the first 30 minutes which given a good overview of aetiology and treatment (53 mins) Basics of cardiac rhythm problems in the ED Palpitations are a common reason for children to present to the emergency department, the majority of these will be benign from a cardiac perspective and instead related to stress or anxiety.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Dr. Smith's ECG Blog

MAY 13, 2024

Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain. See Ken Grauer's additional comments about this ECG at the end of the post!

EKG/ECG 120

EKG/ECG Emergency Department Ultrasounds Documentation/Coding 120

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

Northwestern EM Blog

MARCH 1, 2025

While a randomized control trial should be done to evaluate the effect of early proning in a controlled environment, these studies suggest that we should consider using this in our Emergency Department for patients who present with hypoxia and concern for mild to moderate ARDS without urgent need for intubation. Suction as needed.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

Dr. Smith's ECG Blog

AUGUST 9, 2024

Written by Colin Jenkins and Nhu-Nguyen Le with edits by Willy Frick and by Smith A 46-year-old male presented to the emergency department with 2 days of heavy substernal chest pain and nausea. These diagnoses were not found in his medical records nor even a baseline ECG. The patient continued having chest pain.

EKG/ECG 107

EKG/ECG EMS Emergency Department Wellness 107

Dr. Smith's ECG Blog

DECEMBER 27, 2023

Written by Willy Frick A man in his 50s with a history of hypertension, dyslipidemia, type 2 diabetes mellitus, and prior inferior OMI status post DES to his proximal RCA 3 years prior presented to the emergency department at around 3 AM complaining of chest pain onset around 9 PM the evening prior. The following ECG was obtained.

EKG/ECG 130

EKG/ECG Documentation/Coding Wellness Emergency Department 130

Dr. Smith's ECG Blog

OCTOBER 2, 2021

Triage EKG: What do you think? A prior ECG was available for comparison. Prior EKG from 2 months ago was available: Let's put the precordial leads from the 2 ECGs side by side: Now you can really see the difference. Immediately after the second ECG was performed, the patient's pain resolved completely.

EKG/ECG 52

EKG/ECG Ultrasounds EMS Documentation/Coding 52

EMDocs

SEPTEMBER 19, 2023

Reference: emDOCs – NCSE Journal of Emergency Medicine – Review Case 4: 52-year-0ld male brought in by EMS with “code STEMI” ECG demonstrates ST depressions with rocket like T waves in V2-V4. This document covers high sensitivity troponin, risk disposition pathways, and STEMI equivalents.

Seizures 100

Seizures Documentation/Coding EKG/ECG Emergency Department 100

PEMBlog

OCTOBER 18, 2024

Duchenne Muscular Dystrophy (DMD) is a complex and progressive disease requiring highly specialized care, especially in emergency situations. When patients with DMD present in the Emergency Department (ED), an understanding of the nuanced aspects of their care is essential for optimal management.

Emergency Department 52

Emergency Department Fractures Best Practices Documentation/Coding 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

She presented to the emergency department after a couple of days of chest discomfort. The ECG below was recorded. The ECG was interpreted as showing atrial flutter with 2:1 conduction. Answer : The ECG above shows a regular wide complex tachycardia. How do you interpret the below ECG? This is very prolonged.

EKG/ECG 119

EKG/ECG Stroke Hospitals Documentation/Coding 119

EB Medicine

MARCH 1, 2019

This month, after a few months of primarily medical topics, we’re talking trauma, specifically Blunt Cardiac Injury: Emergency Department Diagnosis and Management. Post opiate hypotension in prehospital trauma patients is a rare but documented complication. New EKG findings requires admission for monitoring.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

AENJ: Current Issue

SEPTEMBER 30, 2023

The overuse of computed tomographic (CT) scans for patients who present to the emergency department (ED) after mild traumatic brain injury (mTBI) has been well-documented. The Canadian Computed Tomography Head Rule (CCHR) is a validated tool to guide ED providers in determining the need for emergent CT of mTBI patients.

Emergency Department 52

Emergency Department Documentation/Coding Outcomes Wellness 52

Dr. Smith's ECG Blog

APRIL 17, 2023

Sean Rees MD, written by Pendell Meyers, other case by Sam Ghali and Steve Smith Take a look at these two ECGs below from two patients in the ED, first without any clinical context. The remainder of his Emergency Department stay was uneventful. His triage at 0127 is the ECG above. His triage at 0127 is the ECG above.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Psychiatric 52

ACEP Now

JUNE 6, 2023

ECG, CXR, and troponin are negative. A medical student reports a murmur, not documented by either the emergency physician or the cardiologist. Troponins #1 and #2 are borderline and ECG is non-specific. In the ED, his troponin, ECG, and chest X-ray (CXR) are normal. ECG, CXR, and troponin are all normal.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

RebelEM

JULY 3, 2023

Impact of intravenous calcium with diltiazem for atrial fibrillation/flutter in the emergency department. Am J Emerg Med. What They Did: Researchers conducted a multicenter, retrospective cohort study in three community hospitals and two freestanding emergency departments. Article: Rossi N et al.

Administration 98

Administration Outcomes Documentation/Coding Emergency Department 98

Dr. Smith's ECG Blog

DECEMBER 29, 2023

It was ongoing on arrival in the emergency department. Below is the old ECG (on top) and then new ECG (on bottom). The old ECG has proportional ST elevation and T waves. So this STE cannot be considered normal even though there was STE on the previous ECG. But the ECG still doesn’t meet STEMI criteria.

EKG/ECG 70

EKG/ECG Documentation/Coding Emergency Department 70

Taming the SRU

AUGUST 4, 2024

to teach you and your learner something new on shift skin adhesives WITH dr. hill Dermabond is a polymer (octyl cyanoacrylate) that can be used to repair lacerations in the Emergency Department faster than sutures, allowing the ED physician to be more efficient.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

This was a male in his 50's with a history of hypertension and possible diabetes mellitus who presented to the emergency department with a history of squeezing chest pain, lasting 5 minutes at a time, with several episodes over the past couple of months. Here is the first ED ECG, with no pain: Sinus rhythm. It was stented.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Wellness 52

EB Medicine

JULY 8, 2019

This month, we are sticking in the abdomen for another round of evidence-based medicine, focusing on Emergency Department Management of Patients With Complications of Bariatric Surgery. Vitamin D, B12, Calcium, foate, iron, and thiamine deficiencies are all well documented complications.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

ACEP Now

APRIL 4, 2024

A 59-year-old male with a past medical history of a repaired ventricular septal defect (VSD), dextrocardia, hypertension, hyperlipidemia, and current smoker presented to the emergency department (ED). It was immediately discerned that the patient had dextrocardia from previous records, and an EKG for dextrocardia was obtained.

EKG/ECG 40

EKG/ECG Burns Documentation/Coding Emergency Department 40

Dr. Smith's ECG Blog

DECEMBER 14, 2018

The pain resolved as he arrived to the emergency department. Here was his triage ECG. This appears to be a classic Wellens' ECG, Pattern A, with terminal T-wave inversion in V2-V4, preserved R-waves, and it appears to be Wellens' syndrome, as it occurred after resolution of typical angina pain. BP was 200/100.

EKG/ECG 52

EKG/ECG Documentation/Coding Emergency Department Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 26, 2015

52-year-old lady presents to the Emergency Department with 2 hours of chest pain, palpitations & SOB. Here is her 12-Lead ECG: There’s a sinus rhythm at around 70 bpm. It is difficult to answer this question based on this single ECG alone. This was written by Sam Ghali ( @ EM_RESUS ), with a few edits by me.

EKG/ECG 52

EKG/ECG Wellness Documentation/Coding Emergency Department 52

Dr. Smith's ECG Blog

JULY 3, 2018

Here is his initial ECG: 00:04 What do you think? With no other information other than the first ECG above, I texted this to Dr. Smith and he responded: ST elevation in lead V2 and terminal QRS distortion in V3. Therefore, this ECG would not have met the criteria for ACO by this formula. LAD occlusion. Great case.

EKG/ECG 52

EKG/ECG Documentation/Coding Administration Outcomes 52

ACEP Now

JULY 8, 2024

Recently published experiments with LLMs in the emergency department fall into a handful of primary areas of interest. In a similar vein, another study evaluated the ability of an LLM to assess “clinical acuity” in the emergency department. J Am Coll Emerg Physicians Open. 2024;26(1):40-46. JAMA Netw Open.

Emergency Department 52

Emergency Department Operations Documentation/Coding EKG/ECG 52

RebelEM

MARCH 9, 2023

However, evaluating and managing patients with acute alcohol intoxication in the emergency department can be challenging. Document at each reassessment and always have a low threshold to add on a CTH or labs if the patient is not progressing appropriately. As always, document clinical sobriety before discharge.

Psychiatric 52

Psychiatric Emergency Department Fractures Documentation/Coding 52

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. 1,4-5 Thus, an electrocardiogram (ECG) and cardiac monitoring should be performed for unstable, electrical injury patients.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

ACEP Now

JULY 6, 2023

Emergency physicians have earned the right to “re-brand” ourselves as indispensable, money-saving change agents in the health care enterprise. Of course, the bill for any episode of emergency department (ED) care can be substantial, exceeding the billed charges for equivalent care provided in some primary care offices.

Head Injuries 52

Head Injuries Emergency Department Research Pediatrics 52

ACEP Now

MAY 10, 2024

A 59-year-old man presents to your community emergency department (ED) with chest pain that is radiating to his back. His vital signs are normal and the ECG does not demonstrate a myocardial infarction. Emerg Med Australas. Your clinical gestalt has you suspecting an acute aortic dissection (AoD). 2018;30:119–21.

Ultrasounds 52

Ultrasounds Outcomes Academics Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Written by Destiny Folk MD, with edits by Meyers, peer reviewed by Smith and Grauer A woman in her late 20s with a past medical history of cervical cancer status post chemotherapy and radiation therapy presented to the emergency department for shortness of breath, chest tightness, and two episodes of syncope.

EKG/ECG 40

EKG/ECG Ultrasounds Documentation/Coding COPD 40

EB Medicine

JUNE 6, 2019

Jeff: Abdominal pain is the one of most frequent complaint in US emergency departments, representing 8% of all adult ED visits, with admission rates for all patients with abdominal pain ranging between 18-42% and reaching as high as 60% for the elderly. Nachi: And finally let’s touch upon the ekg and ACS. Jeff: True. Review) 83.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

Dr. Smith's ECG Blog

APRIL 8, 2015

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. If no previous ECG was available, ECG was classified as abnormal if any abnormality was present. orthostatic vitals b.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

Dr. Smith's ECG Blog

JUNE 8, 2023

Here’s the paramedic ECG (digitized by PMcardio). I sent the ECG to Dr. Meyers without any information, and he immediately replied, “inferior OMI.” Here’s the first and repeat paramedic ECG: According to some interpretations of the literature on “transient STEMI”, this patient doesn’t need the cath lab because ST segments improved.

EKG/ECG 86

EKG/ECG Documentation/Coding EMS Emergency Department 86

EM Updates

DECEMBER 29, 2024

I see one patient at a time, and I document after each patient. Picking up multiple patients at once and postponing documentation seems like it would make you faster, but mostly it just makes you less effective. In most environments, an important goal of documentation is billing. Review at the vital signs. Write your note.

Emergency Department 87

Emergency Department Documentation/Coding Resuscitation Wellness 87

Dr. Smith's ECG Blog

JANUARY 15, 2025

This was submitted by Hans Helseth, who is applying to med school and who is working as an EKG tech right now. He looked back in time in the patient's chart and saw these ECGs and immediately recognized that they manifested subtle OMI. He had an EKG recorded right away. EKG 1, 1646: What do you think?

EKG/ECG 67

EKG/ECG Wellness Documentation/Coding Emergency Department 67

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, million presentation to ED’s throughout the US Usually occur due to falls Also commonly occur due to sports, MVC’s, etc.

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Dr. Smith's ECG Blog

DECEMBER 31, 2024

She presented to the Emergency Department at around 3.5 Here is her triage ECG: What do you think? The ECG shows sinus rhythm with normal QRS complex morphology and significant subendocardial ischemia (SEI) pattern (ST depression in many leads, worst in lateral areas including leads II, V5-6, with reciprocal STE in aVR).

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department Resuscitation 118

Taming the SRU

FEBRUARY 3, 2025

Work-up and Diagnosis in the Emergency Department Initial presentation of TLS typically includes generalized symptoms such as gastrointestinal distress, decreased appetite, muscle cramping, palpitations, hematuria / oliguria, and altered mental status. original document created by author of post. in females and 2.5-7.0

Fluid Resuscitation 56

Fluid Resuscitation Seizures Dehydration Emergency Department 56