Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

This is another case sent by the undergraduate (who is applying to med school) who works as an EKG tech. A 56 year old male with a history of diabetes, dyslipidemia, hypertension, and coronary artery disease presented to the emergency department with sudden onset weakness, fatigue, lethargy, and confusion.

EKG/ECG 119

EKG/ECG Hospitals Emergency Department Outcomes 119

EMDocs

OCTOBER 14, 2024

These are very commonly encountered in the emergency department, so being able to correctly identify the rhythm is extremely important. These are very commonly encountered in the emergency department, so being able to correctly identify the rhythm is extremely important. Take a look at this ECG. Let’s dive in!

EKG/ECG 98

EKG/ECG EMS Resuscitation Emergency Department 98

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Written by Pendell Meyers A teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. Here is his initial ECG around 1330: What do you think? Initial high sensitivity troponin I: 3,830 ng/L (URL 20 ng/L for men) 1445: Similar to initial ECG.

EKG/ECG 114

EKG/ECG Wellness Fractures Emergency Department 114

EMDocs

DECEMBER 11, 2023

As we all know, a critical concern for emergency physicians is identifying patients with heart tissue-threatening ischemia that could benefit from percutaneous catheterization via stent deployment by an interventional cardiologist. The chosen vernacular for these ECG findings has been traditionally called “STEMI equivalents”.

EKG/ECG 120

EKG/ECG Emergency Department Academics Operations 120

Dr. Smith's ECG Blog

JANUARY 27, 2024

Below is the triage ECG, with a computer interpretation (Marquette 12 SL) of “normal” which was confirmed by the over-reading cardiologist. Should this patient continue to stay in the waiting room, without interruption of the physician to interpret the ECG, because the computer interpretation is normal? What do you think?

EKG/ECG 116

EKG/ECG Emergency Department Outcomes Documentation/Coding 116

Dr. Smith's ECG Blog

OCTOBER 18, 2023

All initial ECGs were labeled ‘normal’ or ‘otherwise normal’ by the computer interpretation, and below are the ECGs with the final cardiology interpretation. 1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes.

EKG/ECG 118

EKG/ECG Documentation/Coding Emergency Department Outcomes 118

Dr. Smith's ECG Blog

AUGUST 4, 2024

Written by Pendell Meyers Try first to interpret the ECG without any clinical context: What do you think? Overall, this looks like one of the rare ECGs that is actually specific for pericarditis in my opinion. There was no prior ECG for comparison. Sinus rhythm with abnormal STE in V2-V6, and I, II, aVF. Pericarditis maybe."

EKG/ECG 115

EKG/ECG Wellness Operations Emergency Department 115

Dr. Smith's ECG Blog

APRIL 18, 2024

Written by Jesse McLaren A 70 year old with prior MIs and stents to LAD and RCA presented to the emergency department with 2 weeks of increasing exertional chest pain radiating to the left arm, associated with nausea. What do you think of the ECG, and does it matter? But does this matter? But only 6.4%

EKG/ECG 120

EKG/ECG Documentation/Coding Fractures Emergency Department 120

Dr. Smith's ECG Blog

OCTOBER 12, 2024

A man in his 90s with a history of HTN, CKD, COPD, and OSA presented to the emergency department after being found unresponsive at home. Vital signs were within normal limits on arrival to the Emergency Department. EKG on arrival to the ED is shown below: What do you think? Blood glucose was not low at 162 mg/dL.

EKG/ECG 114

EKG/ECG Documentation/Coding Emergency Department COPD 114

Dr. Smith's ECG Blog

JUNE 11, 2024

Many systems now refrain from showing computer "normal" ECGs to the busy emergency physicians at triage because of very poorly conceived articles that say that if the computer algorithm says "normal," the emergency physician should not be bothered. Three patients with chest pain and “normal” ECGs: which had OMI?

EKG/ECG 112

EKG/ECG Documentation/Coding Emergency Department Wellness 112

Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

A 50 year old presented to the emergency department of a remote rural community (where the nearest cath lab is a plane ride away) with one hour of mild chest pain radiating to the back and jaw, and an ECG labeled ‘normal’ by the computer interpretation. What do you think, and how would you manage the patient?

EKG/ECG 128

EKG/ECG Emergency Department Wellness 128

AENJ: Current Issue

SEPTEMBER 30, 2023

PI monitoring and treatment are often overlooked in the emergency department (ED). Emergency care professionals must be proactive about PI early identification and prevention strategies. Pressure injuries (PIs) are an important quality and patient safety metric for health care organizations.

Emergency Department 97

Emergency Department Patient Safety Documentation/Coding Research 97

ACEP Now

AUGUST 12, 2024

A 35-year-old male presented to the emergency department complaining of chest pain that started 1.5 The patient had an EKG performed within 10 minutes of arrival while in triage (see Figure 1). In the absence of significant ST elevations, the EKG was signed and the patient was placed back in the queue to await a bed.

EKG/ECG 52

EKG/ECG Emergency Department Hospitals 52

EMDocs

FEBRUARY 9, 2024

Authors: Adam Roussas, MD, MBA, MSE // Reviewed by: Jamie Santistevan, MD ( @jamie_rae_EMdoc, EM Physician, Presbyterian Hospital, Albuquerque, NM); Manpreet Singh, MD ( @MPrizzleER ); and Brit Long, MD ( @long_brit ) Case A 40-year-old female presents to the emergency department for palpitations and lightheadedness. What do you do?

EKG/ECG 96

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 96

Dr. Smith's ECG Blog

MARCH 10, 2025

Written by Jesse McLaren A 50 year old presented to triage with one hour of chest pain, and the following ECG labeled normal by the computer (GE Marquette SL) algorithm. see reference below) Whats the gold standard for ECG interpretation: is it cardiologist interpretation? What do you think? The latest is Langlois-Carbonneau et al.

EKG/ECG 88

EKG/ECG Outcomes Documentation/Coding Emergency Department 88

Dr. Smith's ECG Blog

SEPTEMBER 5, 2023

Here is the ECG: Computer interpretation: Normal ECG Interventionalist after doing PCI: SUBTLE STT CHANGES IN LIMB LEADS To me, this first ECG is diagnostic of inferior OMI. I sent this ECG to the Queen of Hearts (PMcardio OMI), and here is the verdict: YOU TOO CAN HAVE THE PM Cardio AI BOT!! He walked in to triage.

EKG/ECG 98

EKG/ECG Documentation/Coding Emergency Department 98

Dr. Smith's ECG Blog

MARCH 14, 2024

Written by Jesse McLaren Three patients presented with acute chest pain and ECGs that were labeled by the computer as completely normal, and which was confirmed by the final cardiology interpretation (which is blinded to patient outcome) also as completely normal. It is well known that NOMI usually has a normal ECG or nonspecific ECG.

EKG/ECG 118

EKG/ECG Documentation/Coding Patient Safety Outcomes 118

AENJ: Current Issue

JULY 31, 2024

Objective: This quality improvement initiative was conducted to determine if a provider in triage and split flow model could decrease the length of stay (LOS) of discharged patients seen in a community hospital emergency department (ED).

Emergency Department 75

Emergency Department Hospitals EKG/ECG 75

Emergency Medicine Journal

DECEMBER 30, 2024

This month’s update is by the Aberdeen Royal Infirmary Emergency Department in Scotland. Currently, most ECG machines in use are not able to update with new diagnostic software, limiting their potential. A smartphone application to extract ECG waveform.

EKG/ECG 52

EKG/ECG Emergency Department Outcomes 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

AslangerE A 65-year-old gentleman presented to the emergency department after experiencing two recent ICD shocks in the preceding hours. An initial electrocardiogram (ECG) is provided below. A subsequent ECG was taken: There is persistent ST elevation, especially being concordant in inferolateral leads. What do you think?

EKG/ECG 111

EKG/ECG Shock Emergency Department Administration 111

Dr. Smith's ECG Blog

FEBRUARY 16, 2024

He presented soon afterward at the Emergency Department with ongoing symptoms. Here is his triage ECG: What do you think? The ECG shows an irregularly irregular polymorphic wide complex rhythm, with some R-R intervals as short as approximately 220 msec or even less. Mentation and blood pressure were normal. What is it?

EKG/ECG 134

EKG/ECG Emergency Department Wellness 134

Dr. Smith's ECG Blog

MAY 23, 2023

EMS arrived and recorded this ECG: What do you think? See same ECG below with computer automated interpretation, using the Glasgow ECG algorithm which apparently is used by many different providers and devices Amazing that the computer calls this normal. Next day ECG. And yet it still says "normal". Learning Points: 1.

EKG/ECG 98

EKG/ECG Wellness Emergency Department EMS 98

ECG Guru

JUNE 28, 2024

The Patient This ECG is from a 57-year-old man complaining of sub-sternal chest pain for 30 minutes. The ECG The rhythm is normal sinus rhythm at 98 bpm. but rather a STEMI equivalent, warranting emergent treatment in a cath lab. EMS found him pale, diaphoretic, and anxious.

EKG/ECG 81

EKG/ECG Emergency Department EMS 81

AENJ: Current Issue

JULY 31, 2024

This case study provides an example of the patient presentation, exam findings, diagnostic results, and intervention modalities required for the health care provider to manage atrial flutter correctly in the emergency department setting.

Emergency Department 68

Emergency Department EKG/ECG 68

Dr. Smith's ECG Blog

NOVEMBER 22, 2023

This ECG was recorded: What do you think? EKG showed sinus rhythm at 100 BPM with a normal axis and diffuse ST depressions. Another ECG was recorded: What do you think? Not knowing anything about the patient, I saw this ECG on our system just as I was leaving the dept. There is widespread ST depression.

EKG/ECG 117

EKG/ECG Emergency Department Wellness Hospitals 117

AENJ: Current Issue

SEPTEMBER 30, 2023

Patients with headaches who present to the emergency department (ED) need prompt pain management. Headaches are a common complaint in the ED. Urgent evaluation is critical to assess for life-threatening headache causes.

Emergency Department 75

Emergency Department EKG/ECG 75

EMDocs

DECEMBER 23, 2024

His initial EKG is the following: What do you think? Its narrow indication for stable VT means many emergency departments may not routinely stock the medication. If procainamide is utilized, a baseline EKG should be obtained to assess the QRS and QTc at baseline.

EKG/ECG 75

EKG/ECG Wellness Shock EMS 75

EMDocs

MAY 4, 2024

. #1: Emergent Cath Lab Activations with “Normal” Computer ECG Interpretations Spoon Feed A significant minority of code STEMI patients have an initial normal computer ECG interpretation. Consequently, emergency physicians must remain vigilant to identify signs of OMI regardless of the initial computer ECG interpretation.

Documentation/Coding 98

Documentation/Coding Stroke Emergency Department Pediatrics 98

EB Medicine

MAY 4, 2021

EMplify - May 2021 Announcements: The Clinical Decision Making in the Emergency Department conference is June 23-27 live and virtual. More information here: [link] Be on the lookout for an announcement regarding the new EB Medicine app, coming to an App Store near you this summer !!

Emergency Department 52

Emergency Department EKG/ECG 52

EB Medicine

FEBRUARY 1, 2024

In this episode, Sam Ashoo, MD, and T.R.

Emergency Department 102

Emergency Department Sepsis EKG/ECG 102

Dr. Smith's ECG Blog

MAY 27, 2024

The ECG did not meet STEMI criteria, and the final cardiology interpretation was “ST and T wave abnormality, consider anterior ischemia”. 1] But there are multiple other abnormalities that make this ECG diagnostic of Occlusion MI, localized likely to the right coronary artery: 1. But are there any other signs of Occlusion MI?

EKG/ECG 122

EKG/ECG Documentation/Coding Emergency Department 122

The Skeptics' Guide to EM

FEBRUARY 11, 2024

Diagnosis of Acute Aortic Syndrome in the Emergency Department (DAShED) study: an observational cohort study of people attending the emergency department with symptoms consistent with acute aortic syndrome. first appeared on The Skeptics Guide to Emergency Medicine. EMJ Nov 2023. EMJ Nov 2023.

Emergency Department 132

Emergency Department Resuscitation Hospitals EKG/ECG 132

AENJ: Current Issue

MAY 8, 2024

Introduction: Emergency department (ED) fast track (FT) for the ambulatory, minor injury patient cohort requires rapid patient assessment, treatment, and turnover, yet specific nursing education is limited.

Emergency Department 67

Emergency Department Hospitals EKG/ECG 67

Emergency Medicine Journal

SEPTEMBER 25, 2024

Clinical introduction A woman in her 60s with a history of hypertension and diabetes arrived at the emergency department reporting chest pain persisting for the past 4 hours. A 12-lead ECG was promptly obtained ( figure 1 ). She had a resting pulse of 70 bpm and blood pressure of 130/80 mm Hg.

Emergency Department 96

Emergency Department EKG/ECG 96

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Our first 12 lead ECG was then recorded at 0926. Another ECG was recorded 5 minutes later just before arrival at the hospital: Similar The patient was transported to a nearby suburban hospital with PCI capabilities while my partner cared for her. Smith: this ECG and clinical presentation is diagnostic of LAD Occlusion.

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

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

EB Medicine

JANUARY 7, 2021

EMplify January 2021 Evaluation and Management of ST-Segment Elevation Myocardial Infarction in the Emergency Department Authors Marshall Frank, DO, MPH, FACEP Carson Sanders, BS, NRP, CCEMT-P Bryan P.

Emergency Department 52

Emergency Department EKG/ECG 52