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 118

EKG/ECG Emergency Department Academics Operations 118

Dr. Smith's ECG Blog

OCTOBER 24, 2024

She was brought to an Emergency Department for evaluation. Here is her ECG: What do you think? This ECG shows sinus bradycardia with massively long QT (or QU?) She then had several more syncopal episodes the next day, and returned to a different Emergency Department. The patient was sent home!

EKG/ECG 112

EKG/ECG Emergency Department Hospitals EMS 112

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.

EKG/ECG 87

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 87

Dr. Smith's ECG Blog

MARCH 28, 2024

male with pertinent past medical history including Atrial fibrillation, atrial flutter, cardiomyopathy, Pulmonary Embolism, and hypertension presented to the Emergency Department via ambulance for respiratory distress and tachycardia. Here is the prehospital ECG: First ED ECG What do you think?

EKG/ECG 132

EKG/ECG EMS Emergency Department Ultrasounds 132

EMDocs

DECEMBER 18, 2024

A 36-year-old male presents to the emergency department after being found down at home by his spouse. Upon EMS arrival the male is noted to be anxious and tremulous with a GCS of 14. Acad Emerg Med. This series provides evidence-based updates to previous posts so you can stay current with what you need to know.

Seizures 102

Seizures Hyperthermia / Hypothermia Emergency Department EMS 102

ACEP Now

FEBRUARY 18, 2025

Emergency medical services (EMS) were called to the home of a 22-year-old woman after a syncopal episode and seizure-like activity. On EMS arrival, the patient was alert, pulse was fluctuating between 40 and 130 beats/min, and manual systolic blood pressure was 60 mmHg.

EKG/ECG 52

EKG/ECG Seizures Emergency Department EMS 52

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. EMS found him pale, diaphoretic, and anxious. The ECG The rhythm is normal sinus rhythm at 98 bpm. but rather a STEMI equivalent, warranting emergent treatment in a cath lab.

EKG/ECG 78

EKG/ECG Emergency Department EMS 78

Dr. Smith's ECG Blog

JUNE 21, 2023

EMS was called, and they recorded the following ECG on scene at 13:16: What do you think? In this medical system, the EMS provider can then be routed to the ED or to a type of urgent care facility that is open 24 hrs/day and staffed by a primary care provider. No troponins were measured! Long term follow up is unavailable.

Urgent Care 98

Urgent Care EKG/ECG EMS Emergency Department 98

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".

EKG/ECG 98

EKG/ECG Wellness Emergency Department EMS 98

The Skeptics' Guide to EM

MARCH 2, 2024

Date: February 28, 2024 Guest Skeptic: Dr. Neil Dasgupta is an emergency medicine physician and ED intensivist from Long Island, NY. He is the Vice Chair of the Emergency Department at Nassau University Medical Center in East Meadow, NY, the safety net hospital for Nassau County. AEM February 2024.

Emergency Department 129

Emergency Department Stroke Operations Hospitals 129

EMDocs

SEPTEMBER 26, 2024

EKG, labs, and a CXR are interpreted by the EP as normal. An attorney is consulted and a lawsuit filed against the hospital, the first ED physician, the EM group, and the PCP. Too much weight was given to the EKG, CXR, and labs. Plaintiff : You told me you would call me if the radiology report was “different.” Baccei SJ et al.

Radiology 90

Radiology Radiology EKG/ECG Documentation/Coding 90

Dr. Smith's ECG Blog

JUNE 27, 2024

EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. Smith comment: Go here for a comprehensive blog post on syncope and link to the most detailed version of the Canadian Syncope Rule: Emergency Department Syncope Workup. Troponins were all negative.

EKG/ECG 123

EKG/ECG Documentation/Coding Emergency Department Wellness 123

EB Medicine

MARCH 7, 2022

Episode 67 – Managing Postpartum Complications in the Emergency Department – An Interview with Dr. Nicole Yuzuk, Dr. Joseph Bove, and Dr. Riddhi Desai EMplify – March 2022 Interview with the Authors: Nicole Yuzuk, DO, Joseph Bove, DO, and Riddhi Desai, DO Episode Outline: 1.Why Why is this an important topic in EM?

Emergency Department 52

Emergency Department Seizures EMS EKG/ECG 52

Dr. Smith's ECG Blog

OCTOBER 2, 2021

Triage EKG: What do you think? Today’s pain lasted around 20 mins, but was severe enough that the patient called EMS. Pain largely resolved prior to EMS arrival but completely subsided after prehospital NTG and aspirin. A prior ECG was available for comparison. There is STE present in leads V2-V5. ng/mL (undetectable).

EKG/ECG 52

EKG/ECG Ultrasounds EMS Documentation/Coding 52

EMDocs

SEPTEMBER 19, 2023

Episode 86: Tricky Cases Part 2 Case 3: 56-year-old female with history of seizures, actively seizing, EMS called. Patient seized for approximately 20 minutes prior to EMS arrival. “The application of STEMI ECG criteria on a standard 12-lead ECG alone will miss a significant miry of patients who have acute coronary occlusion.”

Seizures 86

Seizures Documentation/Coding EKG/ECG Emergency Department 86

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. The TOMAHAWK Investigators.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Emergency Medicine Cases

APRIL 26, 2022

Computer interpretation of the ECG has been called a double-edged sword: when correct, it increases physician accuracy, but when incorrect it increases errors. This is especially problematic in the emergency department, where computer accuracy drops as clinical significance increases—with common errors for arrhythmias and ischemia.

EKG/ECG 52

EKG/ECG Emergency Department EMS 52

Critical Care Now

JULY 21, 2024

Patients with OMI have higher mortality and worse left ventricular function than those with NOMI, making detection crucial but challenging in busy emergency departments. OMI signs on ECG include subtle ST elevation, isolated ST depressions, and hyperacute T waves, often missed under current STEMI criteria.

EKG/ECG 75

EKG/ECG Emergency Department EMS Wellness 75

ACEP Now

NOVEMBER 6, 2024

A gravid woman presents to your emergency department (ED). 1 If HR is below 60, chest compressions should be started and an ECG placed. Turner , originally trained at the Medical University of South Carolina, is an EM intern at Hershey Medical Center in Hershey, Pa. Garvey AA, Dempsey EM. Adv Med Educ Pract.

Resuscitation 98

Resuscitation Pediatrics Hyperthermia / Hypothermia EMS 98

EB Medicine

DECEMBER 1, 2021

Risk Factors Prehospital Care – what should EMS be looking for? Table 3 ADD-RS score Exam Diagnostics Labs EKG – STEMI? Risk Factors* Prehospital Care – what should EMS be looking for? * It is in Beta and your feedback is welcome. It is in Beta and your feedback is welcome. Table 3ADD-RS scoreExamDiagnosticsLabsEKG – STEMI?

EKG/ECG 52

EKG/ECG Emergency Department EMS Shock 52

EMDocs

SEPTEMBER 15, 2023

1: How to Spot Ischemia in RBBB Patients Spoon Feed In non-ischemic right bundle branch block (RBBB) ECGs, we expect discordant ST depression and T wave inversions in leads V1-V3. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: Try this checklist!

Pediatrics 72

Pediatrics Emergency Department Resuscitation EMS 72

EM Curious

JULY 8, 2015

The idea of the FOAMed review is to give you a digestible selection of reliable content from the online EM/CC world that you can fit into your busy weekly schedule. Over a year's span we will be sure to include topics from all core EM content areas.even the ones that may not be the coolest. With a bonus brief on disaster management.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 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. EMS is called and finds his blood pressure 175/100. In the ED, his troponin, ECG, and chest X-ray (CXR) are normal.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

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

DECEMBER 14, 2022

EMS arrived and administered aspirin and nitroglycerin. Here are his three EMS ECGs: EMS1 at 0735 This was sent to Dr. Smith with no other information. Meyers sent this ECG to Smith without any other info and this was the response: Smith interpretation: "A very rare anterior OMI w high S-wave voltage." Do not miss them!

EKG/ECG 52

EKG/ECG EMS Documentation/Coding Emergency Department 52

Cook County EM Blog

APRIL 27, 2022

Effectiveness and safety of droperidol in a United States emergency department. Am J Emerg Med. 2019.09.007 What : Retrospective cohort study of all droperidol administrations between January 2012 and April 2018 at an academic and pediatric emergency department in the US with 77,000 annual visits.

Administration 52

Administration EKG/ECG Emergency Department EMS 52

EMergucate

JULY 11, 2013

A 53 year old male presents to your Emergency Department following an episode of collapse and this ECG.

EKG/ECG 40

EKG/ECG Emergency Department EMS 40

EMergucate

AUGUST 9, 2013

A 83 year old patient presents to your Emergency Department complaining of lethargy, nausea, and vomiting. This is his ECG.

EKG/ECG 40

EKG/ECG Emergency Department EMS 40

EMergucate

FEBRUARY 7, 2014

This week’s ECG is from a 39 yr old female who presented to the Emergency Department with vomiting, diarrhoea, and … Continue reading →

EKG/ECG 40

EKG/ECG Emergency Department EMS 40

EMergucate

FEBRUARY 15, 2014

This week’s ECG is from a middle aged male who presented to the Emergency Department with abdominal pain. His ‘routine’ … Continue reading →

EKG/ECG 40

EKG/ECG Emergency Department EMS 40

EMergucate

FEBRUARY 21, 2014

Clinical conclusion and interpretation on last week’s ECG case of a middle aged male who presented to the Emergency Department with … Continue reading →

EKG/ECG 40

EKG/ECG Emergency Department EMS 40

EM Curious

JULY 1, 2015

The idea of the FOAMed review is to give you a digestible selection of reliable content from the online EM/CC world that you can fit into your busy weekly schedule. Over a year's span we will be sure to include topics from all core EM content areas.even the ones that may not be the coolest. Check out his post here.

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

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 73

EKG/ECG Shock Wellness EMS 73

Dr. Smith's ECG Blog

DECEMBER 26, 2020

An ECG was recorded quickly on return to the ED: (sorry for poor quality, cannot get originals) What do you think? They called their transfer center cardiologist on call, who reviewed the case on the phone with them, as well as the ECG. The EM provider asked if the cardiologist thought it was a "STEMI."

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

Dr. Smith's ECG Blog

MARCH 6, 2023

If you saw this ECG only knowing that it is an acute chest pain patient, what would be your interpretation? But you can make a diagnosis here, and Pendell and I do this all the time when reading ECGs from databases. The patient had this ECG recorded at 7 minutes after registration at triage as a walk-in (not by EMS): What do you think?

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds EMS 52

The Skeptics' Guide to EM

APRIL 21, 2018

AEM April 2018 Guest Skeptic: Dr. Corey Heitz is an emergency physician in Roanoke, Virginia. He is also the CME editor for Academic Emergency Medicine (AEM). He is also the CME editor for Academic Emergency Medicine (AEM). The EKG and laboratory tests are normal. Reference: Ohle R et al.

Emergency Department 52

Emergency Department Academics EKG/ECG Research 52

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. Post-resuscitation ECGs demonstrating ST segment elevation are significant in delineating which patients might benefit most from advanced reperfusion techniques. Circulation. 2018;137(12). Kimblad H, et al.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98