EMDocs

SEPTEMBER 23, 2023

We’ll keep it short, while you keep that EM brain sharp. Her presenting EKG is shown below. Clinical features Patients often present after an episode of sudden syncope, although Brugada syndrome can also be found on a routine EKG. ECG to evaluate for arrhythmia. Neurological exam is also unremarkable.

EMS 105

EMS EKG/ECG Documentation/Coding Emergency Department 105

EMDocs

OCTOBER 14, 2024

These are very commonly encountered in the emergency department, so being able to correctly identify the rhythm is extremely important. When you are presented with a tachycardic ECG, we want you to focus on two major factors right away. This ECG comes from a 75-year-old female presenting with palpitations. Let’s dive in!

EKG/ECG 98

EKG/ECG EMS Resuscitation Emergency Department 98

EMDocs

MAY 11, 2024

We’ll keep it short, while you keep that EM brain sharp. A 74-year-old female with a past medical history of hypertension, diabetes, recent basilar artery stent placement with a 20 pack-year smoking history presents to the ED via EMS for altered mental status and episodes of apnea. Ann Emerg Med. Erratum in: Ann Emerg Med.

Stroke 110

Stroke EMS EKG/ECG Radiology 110

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? Troponins and EKGs should be trended until normalization (Sybrandy).

EKG/ECG 115

EKG/ECG Wellness Fractures Emergency Department 115

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. With EMS, patient had a GCS of 3 and was saturating 60% on room air. Vital signs were within normal limits on arrival to the Emergency Department. or basilar ischemia.

EKG/ECG 116

EKG/ECG Documentation/Coding Emergency Department COPD 116

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 119

EKG/ECG Emergency Department Academics Operations 119

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 121

EKG/ECG Documentation/Coding Fractures Emergency Department 121

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 110

EKG/ECG Emergency Department Hospitals EMS 110

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 96

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 96

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 Shock Wellness EMS 75

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 81

EKG/ECG Emergency Department EMS 81

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

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 129

EKG/ECG EMS Emergency Department Ultrasounds 129

ACEP Now

JANUARY 4, 2025

The specialty, he said, spoke to his interest in surgery and EMS in a way that family medicine did not. A phone call to LA CountyUSC revealed that the emergency medicine program had one spot left for the following year. Emergency medicine was fairly new then, and most attendings were not emergency physicians, Dr. Clarke said.

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

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

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 97

Radiology Radiology EKG/ECG Documentation/Coding 97

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 132

Emergency Department Stroke Operations Hospitals 132

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

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.

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EKG/ECG Documentation/Coding Emergency Department Wellness 120

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Our first 12 lead ECG was then recorded at 0926. What do you think?

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

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

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 98

Seizures Documentation/Coding EKG/ECG Emergency Department 98

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

Dr. Smith's ECG Blog

DECEMBER 13, 2024

Written by Magnus Nossen and Ken Grauer ( with Comment by Smith ) The ECG in Figure-1 was electronically transmitted by the ambulance service for evaluation. He was hemodynamically stable at the time ECG #1 was recorded. QUESTIONS: How would you interpret this ECG? Figure-1: The initial ECG in today's case. ( in duration.

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EKG/ECG Ambulance Services Emergency Department EMS 103

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

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. Jeff: And don’t forget to get the crash details from the EMS crew before they depart! New EKG findings requires admission for monitoring.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

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. Orphanet J Rare Dis. Pediatrics.

Emergency Department 52

Emergency Department Fractures Best Practices Documentation/Coding 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 85

Pediatrics Emergency Department Resuscitation EMS 85

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

EMDocs

NOVEMBER 27, 2023

Authors: Katey DG Osborne, MD (EM Attending Physician; Tacoma, WA), Rachel Bridwell, MD (EM Attending Physician; Tacoma, WA) // Reviewed by: Alex Koyfman, MD (@EMHighAK, EM Attending Physician, UTSW / Parkland Memorial Hospital) and Brit Long, MD (@long_brit, EM Attending Physician, San Antonio, TX) Welcome to emDOCs revamp!

EMS 96

EMS Sepsis Burns EKG/ECG 96

EMDocs

JANUARY 4, 2024

3 Always get an EKG to assess for cardiotoxicity, including widened QRS and prolonged QTc, although this may not be evident right away. 3 Cardiotoxicity 3 All patients need an EKG and cardiac monitoring. Case Follow-up: The patient required a dose of lorazepam in the emergency department. EMIT II immunoassay).

Seizures 92

Seizures EKG/ECG Poisoning Shock 92

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

EB Medicine

JANUARY 10, 2020

Show Notes Please click here and take our listener survey Emergency Department management of Non-St Segment Elevation Myocardial Infarction, by Drs Julianna Jung and Sharon Bord. Part 4: Pre-hospital care Prehospital ECGs decrease time to intervention. Diagnostics Telemetry ECG. Patterns to know… Troponin.

Emergency Department 40

Emergency Department Shock EKG/ECG Sepsis 40

The Skeptics' Guide to EM

JULY 10, 2021

He is […] The post SGEM#337: Amazing GRACE-1 How Sweet the Guidelines – Recurrent, Low Risk Chest Pain in the Emergency Department first appeared on The Skeptics Guide to Emergency Medicine. Date: July 1st, 2021 Guest Skeptic #1: Dr. Chris Carpenter is Professor of Emergency Medicine at Washington University in St.

Emergency Department 40

Emergency Department Academics Research EMS 40

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

EB Medicine

NOVEMBER 1, 2018

But this month’s episode is special in its own way - we’ll be tackling Electrical Injuries in the emergency department - from low and high voltage injuries to the more extreme and rare lightning related injuries. Jeff: Let’s move on to evaluation in the emergency department. Jeff: You’re right. Let’s move on to treatment.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40