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.

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EKG/ECG Documentation/Coding Emergency Department Outcomes 120

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.

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EKG/ECG Emergency Department Outcomes 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

This was sent by anonymous The patient is a 55-year-old male who presented to the emergency department after approximately 3 to 4 days of intermittent central boring chest pain initially responsive to nitroglycerin, but is now more constant and not responsive to nitroglycerin. This ECG was recorded in triage.

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EKG/ECG Resuscitation CPR Emergency Department 137

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.

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Documentation/Coding Stroke Emergency Department Pediatrics 95

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.

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EKG/ECG Hospitals Shock Documentation/Coding 98

EMDocs

DECEMBER 23, 2024

His initial EKG is the following: What do you think? Gorgels et al (5) looked at procainamide vs lidocaine and again and primary outcome was VTach termination. Its narrow indication for stable VT means many emergency departments may not routinely stock the medication.

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EKG/ECG Shock Wellness EMS 75

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.

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EKG/ECG Wellness Emergency Department EMS 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!

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EKG/ECG Emergency Department Ultrasounds Documentation/Coding 121

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.

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Emergency Medicine Journal

APRIL 22, 2024

Objective We sought to validate the clinical performance of a rapid assessment pathway incorporating the Siemens Atellica IM high sensitivity cardiac troponin I (hs-cTnI) assay in patients presenting to the emergency department (ED) with suspected acute myocardial infarction (AMI).

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Emergency Department Outcomes EKG/ECG Hospitals 98

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.

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EKG/ECG EMS Emergency Department Wellness 108

EMDocs

SEPTEMBER 26, 2024

This story, while unlikely to reflect the standards of most readers, has a somewhat surprising outcome. EKG, labs, and a CXR are interpreted by the EP as normal. Too much weight was given to the EKG, CXR, and labs. He is diagnosed with “chest wall pain” and discharged with instructions to see his PCP in 2-3 days.

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Radiology Radiology EKG/ECG Documentation/Coding 93

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? The ECG was also interpreted as normal by the primary care physician. We can tell in retrospect whether the artery was occluded or not at the time of the ECG by the peak troponin. link] ] Outcome The patient emerged neurologically intact.

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Urgent Care EKG/ECG EMS Emergency Department 98

Taming the SRU

JANUARY 10, 2024

89% agree that violence in the emergency department has harmed patient care. Phenobarbital has been proven to be equivalent to benzodiazepines with regard to clinical, pharmacologic and utilization outcomes. None of the physicians in the study believe that the rate of violence has decreased at all.

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EKG/ECG Shock Fractures Dislocations 93

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.

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EKG/ECG Emergency Department Ultrasounds Hospitals 52

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.

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EKG/ECG Documentation/Coding Wellness Emergency Department 132

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.

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EKG/ECG Ultrasounds EMS Documentation/Coding 52

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.

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Resuscitation EKG/ECG Documentation/Coding COPD 98

ACEP Now

DECEMBER 7, 2024

A submassive PE does not result in hypotension but does result in right ventricular (RV) dysfunction (as evidenced by CT or ECG) and/or signs of myocardial injury, such as elevated B-type natriuretic peptide, elevated troponin, or new ECG changes.

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Ultrasounds Radiology Radiology EKG/ECG 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 it likely goes without saying, but an EKG is a must on all trauma patients with suspicion for blunt cardiac injury in accordance with the EAST guidelines.

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Emergency Department EKG/ECG Operations Fractures 40

Dr. Smith's ECG Blog

AUGUST 26, 2019

She was brought to the Emergency Department and this ECG was recorded while she was still feeling nauseous but denied chest pain, shortness of breath, or other symptoms: What do you think? I wouldn't activate the lab for this EKG alone, but if the patient is clinically compatible with ACS you could call a heart alert.

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EKG/ECG Emergency Department Outcomes Hospitals 52

Dr. Smith's ECG Blog

JUNE 18, 2013

I want all to know that, with the right mind preparation, and the use of the early repol/LAD occlusion formula, extremely subtle coronary occlusion can be detected prospectively, with no other information than the ECG. His ECG was repeated at this point: This shows a well developed anterior STEMI. Ann Emerg Med 1998;31(1):3-11.

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EKG/ECG Outcomes Emergency Department Hospitals 52

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

She arrives in the emergency department (ED) with decreased level of consciousness and shock. The EKG shows sinus tachycardia with nonspecific changes and no ST segment elevations, Q waves, or hyperacute T waves. Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients.

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EKG/ECG Academics EMS CPR 52

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

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. received CaCl 89.3%

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Administration Outcomes Documentation/Coding Emergency Department 91

Dr. Smith's ECG Blog

FEBRUARY 4, 2022

He had a triage ECG at time zero: Here is the computer interpretation (Normal) This was the Veritas algorithm. This ECG is DIAGNOSTIC of acute LAD Occlusion. He came to me with the ECG and I said, "Yup, this is an LAD Occlusion." But even this ECG by itself is quite suspicious. Am J Emerg Med. What do you think?

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EKG/ECG Wellness Emergency Department Outcomes 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. Full case details and outcomes are below. The remainder of his Emergency Department stay was uneventful. His triage at 0127 is the ECG above.

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EKG/ECG Documentation/Coding Emergency Department Psychiatric 52

ACEP Now

JULY 7, 2023

emergency departments (EDs), with statistics reporting more than 356,000 out-of-hospital cardiac arrests per year. 2,3 In general, patients who develop cardiac arrest with an initial rhythm of VT or VF tend to have favorable outcomes compared to patients who develop cardiac arrest from either asystole or pulseless electrical activity.

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Resuscitation Shock Stroke Hospitals 98

AENJ: Current Issue

SEPTEMBER 30, 2023

Managing agitation in pregnancy is a challenging dilemma due to the fear of adverse maternal and neonatal outcomes as well as the legal risk involved. Should medication be necessary, first-generation antipsychotics, second-generation antipsychotics, antihistamines, or benzodiazepines may be considered.

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Psychiatric Emergency Department Outcomes Wellness 52

Broome Docs

MARCH 28, 2024

Emerg Med J. PMID: 38050078 Bottom line: High dose nitroglycerin seems to result in better outcomes in SCAPE, at least according to this small, single center, unblinded trial. Am J Emerg Med. Myth 3: The ECG changes from hyperkalemia are predictable and reliable. 2024 Jan 22;41(2):96-102. doi: 10.1136/emermed-2023-213285.

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PPE Ultrasounds Resuscitation Emergency Department 96

ACEP Now

OCTOBER 9, 2024

In the emergency department (ED), physicians face the challenge of making rapid decisions that can significantly impact patient outcomes. Our workup started with an ultrasound and EKG. EKGs will have abnormalities in about 90 percent, but they are typically nonspecific findings. Revista Portuguesa de Cardiologia.

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EKG/ECG Fluid Resuscitation Ultrasounds Burns 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

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Two prehospital 12-lead ECGs looked similar to this ED ECG: This shows diffuse ST depression (I, II, III, aVL, aVF, V3-V6) with reciprocal ST elevation in lead aVR. This ECG is diagnostic of diffuse subendocardial ischemia. Data collected included demographics, initial rhythm, EKG, emergency department (ED) CT and outcomes.

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Resuscitation EKG/ECG Hospitals Emergency Department 52

Taming the SRU

JANUARY 26, 2024

Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2 10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8

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Stroke EKG/ECG Seizures Outcomes 59

Dr. Smith's ECG Blog

AUGUST 9, 2019

Some total LAD occlusion manifest on the ECG similarly to some left main occlusions. Depending on where the STE vector of the LM occlusion shows up on the ECG, there may be either STE, or STD, or neither in aVR, and lead aVR will not be the important part of the ECG interpretation in these cases.

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EKG/ECG Shock Emergency Department Wellness 52

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. In my opinion this makes the flutter waves slightly easier to recognize in this ECG.

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EKG/ECG Stroke Administration Seizures 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

Submitted and written by Megan Lieb, DO with edits by Bracey, Smith, Meyers, and Grauer A 50-ish year old man with ICD presented to the emergency department with substernal chest pain for 3 hours prior to arrival. The screening physician ordered an EKG and noted his ashen appearance and moderate distress. ng/mL (ULN 0.04).

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EKG/ECG Shock Emergency Department Ultrasounds 52