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. Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI.

Resuscitation 52

Resuscitation EKG/ECG Hospitals Emergency Department 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. Resuscitation. Resuscitation.

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Resuscitation Shock Stroke Hospitals 98

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. She was defibrillated and resuscitated. What do you think? V1 has 0.5

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

EMDocs

SEPTEMBER 14, 2024

Source Use of Glucagon-Like Peptide-1-Agonists and Increased Risk of Procedural Sedation and Endotracheal Intubation in the Emergency Department. Ann Emerg Med. Resuscitation. The post Journal Feed Weekly Wrap-Up appeared first on emDOCs.net - Emergency Medicine Education. 2024 Aug;84(2):226-227. 2024.03.007.

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Emergency Department Resuscitation Pediatrics EKG/ECG 90

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He presented to the Emergency Department with a blood pressure of 111/66 and a pulse of 117. He had this ECG recorded. He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6.

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 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.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

EMDocs

SEPTEMBER 19, 2023

Airway plan discussed with resuscitation team. 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. Cric is progression of the airway plan ; it is not a failure.

Seizures 90

Seizures Documentation/Coding EKG/ECG Emergency Department 90

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. Resuscitation. The post Journal Feed Weekly Wrap-Up appeared first on emDOCs.net - Emergency Medicine Education. Try this checklist! 2023.109834.

Pediatrics 76

Pediatrics Emergency Department Resuscitation EMS 76

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

EMDocs

OCTOBER 8, 2024

Glucose POC ECG: Is this actually sinus tachycardia? Looking at the initial or even repeating the ECG will be helpful here. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? Unanticipated death after discharge home from the emergency department.

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Shock Emergency Department Pediatrics EKG/ECG 105

Broome Docs

MARCH 28, 2024

Am J Emerg Med. Myth 3: The ECG changes from hyperkalemia are predictable and reliable. A non-inferiority randomized controlled trial comparing nebulized ketamine to intravenous morphine for older adults in the emergency department with acute musculoskeletal pain. Resuscitation. 2022 Feb;52:85-91. 2021.11.030.

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PPE Ultrasounds Resuscitation Emergency Department 96

Dr. Smith's ECG Blog

OCTOBER 4, 2010

He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. He arrived in the emergency department hemodynamically stable. His initial ECG is shown here. A bedside echo performed by the emergency physician showed no wall motion abnormality and confirmed LVH.

EKG/ECG 52

EKG/ECG Emergency Department Resuscitation Wellness 52

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.

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

PHEM Cast

APRIL 10, 2016

It is worth noting, that with “Sepsis 3” many of these terms will become out-of-date – but validation work is required… The Rivers’ paper can be accessed here: [link] It was a single centre study which compared standard care with protocolised resuscitation packaged together as early goal-directed therapy (EGDT).

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Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

EM Curious

JULY 8, 2015

CARDIOLOGY NUGGETS CASE OF A 59 Y/O M APPEARING UNWELL [BLOG]: You must learn to recognize these ecg patterns, and have a practical ecg reading algorithm. BENIGN EARLY REPOLARIZATION [BLOG]: Have a quick skill brush-up on this common ECG finding that could be looking quite concerning if you are not familiar with it.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

ACEP Now

OCTOBER 9, 2024

In the emergency department (ED), physicians face the challenge of making rapid decisions that can significantly impact patient outcomes. However, the persistence of tachycardia despite fluid resuscitation and dosing with lorazepam to help with his panic disorder raised concerns that warranted further investigation.

EKG/ECG 52

EKG/ECG Fluid Resuscitation Ultrasounds Burns 52

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Audrey’s academic interests include trauma and resuscitation. Outside of medicine, Audrey likes […] The post SGEM#301: You Can’t Stop GI Bleeds with TXA first appeared on The Skeptics Guide to Emergency Medicine. Audrey’s academic interests include trauma and resuscitation. Reference: Roberts et al.

Academics 52

Academics Resuscitation EMS Stroke 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. Nachi: Check an EKG immediately after arrival for any patient that may be concerning for ACS. I hope everybody enjoyed a fantastic conference.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

EMDocs

APRIL 22, 2024

4 In an emergency department (ED) presentation of cardiac arrest, the diagnosis of PE is challenging without the use of CT angiography. Point-of-Care-Ultrasound (POCUS) is a bedside modality that can assist Emergency Physicians (EPs) in differentiating PE from other causes of cardiac arrest. EKG RV strain.

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Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 97

Taming the SRU

APRIL 10, 2023

UDS : positive for amphetamines, benzodiazepines, fentanyl, THC EKG : Normal sinus rhythm, incomplete right bundle branch block, normal axis, normal intervals. HOSPITAL COURSE The patient was initially found to be hypotensive in the Emergency Department with a blood pressure of 87/58 mmHg. Diagnostics WBC : 8.6 TSH : 18.04

EKG/ECG 52

EKG/ECG Fluid Resuscitation Administration Emergency Department 52

EMDocs

JANUARY 17, 2024

She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). She had return of spontaneous resuscitation (ROSC) and was subsequently intubated and transported to the emergency department (ED).

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Poisoning Seizures Pediatrics EMS 81

EMDocs

SEPTEMBER 25, 2023

Incidence and factors associated with cardiac arrest complicating emergency airway management. Resuscitation 2013; 84(11): 1500 – 4. actors Associated with the Occurrence of Cardiac Arrest after Emergency Tracheal Intubation in the Emergency Department. Int J Emerg Med. J Emerg Med. 2017 Dec;10(1):1.

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Emergency Department Soft Tissue Injuries Airway Management Operations 84

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He had the following EKG recorded: Low voltage, suggests effusion. He was started on Extracorporeal Life Support ("VA ECMO") Here is the ECG on ECMO: Very low voltage On Day 3, the EF recovered (that seems quick!) This is the ECG on V-V ECMO: Very little STE He had a lot of troponins measured. He was moderately hypoxic.

Shock 52

Shock EKG/ECG Outcomes Hospitals 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

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

What is your ECG interpretation and what would you do next? This ECG shows a normal sinus rhythm with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, late R wave progression (and misplaced V2), normal voltages, ST-elevation in aVR and global ST-depressions. BP was 110 and oxygen saturation was normal.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). A followup ECG was recorded 2 days later: No definite evidence of infarction. As per Dr. Smith — “ S hark F in” m orphology was noted on the initial monitoring strip, and initial 12-lead ECG.

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

Taming the SRU

FEBRUARY 23, 2024

Consider starting more goals of care discussions in the emergency department, not just for patients who are actively dying. Consider alternative pathways that can facilitate a quicker disposition such as utilizing CCTAs for chest pain patients. The intensity of the care plan while inpatient tends to follow that started in the ED.

Pediatrics 75

Pediatrics Ultrasounds Fractures Wellness 75

EM SIM Cases

MAY 9, 2023

EHS arrived, provided oxygen supplementation, and brought them to your tertiary emergency department, with access to PICU. Pediatric Emergency Care,32 (9), 623-626. Normal paediatric ECG When the child was brought to the surface, they were unconscious and coughing up foam. doi: 10.1097/PEC.0000000000000477.

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Pediatrics CPR Radiology Radiology 52

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. There is a subset of patients who, despite aggressive conventional resuscitation, have an inadequate hemodynamic response and develop refractory shock. Critical Care Medicine.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

ACEP Now

AUGUST 12, 2024

Dermatology Jeopardy Radiology Jeopardy Eye Can See the Problem Head and Neck ECG Games: Seize the Iron Throne ACEP Knowledge Bowl: Flex your medical knowledge and compete against your peers in the BattleDocs Arena. Emergency Ultrasound Management Course: (Sept. Resuscitation: Hone life-saving clinical measures. 28: 8 a.m.–5:30

Ultrasounds 52

Ultrasounds Research Radiology Radiology 52

Taming the SRU

APRIL 13, 2023

stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e. EtOH, amphetamines, or cocaine) Prescription drugs (i.e.

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Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 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.

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EKG/ECG Ultrasounds Documentation/Coding COPD 40

Taming the SRU

FEBRUARY 22, 2023

Multitasking is performing two tasks simultaneously In studies of emergency physicians, around 70% of responses to an interruption result in a task switch Multitasking accounts for only 8% of responses to interruption Multitasking is only truly possible for manual tasks (hand-washing, gathering equipment, etc.) Paske et al.

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Hospice EKG/ECG Resuscitation Seizures 40

EB Medicine

JUNE 6, 2019

CT is good but you really should learn ultrasound, and lastly, sick patients need prompt consultation and resuscitation, not rapid trips to radiology. Unstable patients do not belong in a radiology suite - they belong in the ED resus bay to be resuscitated first. Nachi: And finally let’s touch upon the ekg and ACS. Review) 83.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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. Ann Emerg Med.

Seizures 84

Seizures EKG/ECG Poisoning Shock 84

EMDocs

OCTOBER 7, 2023

neurologic damage and thrombosis) 20,21 Resuscitation Lactated ringers > Normal saline due to reduced need for urinary alkalinization 22 Place foley and target urine output >300 mL/hr Electrolyte abnormalities Hyperkalemia: Obtain an ECG Stabilization: Calcium gluconate 2 g over 5-10 min. He has no medical problems.

EMS 92

EMS Fluid Resuscitation Fractures Resuscitation 92

ACEP Now

DECEMBER 10, 2023

A middle-aged male with squamous cell carcinoma and extensive metastases is brought to the emergency department (ED) after being found unresponsive following a believed suicide attempt (SA) by methadone ingestion. You want to respect patient autonomy, but is it legal to let him die without any emergency resuscitation?

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Resuscitation EKG/ECG Documentation/Coding Hospitals 52