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."

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EKG/ECG Wellness Operations Emergency Department 118

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?

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EKG/ECG Emergency Department Outcomes Documentation/Coding 118

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.

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EKG/ECG Documentation/Coding Emergency Department COPD 117

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”.

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EKG/ECG Emergency Department Academics Operations 119

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

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.

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EKG/ECG Outcomes Documentation/Coding Emergency Department 87

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. Queen of Hearts is available and performs well. How about the physicians?

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EKG/ECG Documentation/Coding Emergency Department Wellness 114

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?

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EKG/ECG Emergency Department Wellness 131

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.

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EKG/ECG Documentation/Coding Patient Safety Outcomes 120

EMDocs

DECEMBER 23, 2024

His initial EKG is the following: What do you think? The most recent and well-known trial is the PROCAMIO trial (1). Well, the trial was a multicenter prospective open label trial. Well, lets look at some other trials. It was published in European Heart Journal in 2017. Ok, so what did the PROCAMIO trial find?

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EKG/ECG Shock Wellness EMS 75

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?

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EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 91

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. The patient did well and was referred for ablation.

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EKG/ECG Emergency Department Wellness 137

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

Dr. Smith's ECG Blog

OCTOBER 25, 2023

A man in his 60s with a history of severe alcohol use disorder and epidural abscess on long-term ciprofloxacin presented to the emergency department after an episode of syncope while standing in line at a grocery store. Here is his triage ECG: What do you think? What does the ECG show? What does the ECG show?

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EKG/ECG Seizures Hospitals Stroke 125

Northwestern EM Blog

MARCH 1, 2025

In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Remove ECG leads and patches. The PROSEVA study is the most recent and famous randomized control trial. What are the contraindications to proning? Suction as needed.

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Emergency Department Fractures EKG/ECG Wellness 52

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The ECG below was recorded about 20 minutes after he regained consciousness. ECG #1 The above ECG shows sinus rhythm at about 60 bpm. Figure A It now becomes apparent that there is ST segment depression in almost every lead of the ECG (V1-V6, I, II, aVL and aVF). In the initial ECG (ECG# 1) aVR had ST elevation.

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EKG/ECG Shock Emergency Department Ambulance Services 130

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.

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EKG/ECG Emergency Department Wellness Hospitals 120

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

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

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

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 23, 2023

Physical exam reveals a well-appearing female in no acute distress. 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.

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EMS EKG/ECG Documentation/Coding Emergency Department 102

Dr. Smith's ECG Blog

JUNE 27, 2024

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. This is her first ECG in the ED: What do you see? This ECG shows both a right bundle branch block and a posterior fascicular block.

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EKG/ECG Documentation/Coding Emergency Department Wellness 121

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

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

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. Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST.

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Emergency Department EKG/ECG Operations Fractures 40

Dr. Smith's ECG Blog

JANUARY 15, 2024

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. A patient in their 40s with type 1 diabetes mellitus and hyperlipidemia presented to the emergency department with 5 days of “flu-like” illness.

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EKG/ECG Point-of-Care Testing Wellness Shock 65

ALiEM

FEBRUARY 9, 2024

Intermediate-risk patients may be further stratified based on recent stress testing or coronary angiogram findings plus a modified HEART or Emergency Department Assessment of Chest Pain (EDACS) score. Applying the 2022 ACC guideline Before delving into the specifics of the hs-cTn pathways, start with the ECG.

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EKG/ECG Emergency Department Burns Wellness 110

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 104

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. The AI performed well in both accuracy and in improving sensitivity. Ann Emerg Med. 2024 Aug;84(2):226-227. DOI: 10.1016/j.annemergmed.2024.03.007.

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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.

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EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

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

EMDocs

OCTOBER 8, 2024

Tachycardia may be present both from many medications or drugs, as well as withdrawal. Glucose POC ECG: Is this actually sinus tachycardia? Looking at the initial or even repeating the ECG will be helpful here. Let’s use the example of the well appearing patient, without significant comorbidities. Ann Emerg Med.

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Shock Emergency Department Pediatrics EKG/ECG 105

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

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.

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EKG/ECG Emergency Department EMS Wellness 75

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: Vascular injuries include coagulation necrosis as well as thrombosis. Jeff: You’re right.

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Emergency Department Burns EKG/ECG Shock 40