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I was sent the 2 ECGs shown in Figure-1 — which were recorded from an elderly man whose heart beat "has been irregular for years". Regarding the 2 ECGs in Figure-1 : ECG #1 is the initial tracing obtained at the scene by the EMS ( E mergency M edical S ystems ) team — in association with an alert but markedly hypotensive patient.
For full discussion of this case — See ECG Blog #351 — == The ECG in Figure-1 — was obtained from a previously healthy older man who contacted EMS ( E mergency M edical S ervices ) because of "chest tightness" that began ~1 hour earlier. Given this history: QUESTIONS: How would YOU interpret the ECG in Figure-1 ?
The ECG in Figure-1 was obtained from a man in his 60s — who described the sudden onset of "chest tightness" that began 20 minutes earlier, but who now ( at the time this ECG was recorded ) — was no longer having symptoms. In view of this history — How would YOU interpret this ECG? Figure-1: The initial ECG in today's case. (
The ECG in Figure-1 — was obtained on the scene by EMS ( E mergency M edical S ervices ). He was hemodynamically stable — but clearly distressed with a sense of “impending doom” at the time ECG #1 was recorded. QUESTIONS: How would YOU interpret the initial ECG in Figure-1 ? Figure-1: The initial ECG in today's case.
For full discussion of this case — See ECG Blog #392 — == The ECG in Figure-1 was obtained from a man in his 60s — who described the sudden onset of "chest tightness" that began 20 minutes earlier, but who now ( at the time this ECG was recorded ) — was no longer having symptoms. Figure-1: The initial ECG in today's case. (
The post EM Quick Hits 62 Optimizing RSI Medication Timing, ED Boarding of Older Patients, Prolonged Tourniquet Use, Rural Peer Support Programs, ECG Reciprocal Changes, Nutrition Tips for Shift Workers appeared first on Emergency Medicine Cases.
The ECG in Figure-1 was obtained from a middle-aged woman — who presented with low back pain, shortness of breath and marked hypertension — but no CP ( C hest P ain ). QUESTIONS: In view of this history — How would YOU interpret this ECG? Figure-1: The initial ECG in today's case. Figure-1: The initial ECG in today's case.
This week, we feature a post from Dr. Tannenbaums ECG Teaching Cases , a free ECG resource. Without further ado, lets look at some ECGs! I dont think this is normal the tech tells you as he hands you an ECG. Hes stable for the moment, so lets take a look at his ECG: Rate: really fast! Please check it out.
This was sent by an undergraduate (not yet in medical school, but applying now) who works as an ED technician (records all EKGs, helps with procedures, takes vital signs) and who reads this blog regularly. He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic.
She had an ECG recorded: This is left bundle branch block (LBBB), with appropriate proportional discordance. Dodd KW, Elm KD, Dodd EM, Smith SW. Here is one of the strips This is clearly polymorphic VT and probably torsade de pointes Subsequent ECGs. CT of the chest showed no pulmonary embolism but bibasilar infiltrates.
EMS obtained the following vital signs: pulse 50, respiratory rate 16, blood pressure 96/49. It appears EMS obtained two EKGs, but unfortunately these were not saved in the medical record. The EMS crew was only BLS certified, so EKG interpretation is not within their scope of practice.
Recommend obtaining multiple EKGs to aid in the diagnosis of cardiotoxic effects such as dysrhythmias or interval widening, even if not apparent immediately after the overdose. 1,2 Cardiovascular: Obtain an initial EKG to determine the patient’s baseline and repeat. His roommate found an empty pill bottle on the floor next to him.
EKG Reasonable screen for cardiac etiology [ Kane, 2010 ]: Chest Pain with Exertion? doi:10.1186/s13089-021-00205-x The post Chest Pain in Children: ReBaked Morsel appeared first on Pediatric EM Morsels. Is there a family history of sudden death, hypertrophic cardiomyopathy, long QT syndrome, or tachyarrhythmias? Ultrasound J.
The ECG in Figure-1 was obtained from an elderly man with a history of coronary disease — who contacted EMS for "burning" chest discomfort that woke him at 3am. QUESTIONS: How would YOU interpret the initial ECG in today's case? In view of the above history — Does ECG #1 suggest an acute event?
Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. If this EKG were handed to you to screen from triage without any clinical information, what would you think? Do you appreciate any dynamic changes compared to the patient’s prior EKG? What do you think?
The ECG in Figure-1 was obtained from a previously healthy middle-aged man — who while performing his regular exercise routine, developed "slight" chest discomfort and "palpitations". These symptoms persisted for over an hour, which led the patient to contact EMS. Figure-1: The initial ECG in today's case. What would you do?
When you are presented with a tachycardic ECG, there are two major factors we want you to focus on right away. This ECG comes from a 22-year-old female presenting with palpitations. Take a look at her ECG: What do you notice about this ECG? Take a look at his ECG: What do you notice about this ECG?
Eckler, MD discuss the January 2025 Emergency Medicine Practice article, Alkali Exposure: An Evidence-Based Approach to Diagnosis and Treatment Patient Demographics and Case Scenarios: Types of patients prone to alkali exposure Causes and scenarios leading to alkali exposure (e.g.,
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.
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.
He called EMS who brought him to the ED. He had active chest pain at the time of triage at 0137 at night, with this triage ECG: What do you think? I sent this ECG, without any text at all, to Dr. Smith, and he replied: "LAD OMI with low certainty. Back to the case: Unfortunately, the ECG was not understood by the provider.
Olivia Ostrow on the management of button battery ingestions, Brit Long on C difficile infection, Jesse McLaren on an approach to ECG's in the tox patient, Joe Mullally on the identification and treatment of bed bug bites, Andrew Petrosoniak on fibrinogen replacement in bleeding trauma patients, Justin Morganstern on Cold Air for Croup.
If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately. POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations. If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately.
Upon EMS arrival the male is noted to be anxious and tremulous with a GCS of 14. A 36-year-old male presents to the emergency department after being found down at home by his spouse. Per the mans wife, the patient is a heavy drinker often consuming two to three pints of vodka daily.
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. Take a look at her ECG: Figure 3: ECG from a 75-year-old female with palpitations. Take a look at this ECG. Take a look at this ECG.
We’ll keep it short, while you keep that EM brain sharp. According to EMS, she was in labor at home and delivered the newborn shortly after they had loaded her into the ambulance. The post EM@3AM: Amniotic Fluid Embolism appeared first on emDOCs.net - Emergency Medicine Education. link] j.ajog.2016.03.012
Written by Pendell Meyers A woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed: What do you think? Here is her ECG the next day with normal potassium level: She did well.
In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. The post ECG Cases 49 – ECG and POCUS for Dyspnea and Chest Pain appeared first on Emergency Medicine Cases.
ECG Pointers: A Dynamic Approach to Tachydysrhythmias Part 2 Lloyd Tannenbaum, Mai Saber, and Rachel Bridwell cover narrow and irregular tachydysryhtmias. ECG Pointers: A Dynamic Approach to Tachydysrhythmias Part 3 Lloyd Tannenbaum, Mai Saber, and Rachel Bridwell return are back on the list to cover wide and irregular tachydysrhythmias.
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. Vital signs include BP 168/89, HR 96, T 98.3,
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? The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia.
Written by Pendell Meyers A woman in her 70s had acute chest pain and called EMS. On arrival, EMS recorded relatively normal vital signs and this EMSECG: What do you think? The EMS crew recorded another ECG about 10 minutes later (unknown if pain changed): New LAFB. No further ECGs were recorded.
In this ECG Cases blog we look at 5 cases of ECGs falsely labeled 'normal'. October 2024 Five patients presented with ECGs labeled ‘normal’. Can you use systematic ECG interpretation to identify the [.] The post ECG Cases 51 – ECGs falsely labeled “normal” appeared first on Emergency Medicine Cases.
Below are serial ECGs focusing on the inferior leads and aVL. First, what’s the interpretation of each ECG on its own? #1 2 Normal ECG #3. 2 Normal ECG #3. But 90 minutes later troponin returned at 70ng/L (normal <26 in males and <16 in females), and a repeat ECG was done (ECG#2) for recurring chest pain.
There were 2 prehospital ECGs: What do you think? When I was shown this ECG, I said it looks like such widespread ischemia that is might be a left main occlusion, or LM ischemia plus circumflex occlusion (high lateral and posterior OMI). Total Left Main Occlusion presents with different ECG findings which are multi-faceted.
Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both cases had an EMSECG that was transmitted to the ED physician asking "should we activate the cath lab?" Serial ECGs remained unchanged. Both were awake and alert with normal vital signs.
Help Support EM Cases by Giving a Donation here: [link] The post EM Quick Hits 59 Traumatic Coronary Artery Dissection, Proper Use of Insulin, Mesenteric Ischemia, Exercise Associated Hyponatremia, AI for OMI appeared first on Emergency Medicine Cases.
What do you think of the ECG, and does it matter? I sent this to the Queen of Hearts So the ECG is both STEMI negative and has no subtle diagnostic signs of occlusion. 2] This is because, contrary to Bayesian reasoning, the STEMI paradigm is named after and defined by one part of one test: ST elevation on ECG. But only 6.4%
Don't miss his analysis and assessment of the Queen of Hearts AI OMI ECG bot -- that assessment is at the very bottom of the post. Here is her ED EKG: What do you think? I would have very high suspicion for OMI on this ECG. EMS arrived to a pulseless patient in V fib. But which artery? A chest x-ray was unremarkable.
With EMS, patient had a GCS of 3 and was saturating 60% on room air. He improved to 100% with the addition of non-rebreather, however remained altered and was intubated by EMS with ketamine and succinylcholine. EKG on arrival to the ED is shown below: What do you think? 2) There was no terminal QRS distortion on these ECGs.
Here is the case: Report from EMS was witnessed syncope, his son did CPR, but the patient had pulses when EMS arrived. When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Here is the ED ECG (a photo of the paper printout) What do you think? No Chest Pain, but somnolent.
This was written by Magnus Nossen, from Norway, with comments and additions by Smith A 50 something smoker with no previous medical hx contacted EMS due to acute onset chest pain. Upon EMS arrival the patient appeared acutely ill and complained of chest pain. An ECG was recorded immediately and is shown below.
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