Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

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.

EKG/ECG 133

EKG/ECG Resuscitation Academics EMS 133

Dr. Smith's ECG Blog

JULY 9, 2024

His family started CPR and called EMS, who arrived to find him in ventricular fibrillation. 15 minutes after EMS arrival, after at least 6 defibrillations, the patient achieved sustained ROSC. He underwent resuscitation including vasopressors, inotropic support, and intubation. The ECG is diagnostic of acute LAD occlusion MI.

EKG/ECG 116

EKG/ECG Resuscitation Shock CPR 116

Emergency Medicine Cases

MAY 10, 2022

On this month's EM Quick Hits: Christina Shenvi on ACS in older people, Nour Khatib on rural NRP, Jess McLaren on how not to get fooled by ECG computer interpretation, Brit Long on hemophilia recognition and workup, Maria Ivankovic on persistent and intractable hiccups from EM Cases Summit 2021.

Resuscitation 52

Resuscitation EMS EKG/ECG Pediatrics 52

Dr. Smith's ECG Blog

JUNE 11, 2023

Here is his triage ECG: He had several more ECGs taken in the resuscitation bay over the next few minutes: What do you think? The ECGs show a wide complex, irregularly irregular tachycardia. The following EKG was obtained after 200J cardioversion: What is your interpretation of this EKG?

EKG/ECG 98

EKG/ECG Resuscitation Shock EMS 98

Dr. Smith's ECG Blog

JANUARY 8, 2024

I was reviewing ECGs for a study, and came across this one, and was able to get all the clinical information: What do you think? I do not have the EKG, but it was described as "non-diagnostic" (that probably means that the physician did not know how to diagnose it). Medics recorded the above ECG and called a STEMI alert.

EKG/ECG 71

EKG/ECG Resuscitation Hospitals EMS 71

Emergency Medicine Cases

JUNE 18, 2024

To support EM Cases, please consider a donation here: [link] The post EM Quick Hits 57 – HIV Diagnosis, Failed Paradigm of STEMI Criteria, Poisoned Patient Airway Management, Spontaneous Bacterial Peritonitis, DIY Investments appeared first on Emergency Medicine Cases.

Airway Management 75

Airway Management Poisoning EMS EKG/ECG 75

RebelEM

JUNE 1, 2023

Population: Patients successfully resuscitated from OHCA without a clear diagnosis on presentation who were stable for CT. Costs include actual cost of the scans as well as delaying other patients’ scans but also includes time taken away from resuscitation to move the patient to and from CT. Resus 2023.

Outcomes 145

Outcomes Resuscitation Hospitals CPR 145

Dr. Smith's ECG Blog

APRIL 30, 2024

He was resuscitated into a perfusing rhythm. Here is the only prehospital 12-lead: Sinus tachycardia, somewhat wide QRS, Ischemia Here is the first ED ECG: What is the rhythm here? This ECG is pathognomonic of hyperkalemia , with wide QRS, very SHARPLY peaked T-waves, flat ST segments, RBBB pattern and large R-wave in aVR.

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EKG/ECG CPR EMS Resuscitation 108

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. The described rhythm was an irregular, wide complex rhythm. No ischemic ST changes. Today's post by Drs.

EKG/ECG 131

EKG/ECG Documentation/Coding Psychiatric EMS 131

Emergency Medicine Cases

OCTOBER 18, 2021

The post EM Quick Hits 33 Polytrauma Tips & Tricks, Toxic Megacolon, ECG in PE, Patch Calls, CT Before LP, Nebulized Ketamine appeared first on Emergency Medicine Cases.

EMS 52

EMS EKG/ECG Ultrasounds Resuscitation 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. Airway plan discussed with resuscitation team. They administer two doses of 10 mg midazolam IM. First attempt with hyperangulated blade.

Seizures 100

Seizures Documentation/Coding EKG/ECG Emergency Department 100

ACEP Now

JULY 7, 2023

17,18 Given this, the advent of extracorporeal membrane oxygenation (ECMO) presents an opportunity to bridge care between traditional resuscitation of refractory VF patients in the ED and more definitive management in the catheterization lab. Resuscitation. Resuscitation. Resuscitation. Resuscitation. N Engl J Med.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Initial ROSC was obtained, during which this ECG was obtained: What do you think? The morphology of V2-V4 is very specific in my experience for acute right heart strain (which has many potential etiologies, but none more common and important in EM than acute pulmonary embolism). CPR was initiated immediately.

EKG/ECG 52

EKG/ECG Resuscitation Ultrasounds CPR 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. Resuscitation. Follow Dr. Clay Smith at @spoonfedEM , and sign up for email updates here. #1: J Thromb Haemost. 2023 Jul 20:S1538-7836(23)00573-1.

Pediatrics 87

Pediatrics Emergency Department Resuscitation EMS 87

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. Her initial EKG showed sinus tachycardia with a QRS of 86 msec and QTc of 414 msec. EMIT II immunoassay). 2011; 109: 418-422.

Seizures 94

Seizures EKG/ECG Poisoning Shock 94

EM SIM Cases

NOVEMBER 12, 2022

EM physicians are required to task switch numerous times, often assessing a new patient immediately after critical interventions have been implemented on their current patient. As soon as tPA is pushed, the resident will be handed an EKG with signs of hyperkalemia and told that a patient with depression has checked in.

Resuscitation 40

Resuscitation Stroke EKG/ECG Fractures 40

EMDocs

APRIL 10, 2024

Authors: Alex Rogers, MD (EM Resident Physician, Christus Spohn/Texas A&M University School of Medicine, Corpus Christi, TX); J.D. 1-3,5,7,9] All patients developing symptoms of LAST should be placed on a continuous cardiac monitor and have an ECG performed. [2] Epidemiology Most common cause: inadvertent intravascular injection.

Advances Cardiac Life Support (ACLS) 111

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 111

EMDocs

NOVEMBER 1, 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!

Operations 95

Operations Radiology Radiology Fluid Resuscitation 95

Emergency Medicine Cases

APRIL 21, 2020

The post EM Quick Hits 17 Adrenal Crisis, Strep Throat, Posterior MI, DKA Just the Facts, Ovarian Torsion Imaging, HINTS Exam, Canadian CT Head Rule appeared first on Emergency Medicine Cases.

EMS 52

EMS EKG/ECG Head Injuries Resuscitation 52

Dr. Smith's ECG Blog

MAY 5, 2022

Submitted and written by Destiny Folk MD , peer reviewed by Meyers, Smith, Grauer, McLaren A man in his early 30s with no significant past medical history was brought to the ED by EMS after being found unresponsive by a friend. EMS arrived and found him awake and alert. Fluid resuscitation was initiated.

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

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

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

EMS recorded the following ECG: What do you see? In other words, the ST segment and T-wave should be discordant to (in the opposite direction of) the positive R' wave [ see the 2nd ECG of this post ]. A male in late middle age with a history of RCA stent 8 years prior complained of chest pain.

CPR 52

CPR Resuscitation EKG/ECG Outcomes 52

EM Curious

JULY 8, 2015

The idea of the FOAMed review is to give you a digestible selection of reliable content from the online EM/CC world that you can fit into your busy weekly schedule. Over a year's span we will be sure to include topics from all core EM content areas.even the ones that may not be the coolest. With a bonus brief on disaster management.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

EMDocs

JANUARY 17, 2024

When emergency medical services (EMS) arrived, she was in asystole with an empty, recently full, bottle of benzonatate 100 mg capsules. She received cardiopulmonary resuscitation (CPR) and standard advanced cardiovascular life support (ACLS). Her electrocardiogram (ECG) showed atrial fibrillation which was cardioverted to sinus rhythm.

Poisoning 92

Poisoning Seizures Pediatrics EMS 92

RebelEM

MARCH 13, 2023

Does the inclusion of patients pronounced dead on scene and the presence of a physician-based EMS organization affect the pooled mortality rate and survival with favorable neurologic outcomes for prehospital TCA? Subcategory data on EMS system type is still extremely variable, given the range of included EMS systems and regions.

Basic Life Support 52

Basic Life Support EMS Outcomes Resuscitation 52

PHEM Cast

APRIL 10, 2016

And from our buddies at HEFT EM CAST: [link] A bit more detail covering some of the research in an easy to understand way. Think about ECG as an example, So, where the box is green, the test has given us the correct result for the patient. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine; 2012 Jun 27;20(1):1–1.

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

It was edited by Smith CASE : A 52-year-old male with a past medical history of hypertension and COPD summoned EMS with complaints of chest pain, weakness and nausea. An immediate 12-lead EKG was obtained: There is ST elevation in leads aVR and V1, with marked ST depression in I, II, III, aVF, V3-V6. What should be done?

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Taming the SRU

JULY 31, 2024

However, believers in this superstition will perceive crazier shifts if the word is uttered so you probably shouldn’t say it, or use cautiously Full moons have no impact on ED, EMS, or HEMS volumes or acuity. Nice people are not more likely to get cancer.

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

The Skeptics' Guide to EM

SEPTEMBER 19, 2020

Alongside his EM residency, he is doing a PhD in epidemiology. Audrey’s academic interests include trauma and resuscitation. Alongside his EM residency, he is doing a PhD in epidemiology. Audrey’s academic interests include trauma and resuscitation. Robert’s academic interests include research and evidence-based medicine.

Academics 52

Academics Resuscitation EMS Stroke 52

Dr. Smith's ECG Blog

JANUARY 19, 2020

Her family called EMS and EMS recorded hypotension and this ECG: What do you think? It is impossible to determine from this ECG if there is also a right ventricular MI, but there is a suggestion of RVMI: the STD in V2 is very deep and yet minimal in V1. This is an obvious inferoposterior OMI. The cath lab was activated.

EKG/ECG 52

EKG/ECG EMS Resuscitation Wellness 52

Dr. Smith's ECG Blog

JULY 24, 2018

We asked for the ECGs to be faxed over while they prepared to transfer him. We received 4 ECGs, including his baseline on file, and three from today, including triage, peri-arrest, and post-ROSC (sorry for the poor quality due to scanning). Prior ECG on file: Sinus tachycardia, imperfect baseline, otherwise unremarkable.

EKG/ECG 52

EKG/ECG Dehydration Resuscitation Documentation/Coding 52

Cook County EM Blog

MAY 29, 2023

As resuscitation measures are underway, you obtain collateral from EMS and parents. Upon EMS arrival, the patient was in cardiac arrest. EMS shows you the prescription bottle with a handful of capsules remaining. The Case: A 4-year-old boy born with no past medical history presents in cardiac arrest.

Seizures 52

Seizures Administration Resuscitation Poisoning 52

EMDocs

APRIL 22, 2024

EMS verbalized concern to EPs that an “intracranial bleed” may have precipitated the event. During this resuscitation two different ultrasound machines were used to capture images due to a malfunction with the first machine after initial images were captured. During a short period of ROSC an ECG was performed. EKG RV strain.

Ultrasounds 98

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 98

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

Written by Pendell Meyers Family of an elderly woman with many comorbidities called EMS when she suddenly experienced shortness of breath, nausea, vomiting, and near syncope. A 12 lead ECG was obtained by EMS and is shown below: What do you think? This one of the highest risk OMI patterns possible to see on an ECG.

EKG/ECG 52

EKG/ECG Shock EMS Documentation/Coding 52

RebelEM

MARCH 30, 2023

However, there are no clear guidelines for management in post-cardiac arrest patients without ST-segment elevations on ECG. Clinical Question : In patients who suffer an OHCA without ST-segment elevation on the post-resuscitation ECG, will early coronary angiogram (CAG) vs. delayed CAG improve outcomes?

Hospitals 62

Hospitals Outcomes EKG/ECG Resuscitation 62

Dr. Smith's ECG Blog

APRIL 7, 2019

This was sent by a reader: Dear Dr Smith, I am an EM resident and a rather new reader of your blog. I am writing to ask for your opinion on an ECG one of my colleagues recently came across. Our triage nurse therefore ordered an ECG for him (which is standard in our dept for epigastric pain patients): What do you think?

EKG/ECG 52

EKG/ECG Resuscitation Wellness EMS 52

EM SIM Cases

NOVEMBER 3, 2023

Jared Baylis and Dr. Kelly Huang Dr. Baylis is the Simulation Medical Director at University of British Columbia – Southern Medical Program and Interior Health, as well as an editor of EM Sim Cases. Heat Related Illness Download ECG Curtesy of Life in the Fast Lane, ECG Library for sinus tachycardia.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG EMS Hospitals 52