Dr. Smith's ECG Blog

DECEMBER 9, 2023

He had a prehospital ECG. They recorded a prehospital ECG: What do you think? The Queen of Hearts interprets it blinded also (no clinical information and no previous ECGs or serial ECGs). And that is what we see in the presenting 2 ECGs at the top. A 50-something had syncope while driving. Learning Points: 1.

EKG/ECG 105

EKG/ECG Seizures Wellness EMS 105

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. On ED arrival GCS is 3, there are rapid eye movements to the right but no other apparent seizure activity.

Seizures 72

Seizures Documentation/Coding EKG/ECG Emergency Department 72

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. She reportedly received a landmark guided peripheral nerve block with bupivacaine and shortly thereafter developed generalized seizures. 2,9] Benzodiazepines are the first line treatment for seizures.

Advances Cardiac Life Support (ACLS) 93

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 93

Dr. Smith's ECG Blog

OCTOBER 7, 2019

This is by one of our outstanding 3rd year residents , Aaron Robinson, with some edits and comments by Smith EMS responded to a reported seizure in a 42 year old male. He reports no personal or familial history of seizures. The physicians quickly recognized that this was not a seizure and likely cardiac in nature.

Seizures 40

Seizures EKG/ECG Shock EMS 40

Dr. Smith's ECG Blog

MAY 8, 2014

EMS was called by a roommate after the patient was noticed to be nonverbal and lethargic. His HR was 160 on arrival of EMS, and they gave him adenosine 6 mg and 12 mg and 500 cc NS, but with no response. The preshospital ECG and strips are not available. The preshospital ECG and strips are not available.

Seizures 52

Seizures EKG/ECG Administration EMS 52

Dr. Smith's ECG Blog

JULY 14, 2010

A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. Before EMS arrived, she had "seizure activity" and became unresponsive. She arrived comatose and in cardiogenic shock and the following ECG was recorded. She was intubated.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Seizures EKG/ECG EMS 52

EB Medicine

MARCH 7, 2022

Why is this an important topic in EM? Fever and infection (labs, imaging – US or CT, antibiotics) Cardiopulmonary complaints (labs, imaging, ECG) 11.Treatment Treatment Hemorrhage Headache (CVT) Infection (mastitis, endometritis, wound Infection) Preeclampsia, eclampsia, HELLP, seizures Cardiomyopathy 12.What

Emergency Department 52

Emergency Department Seizures EMS EKG/ECG 52

Dr. Smith's ECG Blog

JUNE 17, 2016

He had a seizure this morning and rolled out of bed unable to get up. The medics recorded a prehospital ECG: The computerized QTc is 397 ms Jason writes: " What's your thoughts Steve?" Unfortunately, the R-wave is cut off on this ECG but it appears as if it would be at least 20 mm. So this was the patient's baseline ECG.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 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. Her electrocardiogram (ECG) showed atrial fibrillation which was cardioverted to sinus rhythm. Benzodiazepines are first-line therapy for seizures. Her QRS interval was 90 and QTc was 491.

Poisoning 67

Poisoning Seizures Pediatrics EMS 67

Dr. Smith's ECG Blog

FEBRUARY 4, 2023

He had a seizure this morning and rolled out of bed unable to get up. The medics recorded a prehospital ECG: The computerized QTc is 397 ms Jason writes: " What's your thoughts Steve?" Unfortunately, the R-wave is cut off on this ECG but it appears as if it would be at least 20 mm. So this was the patient's baseline ECG.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

Evelyn Dell, with edits from Jesse McLaren EMS brought a John Doe, in his 30s, who was found in an urban forest near a homeless encampment on a cool fall day. EMS reported an initial GCS of 8 with pupils equal and reactive. The patient had a witnessed generalized tonic-clonic seizure leading to GCS 4. What do you think?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 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. Seizures should be treated with benzodiazepines. Seizures should be treated with benzodiazepines.

Seizures 52

Seizures Administration Resuscitation Poisoning 52

Dr. Smith's ECG Blog

DECEMBER 26, 2020

Side note: The differential of sudden persistent loss of consciousness with adequate hemodynamics is relatively short: seizure, intracranial hemorrhage, basilar artery occlusion. An ECG was recorded quickly on return to the ED: (sorry for poor quality, cannot get originals) What do you think? Atrial flutter was recognized at this time.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

Emergency Medicine Cases

AUGUST 2, 2022

David Carr joins Anton to give us his simplified approach to syncope based solely on history, physical and ECG to help guide disposition decisions. We answer questions such as: What features have the best likelihood ratios to help distinguish syncope from seizure?

Seizures 52

Seizures EKG/ECG EMS 52

RebelEM

OCTOBER 5, 2022

Rezaie, MD (Twitter: @srrezaie ) The post REBEL Core Cast 87.0 – Hypercalcemia appeared first on REBEL EM - Emergency Medicine Blog. mg/dL 10.5 – 12.0 Read More LITFL: QT Interval LITFL: Hypercalcemia LITFL: Hypercalcemia Post Peer Reviewed By: Salim R.

Dehydration 52

Dehydration Psychiatric Administration EKG/ECG 52

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 67

Operations Radiology Radiology Fluid Resuscitation 67

Taming the SRU

FEBRUARY 23, 2024

Location of the block will determine the morphology of the QRS (as a higher block may have a narrow QRS with a rate of 40-60bpm) Evaluation in the ED: basic labs including BMP and troponin, EKG, bedside echo, CXR Management: Atropine: push-dose 0.5-1mg,

Pediatrics 73

Pediatrics Ultrasounds Fractures Wellness 73

PEMBlog

MARCH 27, 2024

It is not the job or the expectation of the EM provider. They include neurologic dysfunction, which is one of the most common that includes things like developmental delay, regression, AKA loss of developmental milestones, hypotonia, encephalopathy, or seizures. So what are some of these suggestive clinical features?

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

Taming the SRU

MAY 1, 2023

EMS was bagging him on arrival Primary notable for Compromised Airway Protection, bilateral Breath sounds, strong pulses,GCS 3 CT images of Head, Chest, Abdomen, Pelvis, and Spine No acute findings pH of 6.75 Exertional Hyperthermia Patients with heat stroke will present with Temp > 104, AMS, or seizures.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

EMDocs

JULY 19, 2023

Further, organic mercury readily crosses the placenta where it acts as a teratogen leading to a wide range of birth defects including developmental delay, blindness, seizures, and limb malformation. Mercury, in all forms, reacts with sulfhydryl groups in intracellular sites ultimately interfering with multiple enzymatic processes.

Poisoning 66

Poisoning Fluid Resuscitation Administration Seizures 66

EMDocs

SEPTEMBER 25, 2023

Contraindicated seizures or porphyria. Personal take: While discussing this approach with many EM physicians whom we respect, one recurring critique was “We fought so hard to get the right to use paralytics in the ED, why would you want to go backwards.” Notable Physical Exam: General: Tripoding, severe respiratory distress.

Emergency Department 65

Emergency Department Soft Tissue Injuries Airway Management Operations 65

Taming the SRU

FEBRUARY 22, 2023

EMS Grand Rounds with Dr. Connelly - R4 Case Follow up with Dr. Broadstock - R1 Clinical Knowledge: Vitamin Deficiencies WITH Dr. de Castro - Lecture R3 Small Groups Tox,Tasks,Rashes WITH Dr. Fabiano, Dr. Kein, and Dr. Martella4 - Palliative Medicine Consultation WITH Dr. Kiser EMS Grand Rounds WITH Dr. ConnelLy What I learned in my time with Sydney (..)

Hospice 40

Hospice EKG/ECG Wellness Resuscitation 40

EMDocs

JANUARY 4, 2024

Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 Severe toxicity: Seizures: It is unclear if seizures are caused by bupropion or the active metabolite, hydroxybupropion. 3 Seizures are dose-dependent. 3 Seizures are dose-dependent. EMIT II immunoassay).

Seizures 66

Seizures EKG/ECG Poisoning Shock 66

EMDocs

DECEMBER 16, 2023

We’ll keep it short, while you keep that EM brain sharp. A 34-year-old male is brought via EMS after collapsing during an outdoor adventure race. EMS reports the patient was conscious but altered, with slurred speech and confusion. A 12-lead EKG shows sinus tachycardia but is otherwise normal. Temps greater than 41.5C

Hyperthermia / Hypothermia 68

Hyperthermia / Hypothermia EMS Stroke Seizures 68

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, HAJDU Mild TBI’s & Concussions in the Emergency Department TBI’s are relatively common >3 million TBI’s in the US annually 2.5

Documentation/Coding 63

Documentation/Coding Seizures Psychiatric Wellness 63

Critical Care Now

JUNE 21, 2022

Reading Time: 3 minutes Mohamed Hagahmed, MD, EMT-P Mohamed is an Emergency Medicine Physician and EMS director. His coach and fellow players witnessed a seizure-like activity immediately after collapsing. CPR was started immediately after the coaching staff could not find a pulse and EMS arrived to find the patient in cardiac arrest.

Seizures 52

Seizures EKG/ECG CPR Shock 52

EB Medicine

AUGUST 1, 2018

Nachi: Sometimes… Jeff: This month’s issue was authored by Mollie Williams, who is the EM residency program director at the Brooklyn Hospital Center. The rhabdo is believed to be due, in part, to associated seizures, muscle tremors, and agitation. Are we still reviewing talking points together before we start recording these episodes?

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

Dr. Smith's ECG Blog

APRIL 8, 2015

First: Are you sure it was syncope, and not SEIZURE? Conversely , frequently syncope has a short episode of tonic-clonic activity that mimics seizure. Abnormal ECG – looks for cardiac syncope. If no previous ECG was available, ECG was classified as abnormal if any abnormality was present. orthostatic vitals b.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

NOVEMBER 4, 2024

Bhana, MD (EM Resident Physician, University of Massachusetts/UMass Chan Medical School); Clarence Kong, MD (Pain Fellow, Eastern Virginia Medical School – Virginia Health Sciences at Old Dominion University); Mani Hashemi, MD (EM Attending, HCA Florida Mercy Hospital); S.M. 2017.04.011 Witt CE, Bulger EM. Authors: Nikhil B.

Emergency Department 98

Emergency Department Fractures Burns EMS 98

Taming the SRU

NOVEMBER 18, 2024

He is a graduate from the UC EM residency, class of 2023. Editing by Arthur Broadstock, MD Dr. Broadstock is an Assistant Professor of Emergency Medicine at the University of Cincinnati and an Assistant Editor of TamingtheSRU. Cite As: Reed, C. Broadstock, A. Diagnostics: Intractable Hiccups. TamingtheSRU.

Stroke 80

Stroke Administration COPD Dehydration 80

ACEP Now

OCTOBER 29, 2024

EMS found the patient pulseless and apneic, with an initial rhythm showing ventricular fibrillation (see figure 1). Figure 1: The EMS rhythm strip. This ECG in combination with presenting symptom of cardiac arrest raised suspicion for Brugada syndrome. Figure 2: The initial ECG. Click to enlarge.) Click to enlarge.)

Pediatrics 52

Pediatrics EKG/ECG Documentation/Coding Hospitals 52