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ECG Cases 45 ECG in Weakness and Neurological Symptoms
Emergency Medicine Cases
SEPTEMBER 12, 2023
The post ECG Cases 45 ECG in Weakness and Neurological Symptoms appeared first on Emergency Medicine Cases.
EKG/ECG EMS Seizures 
EM@3AM: Amniotic Fluid Embolism
EMDocs
JUNE 22, 2024
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. A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. She had a precipitous delivery while the ambulance was pulling in.
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Annals ECG of The Month
ACEP Now
FEBRUARY 18, 2025
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.
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emDOCs Revamp: Alcohol Withdrawal
EMDocs
DECEMBER 18, 2024
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.
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Syncope While Driving. Activate the Cath Lab?
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.
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REBEL Core Cast 109.0 – Na Channel Blocker Poisoning
RebelEM
SEPTEMBER 27, 2023
REBEL Core Cast 109.0 – Na Channel Blocker Poisoning Click here for Direct Download of the Podcast Definition and Physiology Standard definition of a wide QRS is anything > 120 msec (3 small boxes on the ECG) In the context of poisoning, a “wide QRS” is anything greater than 100 milliseconds. Boehnert 1985 ). N Engl J Med.
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emDOCs Podcast – Episode 86 Tricky Cases Part 2
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.
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Agitation and Tachycardia
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.
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Cardiac Arrest, Ventricular Fibrillation, Inferior and Right ventricular MI (RVMI) or "Pseudoanteroseptal MI"
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.
Episode 67 – Managing Postpartum Complications in the Emergency Department – An Interview with Dr. Nicole Yuzuk, Dr. Joseph Bove, and Dr. Riddhi Desai
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
ToxCard: Benzonatate
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.
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Anterior STEMI? Or Benign Early Repolarization?
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.
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This patient did not present with chest pain
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.
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Unconscious + STEMI criteria: activate the cath lab?
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?
The Toxic Shelf
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.
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A 50 year old man with sudden altered mental status and inferior STE. Would you give lytics? Yes, but not because of the ECG!
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.
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Ep 172 Syncope Simplified with David Carr
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?
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emDOCs Revamp: Esophageal Perforation
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!
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REBEL Core Cast 87.0 – Hypercalcemia
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.
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Grand Rounds Recap 2.7.24
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,
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Sweet! A Metabolic Disorders focused podcast episode
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?
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ToxCard: Organic Mercury Poisoning
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.
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Grand Rounds Recap 4.19.23
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.
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Seizure in a 30 something
Dr. Smith's ECG Blog
SEPTEMBER 2, 2024
Her husband called EMS when the patient experienced new onset seizures accompanied by micturition. The ECG below was recorded by EMS. ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. At first glance, the ECG does not look too abnormal. What is your assessment?
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Grand Rounds Recap 2.15.23
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 (..)
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Chest Pain in Children: ReBaked Morsel
Pediatric EM Morsels
MAY 10, 2024
Add the risk assessment for sudden cardiac death into your workflow Have you ever fainted or had a seizure without warning, during exercise or in response to a loud noise? EKG Reasonable screen for cardiac etiology [ Kane, 2010 ]: Chest Pain with Exertion? Have you ever had chest pain or shortness of breath in exercise? Ultrasound J.
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ToxCard: Second Generation Antipsychotic Overdose
EMDocs
NOVEMBER 19, 2024
1 Seizures may occur due to lowered seizure threshold. 6 Seizures have been observed and are dose-dependent. 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. 8 Hypersalivation can occur.
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ToxCard: Local Anesthetic Systemic Toxicity
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.
ToxCard: Bupropion
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).
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Beyond Ketamine: When to use Facilitated Intubation in the ED
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.
Grand Rounds Recap 5.3.23
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
A 40-Something male with a "Seizure," Hypotension, and Bradycardia
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.
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Catecholaminergic Polymorphic Ventricular Tachycardia: Recognize And Treat It Early
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.
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EM@3AM: Hyperthermia
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
Episode 19 - Cannabinoids: Emerging Evidence in Use and Abuse
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?
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Emergency Department Syncope Workup: After H and P, ECG is the Only Test Required for Every Patient.
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.
Pain Management of Common Chief Complaints in the ED
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.
Acute coma, then Sudden PEA arrest in front of paramedics, with STEMI?
Dr. Smith's ECG Blog
FEBRUARY 20, 2025
She was brought to the ED in a deep coma with GCS of 3, with vital signs, and an ECG was recorded: What do you think? From the ECG alone, the diagnosis can only be suspected.) By ECG alone: it is suspicious for stress cardiomyopathy, or takotsubo, due to the diffuse ST Elevation: II, III, aVF AND I and aVL.
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Diagnostics: Intractable Hiccups
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.
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Systemic Lupus Erythematosus: ED presentations, evaluation, and management
EMDocs
FEBRUARY 3, 2025
Collins, MD (EM Resident Physician, San Antonio, Texas); Michael J. These complications affect both the central and peripheral nervous systems and encompass a wide range of conditions, including transient ischemic attacks (TIA), stroke, headaches, mood disorders, seizures, psychosis, neuropathy, and cognitive dysfunction (1,6,7).
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Case Report: Cardiac Arrest in a Child’s Structurally Normal Heart
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.)
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