Dr. Smith's ECG Blog

JUNE 23, 2024

His daughter immediately started CPR and another family member called EMS. When EMS arrived the patient was in ventricular fibrillation. They shocked him twice before return of spontaneous circulation. Here is his presenting ECG: ECG 1, t = 0 What do you think? Smith's ECG Blog.

EKG/ECG 118

EKG/ECG CPR EMS Hospitals 118

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. She denies chest pain.

EKG/ECG 97

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 97

RebelEM

SEPTEMBER 28, 2023

The STREAM-1 trial found that for [2] patients with STEMI presenting within 3 hours of symptom onset and unable to attain PCI within 1 hour of first medical contact, a pharmaco-invasive strategy resulted in similar rates of death, shock, heart failure, or reinfarction compared to primary PCI. Primary PCI: 95.7% Primary PCI: 95.7%

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

EMDocs

DECEMBER 23, 2024

His initial EKG is the following: What do you think? Do we still shock? If procainamide is utilized, a baseline EKG should be obtained to assess the QRS and QTc at baseline. After a little bit of etomidate and a quick shock, the patient was back in normal sinus rhythm and cardiology was consulted for evaluation.

EKG/ECG 75

EKG/ECG Shock Wellness EMS 75

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Written by Pendell Meyers A man in his 40s called EMS for acute chest pain that awoke him from sleep, along with nausea and shortness of breath. In EMS2 ECG, the T waves in V5 is possibly hyperacute. I focus my comment on the KEY ECG findings that led to this decision. Vitals were within normal limits except for tachypnea.

EKG/ECG 121

EKG/ECG EMS Documentation/Coding Shock 121

RebelEM

OCTOBER 11, 2023

When reviewing a syncope ECG, scour it for WPW, Brugada, Hypertrophic Cardiomyopathy, Prolonged/Short QTc and ARVC.

Anaphylaxis 103

Anaphylaxis EMS EKG/ECG Shock 103

Dr. Smith's ECG Blog

SEPTEMBER 19, 2023

Initial ED ECG: What do you think? Then we must consider clinical data other than the ECG, for a pretest probability : Of all wide complex tachydysrhythmias, the majority are VT. Shocked x 2 without effect. Warning: if this is VT, a calcium channel blocker can result in shock and death. Why did I say that? What to do now?

EKG/ECG 139

EKG/ECG Shock Academics Documentation/Coding 139

Dr. Smith's ECG Blog

JUNE 11, 2023

He states that he has a heart condition which he does not know the name of and that he has felt his heart race like this once before and needed to be shocked. Here is his triage ECG: He had several more ECGs taken in the resuscitation bay over the next few minutes: What do you think? 2 hrs later: Still sinus with subtler WPW.

EKG/ECG 98

EKG/ECG Resuscitation Shock EMS 98

Dr. Smith's ECG Blog

JULY 25, 2024

EMS arrived and found him in Ventricular Fibrillation (VF). The patient was brought to the ED and had this ECG recorded: What do you think? The ECG shows severe ischemia, possibly posterior OMI. For clarity in Figure-1 — I've reproduced today's ECG — obtained following successful resuscitation of out-of-hospital cardiac arrest.

Resuscitation 124

Resuscitation EKG/ECG CPR Shock 124

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

When EMS found her, she was dyspneic and diaphoretic. Her ECG is shown below: What do you think? The conventional machine algorithm interpreted this ECG as STEMI. Alternatively, with STE in V1 and III, and STD in I and aVL, this ECG could represent proximal RCA OMI with right ventricular involvement.

EKG/ECG 128

EKG/ECG Ultrasounds Shock EMS 128

Dr. Smith's ECG Blog

APRIL 2, 2024

He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. Here is the initial ED ECG. Another ECG was recorded 12 minutes later: Paced rhythm, probable Pacemaker-Mediated Tachycardia ? ECG with LBBB and QRS of > 210 ms. What do you think?

EKG/ECG 133

EKG/ECG Shock CPR Stroke 133

Taming the SRU

MARCH 10, 2024

Soon you’ll be able to view our whole pathway on the QI/KT page, but for now, we hope everyone remembers these points: 1) Get labs and an EKG on everyone presenting with hypoglycemia. ECG is a must for EVERY syncope patient. It is not specific enough in defining specific findings on the ECG that should be considered high risk.

EKG/ECG 97

EKG/ECG Shock Wellness EMS 97

ACEP Now

JANUARY 4, 2025

The specialty, he said, spoke to his interest in surgery and EMS in a way that family medicine did not. A closer look, though, also shows the technology of the daya bulky, two-way radio for communicating with EMS, metal gurneys, glass saline bottles, and portable ECG monitors the size of a small shopping cart. Click to enlarge.)

Forensics 52

Forensics Urgent Care Hospitals Emergency Department 52

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The below ECG was recorded. The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. This ECG does not have the typical ST-vector of an LAD occlusion. This is lucky!

EKG/ECG 131

EKG/ECG Shock Hospitals Sepsis 131

Dr. Smith's ECG Blog

OCTOBER 1, 2024

== MY Comment , by K EN G RAUER, MD ( 8/30 /2024 ): == I was sent the ECG shown in Figure-1 — knowing only that the patient was being seen in the ED ( E mergency D epartment ). Figure-1: The initial ECG in today's case. After seeing ECG #2 — Can you explain: i ) Why no negative P wave was seen in lead V1 of ECG #1? —

EKG/ECG 113

EKG/ECG Shock EMS 113

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

Dr. Smith's ECG Blog

AUGUST 9, 2024

These diagnoses were not found in his medical records nor even a baseline ECG. An ECG was obtained shortly after arrival: What do you think? There is no evidence of WPW on this ECG, but it is diagnostic for OMI. If the LAD is completely occluded, then why does the ECG show reperfusion? What are we seeing here?

EKG/ECG 107

EKG/ECG EMS Emergency Department Wellness 107

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 ).

Poisoning 104

Poisoning Seizures Administration EKG/ECG 104

Dr. Smith's ECG Blog

OCTOBER 3, 2017

He received aspirin en route via EMS, and no EMS ECGs are available. Here is his ECG on presentation to the ED, approximately 45 minutes after onset of pain, but with pain improving since onset: What is your interpretation? I sent this ECG with no clinical information to Dr. Smith.

EKG/ECG 52

EKG/ECG CPR Shock EMS 52

Dr. Smith's ECG Blog

NOVEMBER 3, 2023

The baseline ECG is basically normal with no ischemia. Here is what the Queen of Hearts says about the Baseline ECG: Active chest pain triage ECG also read as not OMI: She says "not OMI", but she does not have access to the baseline ECG. In the future, we will be able to have her compare with previous and serial ECGs.

EKG/ECG 83

EKG/ECG Shock Documentation/Coding Academics 83

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

EMS was activated and recorded the following ECG (scanned from a prehospital ECG, so the quality is not perfect): Notice the small Q wave in V1 followed by a very large R-wave, with a prolonged QRS. Angiography revealed a very tight LAD stenosis with some flow (confirming the reperfusion that we see on the ECG).

EKG/ECG 52

EKG/ECG Shock EMS Outcomes 52

EMDocs

JANUARY 4, 2024

Cardiogenic shock and hypotension can occur (systolic heart failure with reduced ejection fraction.) 10,12 Refractory shock or malignant arrhythmias occur in < 5% of patients. 3 Always get an EKG to assess for cardiotoxicity, including widened QRS and prolonged QTc, although this may not be evident right away.

Seizures 94

Seizures EKG/ECG Poisoning Shock 94

Taming the SRU

JUNE 7, 2023

CPC: Rheumatic Fever - Carbon Monoxide Poisoning - Pediatrics: Toxicology - Combined EM/IM: Competency CPC: Rheumatic Fever WITH Drs.

Poisoning 76

Poisoning EKG/ECG Pediatrics Burns 76

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. The TOMAHAWK Investigators.

EKG/ECG 52

EKG/ECG Academics EMS CPR 52

Pediatric EM Morsels

MARCH 17, 2023

J Emerg Trauma Shock. doi:10.1186/1757-1626-1-16 The post Snake Bites and Children appeared first on Pediatric EM Morsels. But that puts them at risk for snake bites in some areas. Emergency treatment of a snake bite: Pearls from literature. 2008;1(2):97-105. doi:10.4103/0974-2700.43190 Venomous snake bites: Symptoms & first aid.

CDC 130

CDC Poisoning Pediatrics Shock 130

ACEP Now

JULY 7, 2023

However, between four and five percent of cases of VT or VF will be refractory to standard management, with nonperfusing arrhythmia persisting despite repeated shocks. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. amiodarone or lidocaine). Resuscitation. Sakai T, et al.

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

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Past medical history included RBBB without other cardiac history, but old ECG was not available. As for the ECG, it could represent OMI, but RBBB is also a clue that it may be PE. The paramedic notes called STEMI into question: “EMS disagree with monitor for STEMI callout. Vitals were normal except for oxygen saturation of 94%.

EKG/ECG 73

EKG/ECG EMS Shock Ultrasounds 73

EM Curious

MAY 27, 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. Read on here at Boring EM.

EMS 52

EMS Shock EKG/ECG Pediatrics 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. Here is the initial ED ECG: What do you think?

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 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

EM SIM Cases

SEPTEMBER 19, 2024

WHY IT MATTERS Patients in hemorrhagic shock require blood products expeditiously as well as identification and definitive management of the source of bleeding. This case provides an opportunity to practice identification and treatment of multiple sources of blood loss in hemorrhagic shock.

Shock 52

Shock Emergency Nursing Operations Administration 52

EB Medicine

DECEMBER 1, 2021

Risk Factors Prehospital Care – what should EMS be looking for? Table 3 ADD-RS score Exam Diagnostics Labs EKG – STEMI? Imaging CXR Echo CT MRI Aortogram Treatment BP management Heart Rate Shock Surgery – Who goes and when? Risk Factors* Prehospital Care – what should EMS be looking for? *

EKG/ECG 52

EKG/ECG Emergency Department EMS Shock 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

Dr. Smith's ECG Blog

OCTOBER 28, 2022

Cortland Ashbrook from Spokane County, Washington, sent this message: Hey doctor Smith, I wondered if you’d give me your opinion on these ECG tracings I took as a paramedic in the field? Here are the ECGs: Here I use the PMCardio app (from Powerful Medical ) to clean and digitize the image: There is a paced rhythm, with wide QRS.

EKG/ECG 52

EKG/ECG EMS Shock Wellness 52

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. One of our EMS Fellows along with a Senior EM Resident were on duty that evening, and arrived on the scene with the Fire Department. Why is the patient in shock?

Seizures 40

Seizures EKG/ECG Shock EMS 40

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