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 110

Resuscitation EKG/ECG CPR Shock 110

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 84

EKG/ECG Resuscitation Shock EMS 84

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 131

EKG/ECG Allergic Reactions Shock Stroke 131

RebelEM

OCTOBER 11, 2023

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

Anaphylaxis 81

Anaphylaxis EMS EKG/ECG Shock 81

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 136

EKG/ECG Shock Documentation/Coding Academics 136

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 85

EKG/ECG EMS Emergency Department Outcomes 85

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 129

EKG/ECG Shock CPR Stroke 129

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 86

EKG/ECG Shock Documentation/Coding Academics 86

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

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 112

EKG/ECG Shock Hospitals Sepsis 112

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

Dr. Smith's ECG Blog

MAY 3, 2024

She was found by medics agitated, hypotensive, diaphoretic, and in shock. 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).

Shock 113

Shock EKG/ECG Hospitals EMS 113

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 91

Poisoning Seizures Administration EKG/ECG 91

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

Taming the SRU

JUNE 7, 2023

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

Poisoning 70

Poisoning EKG/ECG Pediatrics Burns 70

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

DECEMBER 10, 2022

I was texted this ECG by one of my partners, with the following history: A 60-something male with diabetes and HTN presented with syncope. Per EMS report, the patient had a syncopal episode at work. There are many ECGs that mimic OMI and they may be very difficult to differentiate from OMI. The angiogram was negative.

EKG/ECG 52

EKG/ECG Operations Shock EMS 52

Critical Care Now

JUNE 21, 2022

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

Seizures 52

Seizures EKG/ECG CPR Shock 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 52

Seizures EKG/ECG Shock EMS 52

ACEP Now

MARCH 14, 2024

A 44 year-old male with unknown past medical history came by emergency medical services (EMS) to the emergency department (ED) for an electrical injury and fall from a high voltage electrical pole. Per EMS, the patient was found at the bottom of a high voltage line with diffuse burns and amputation of his left forearm.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

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

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

Dr. Smith's ECG Blog

MAY 13, 2020

A 60-something man presented by EMS with 5 hours of fairly typical sounding substernal chest pain. Here is the EMS ECG: Obviously massive diffuse subendocardial ischemia, with profound STD and STE in aVR Of course this pattern is most often seen from etoliogies other than ACS. It would be a good topic for study.

EKG/ECG 52

EKG/ECG EMS Shock Ultrasounds 52

Dr. Smith's ECG Blog

MAY 14, 2022

Here is his ED ECG: Regular Wide Complex Tachycardia at a rate of 229 First : What do you want to do? Next : What do you think is the ECG diagnosis? I am sure you already shocked it, right?" ECG analysis: T his is a regular wide complex tachycardia. See this post: Idiopathic Ventricular Tachycardias for the EM Physician.

EKG/ECG 52

EKG/ECG Shock Operations EMS 52

Dr. Smith's ECG Blog

MARCH 15, 2023

Here is her EKG: What is unusual about this? Here is the ECG after ibutilide: What do you notice? Here is the post-cardioversion ECG: Sinus rhythm, still with the longer QT interval. We designed a step-up protocol in which shocks at 50, 100, 200, 300, and 360 J were used for transthoracic cardioversion.

EKG/ECG 52

EKG/ECG Dehydration Stroke Wellness 52

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

DECEMBER 18, 2022

Submitted and written by Quinton Nannet, MD, peer reviewed by Meyers, Grauer, Smith A woman in her 70s recently diagnosed with COVID was brought in by EMS after she experienced acute onset sharp midsternal chest pain without radiation or dyspnea. Here is her ECG on arrival to the ED: What is your differential? What are your next steps?

Ultrasounds 52

Ultrasounds EKG/ECG EMS Radiology 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

RebelEM

MARCH 2, 2023

Essentially there was no difference, meaning we wouldn’t expect to find a difference in outcomes Although not patient oriented, why is there no breakdown of how many patients had cardiogenic shock, congestive heart failure, echocardiographic findings, or even troponin levels. appeared first on REBEL EM - Emergency Medicine Blog.

Outcomes 52

Outcomes EMS EKG/ECG Hospitals 52

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. Jeff: And don’t forget to get the crash details from the EMS crew before they depart! In those with severe injury, you may note refractory hypotension secondary to cardiogenic shock.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

EB Medicine

JANUARY 10, 2020

Show More v Please click here and take our listener survey Part 1: Definitions Myocardial Infarction: elevated cardiac biomarkers (aka troponin) with clinical evidence of acute myocardial ischemia (aka signs and symptoms, ECG changes, abnormal imaging, or coronary thrombosis at cath or autopsy). Diagnostics Telemetry ECG.

Emergency Department 40

Emergency Department Shock EKG/ECG Sepsis 40

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 71

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 71

EM Curious

JULY 1, 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. I would definitely give it a read.

EMS 52

EMS Ultrasounds EKG/ECG Fractures 52

Dr. Smith's ECG Blog

APRIL 6, 2018

EMS report was that the patient had unknown down time with unwitnessed arrest, found initially in VFib arrest, defibrillated x1 followed by PEA arrest alternating with asystolic arrest during transport. Each time we shocked it back to sinus rhythm. She did not perform chest compressions prior to EMS arrival. Learning Points: 1.

Shock 52

Shock EMS Wellness Outcomes 52

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

APRIL 22, 2024

EMS verbalized concern to EPs that an “intracranial bleed” may have precipitated the event. However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). During a short period of ROSC an ECG was performed. EKG RV strain.

Ultrasounds 81

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 81

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. For clarity in Figure-1 — I've reproduced her initial ECG.

EKG/ECG 52

EKG/ECG Ultrasounds Documentation/Coding COPD 52