Dr. Smith's ECG Blog

FEBRUARY 22, 2024

Written by Pendell Meyers A woman in her 30s called EMS for acute symptoms including near-syncope, nausea, diaphoresis, and abdominal pain. EMS arrived and found her to appear altered, critically ill, and hypotensive. An ECG was performed: What do you think? She did well and stabilized after dialysis.

EKG/ECG 141

EKG/ECG EMS Shock Wellness 141

Dr. Smith's ECG Blog

OCTOBER 1, 2023

He called EMS who brought him to the ED. He had active chest pain at the time of triage at 0137 at night, with this triage ECG: What do you think? I sent this ECG, without any text at all, to Dr. Smith, and he replied: "LAD OMI with low certainty. Back to the case: Unfortunately, the ECG was not understood by the provider.

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EKG/ECG EMS Ultrasounds Wellness 131

Dr. Smith's ECG Blog

FEBRUARY 6, 2024

Written by Pendell Meyers A teenager was involved in a motor vehicle collision and presented to the Emergency Department via EMS altered and potentially critically ill. Here is his initial ECG around 1330: What do you think? The ECG shows sinus tachycardia with RBBB and LAFB, without clear additional superimposed signs of ischemia.

EKG/ECG 114

EKG/ECG Wellness Fractures Hospitals 114

Dr. Smith's ECG Blog

DECEMBER 3, 2024

This was written by one of our fine residents, who will soon be an EMS fellow: Michael Perlmutter Case A mid-50s male came to the ED with a burning sensation that was acutely worse while at home. Given his history, an EKG, labs including high sensitivity troponin, and chest radiograph were ordered. Another EKG was also obtained.

EKG/ECG 102

EKG/ECG Burns Wellness Shock 102

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" Serial ECGs remained unchanged. But he did well. What do you think?

EKG/ECG 124

EKG/ECG EMS Outcomes Wellness 124

Dr. Smith's ECG Blog

SEPTEMBER 11, 2024

Hope you’re doing well! Here is the case: Report from EMS was witnessed syncope, his son did CPR, but the patient had pulses when EMS arrived. When the patient arrived in the ED, he was still hypotensive in 70s, slowly improving with EMS fluids. Here is the ED ECG (a photo of the paper printout) What do you think?

EMS 113

EMS CPR EKG/ECG Wellness 113

Dr. Smith's ECG Blog

JANUARY 3, 2024

Written by Pendell Meyers A woman in her 70s had acute chest pain and called EMS. On arrival, EMS recorded relatively normal vital signs and this EMS ECG: What do you think? However, saddlebacks are only true saddlebacks when there is a well-formed normal voltage S-wave. No further ECGs were recorded.

EMS 91

EMS EKG/ECG Wellness Outcomes 91

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 134

EKG/ECG Resuscitation Academics EMS 134

EMDocs

JUNE 22, 2024

We’ll keep it short, while you keep that EM brain sharp. The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. According to EMS, she was in labor at home and delivered the newborn shortly after they had loaded her into the ambulance. RR 28, SpO2 89% on 6L NC.

EMS 96

EMS Resuscitation Blood Transfusions Seizures 96

EMDocs

SEPTEMBER 23, 2023

We’ll keep it short, while you keep that EM brain sharp. Physical exam reveals a well-appearing female in no acute distress. Her presenting EKG is shown below. Clinical features Patients often present after an episode of sudden syncope, although Brugada syndrome can also be found on a routine EKG.

EMS 84

EMS EKG/ECG Documentation/Coding Emergency Department 84

Dr. Smith's ECG Blog

JULY 23, 2024

They recorded a prehospital ECG at 2112 and said that it was “normal”. You need to click on it to enlarge it to view it well I was suspicious for inferior and posterior OMI (Large T-wave in aVF, slight STE in lead III with inverted T-wave in aVL, and a slightly downsloping ST with negative T-wave in V2, and minimal STD in I, V5, and V6).

EKG/ECG 115

EKG/ECG Wellness EMS Hospitals 115

Dr. Smith's ECG Blog

OCTOBER 12, 2024

With EMS, patient had a GCS of 3 and was saturating 60% on room air. He improved to 100% with the addition of non-rebreather, however remained altered and was intubated by EMS with ketamine and succinylcholine. EKG on arrival to the ED is shown below: What do you think? 2) There was no terminal QRS distortion on these ECGs.

EKG/ECG 106

EKG/ECG Documentation/Coding Emergency Department COPD 106

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 123

EKG/ECG EMS Documentation/Coding Shock 123

EMDocs

DECEMBER 11, 2023

The most common diagnostic test to identify patients who might require percutaneous intervention is the electrocardiogram (ECG). Emergency physicians have recognized for some time that there are many occlusions of the coronary arteries that do not present with classic STEMI criteria on the ECG.

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EKG/ECG Emergency Department Academics Operations 110

Dr. Smith's ECG Blog

AUGUST 6, 2024

Written by Magnus Nossen with Edits by Grauer and Smith The ECGs in today’s case are from 3 different patients all presenting with new-onset CP ( Chest Pain ). All ECGs were recorded by EMS, and transferred to a PCI capable center for evaluation. For 2 of the 3 patients — the cath lab was activated based on the ECG.

EKG/ECG 91

EKG/ECG Wellness Hospitals EMS 91

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 96

EKG/ECG Shock Wellness EMS 96

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. Adapted from wikipedia.

EKG/ECG 72

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 72

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? Since that moment, she had had shortness of breath as well as pressure-like chest pain. Patient was given aspirin, sublingual nitro as well as heparin. She also has had some coughing at night.

EKG/ECG 75

EKG/ECG Resuscitation Hospitals EMS 75

Dr. Smith's ECG Blog

MAY 23, 2023

EMS arrived and recorded this ECG: What do you think? See same ECG below with computer automated interpretation, using the Glasgow ECG algorithm which apparently is used by many different providers and devices Amazing that the computer calls this normal. Next day ECG. And yet it still says "normal".

EKG/ECG 93

EKG/ECG Wellness Emergency Department EMS 93

RebelEM

SEPTEMBER 28, 2023

ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% The upper range of this time was 120 minutes from diagnostic ECG in the majority of patients.

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EKG/ECG Allergic Reactions Shock Stroke 138

Dr. Smith's ECG Blog

DECEMBER 9, 2023

He had a prehospital ECG. They recorded a prehospital ECG: What do you think? Inferior Aneurysm morphology is incredibly hard to differentiate from Acute OMI, but you should suspect it whenever there are well-formed inferior Q-waves. A 50-something had syncope while driving. He was belted and it was low speed.

EKG/ECG 115

EKG/ECG Seizures Wellness EMS 115

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.

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EKG/ECG Documentation/Coding Psychiatric EMS 128

Dr. Smith's ECG Blog

JUNE 27, 2024

EMS reports intermittent sinus tachycardia and bradycardia secondary to some type of heart block during transport. This is her first ECG in the ED: What do you see? This ECG shows both a right bundle branch block and a posterior fascicular block. QRS complexes have similar RBBB morphology to the prior ECG.

EKG/ECG 124

EKG/ECG Documentation/Coding Emergency Department Wellness 124

Dr. Smith's ECG Blog

APRIL 14, 2024

Here is his first ECG (1/10 pain): Smith: sinus rhythm with RBBB and normal ST-T. An ECG from 4 years prior was the same. In the absence of clear ECG signs of OMI, one should always start with aspirin and NTG, perhaps intravenous NTG, and see if the pain can be managed. He presented on this day because it did not go away.

EKG/ECG 116

EKG/ECG Ultrasounds EMS Wellness 116

Dr. Smith's ECG Blog

APRIL 30, 2024

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. Figure-1: I've labeled the 2 ECGs in today's case.

EKG/ECG 94

EKG/ECG EMS CPR Resuscitation 94

EMDocs

NOVEMBER 19, 2024

1,2 Neuroleptic malignant syndrome (NMS) (hyperthermia, autonomic instability, rigidity, altered mental status [AMS]) can occur as well and is most often seen with clozapine but has been observed with other atypicals. 1,2 Cardiovascular: Obtain an initial EKG to determine the patient’s baseline and repeat. 1 Class IA (e.g.,

Poisoning 90

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 90

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. All patients with seizures needs an ECG.

Seizures 111

Seizures EKG/ECG EMS Stroke 111

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 118

EKG/ECG Ultrasounds Shock EMS 118

RebelEM

SEPTEMBER 21, 2023

ECG shows a regular, narrow-complex, tachycardia at 190 bpm consistent with SVT. Troponins are highly specific to cardiac myocytes but do exist in other muscle types as well. After conversion to sinus rhythm, do a good history, physical and analysis of the ECG. appeared first on REBEL EM - Emergency Medicine Blog.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

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 92

EKG/ECG EMS Emergency Department Outcomes 92

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. Read this post: Idiopathic Ventricular Tachycardias for the EM Physician 2. Definitive diagnosis that ECG #1 is in fact VT is more than academic.

EKG/ECG 141

EKG/ECG Shock Documentation/Coding Academics 141

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 122

EKG/ECG Shock Hospitals Sepsis 122

Dr. Smith's ECG Blog

DECEMBER 15, 2023

The patient contacted EMS after a few hours of chest pain that started 5:30 AM. The ECG below was recorded and electronically transferred to our PCI center for evaluation. ECG #1 I think many providers might be reassured viewing this ECG. This ECG was recorded roughly 3 minutes after the first ECG.

EKG/ECG 63

EKG/ECG EMS Wellness 63

RebelEM

JUNE 1, 2023

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. The cost difference may be modest here as many of the patients in the standard care cohort were getting CTs as well. Resus 2023.

Outcomes 145

Outcomes Resuscitation Hospitals CPR 145

Dr. Smith's ECG Blog

APRIL 29, 2020

EMS arrived and found her in a wide complex PEA rhythm. Her husband stated that she had not been feeling well in the past 2 weeks and c/o dizziness as well as diarrhea. I was texted this ECG in real time, but it turns out to actually be the 2nd one recorded in the ED. CPR was started immediately. Is this inferior MI?

EKG/ECG 52

EKG/ECG CPR Wellness Academics 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

I remember Allie well from her days in the Research volunteer program at Hennepin. She was ventilated by bag-valve-mask by EMS on arrival and was quickly intubated with etomidate and succinylcholine. An initial EKG was obtained: Computer read: sinus tachycardia, early acute anterior infarct. The article is edited by Smith.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

SheMD

DECEMBER 10, 2023

Why would we choose to take care of children as well? One time, I spent ten minutes of a two year old well visit listening to nursery rhymes and songs on a portable karaoke machine. Internists share this interest as well. Periodically, an ED evaluation is warranted and we need to call EMS for an ambulance.

Pediatrics 98

Pediatrics EKG/ECG Wellness Psychiatric 98