Don't Forget the Bubbles

JULY 26, 2023

Add into this that the majority of children will be in normal sinus rhythm (NSR) by the time of assessment so to truly identify those who have something wrong we have to be confident in identifying arrhythmias where they are present and critical when analysing an ECG in NSR. All were examined and 98% had an ECG. Family history.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

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. In my experience, the pathologic finding in the above ECG is the easiest one to overlook — especially if you are in a rush and do not do a systematic review.

Seizures 114

Seizures EKG/ECG EMS Stroke 114

Dr. Smith's ECG Blog

SEPTEMBER 9, 2024

Her presenting ECG is shown below: ECG 1 What do you think? I had previously run this ECG through QOH in the PMcardio app environment and she reported mid confidence, shown below. You can see that version 2 has a higher number than version 1, hence she sees the ECG as more OMI-like than version 1. I sent this to Drs.

EKG/ECG 67

EKG/ECG Operations Wellness Ultrasounds 67

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

We will start with his baseline EKG: There is voltage suggestive of LVH. This is his presenting EKG (T= 26min): What do you think? Hence, the term "pseudonormalization", because it is not really normal - LVH should have repolarization changes seen in the baseline EKG. Thus, there is relative ST depression.

EKG/ECG 52

EKG/ECG Wellness Operations Ultrasounds 52

Dr. Smith's ECG Blog

MARCH 19, 2019

This patient presented with weakness, decreased urine output, and vomiting: What is the ECG diagnosis? Here was a repeat ECG: QTc 523. The value of recognizing this particular ECG pattern — is that it may expedite your clinical diagnosis even before laboratory results return. This is pathognomonic for hypocalcemia.

EKG/ECG 52

EKG/ECG Seizures Stroke Operations 52

EMDocs

NOVEMBER 1, 2023

ECG – May show tachycardia or rate related ST depressions Laboratory evaluation: CBC w/ differential – may reveal leukocytosis with left shift CMP, Lipase – can reveal alternative intra-abdominal diagnoses as well as show findings of end-organ hypoperfusion (elevated serum creatinine, transaminitis, etc.)

Operations 86

Operations Radiology Radiology Fluid Resuscitation 86

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. Our first 12 lead ECG was then recorded at 0926. Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

EKG/ECG 52

EKG/ECG Emergency Department Ultrasounds Hospitals 52

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. Out-of-hospital cardiac arrest is a commonly encountered entity in U.S.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

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. A formal echo showed 80% EF and no wall motion abnormality The patient ruled out for MI by troponins Here is the post angiogram EKG: No change, proving that this is the baseline ECG.

EKG/ECG 52

EKG/ECG Operations Shock EMS 52

Dr. Smith's ECG Blog

AUGUST 30, 2023

No prior ECG was available. Here is her triage ECG: What do you think? The ECG was sent to me with no information, and I replied "OMI". I sent this ECG to the Queen of Hearts (PMcardio OMI), and here is the verdict: V1 and V2 have abnormal STE, and V2 has a hyperacute T wave. Figure-1: The initial ECG in today's case. (

EKG/ECG 72

EKG/ECG Operations Wellness 72

Dr. Smith's ECG Blog

APRIL 2, 2014

Here is his prehospital ECG: Diagnosis? He had an immediate ED ECG: There is artifact, but the findings appear to be largely gone now The diagnosis is acute MI, but not STEMI. I saw these ECGs, and since there was no immediate urgency, allowed the resident to manage it without any comment. No evidence of RV MI. was much higher.

EKG/ECG 52

EKG/ECG Operations Wellness Outcomes 52

EB Medicine

MARCH 1, 2019

Nachi: This month’s team parsed through roughly 1200 articles as well as guidelines from the eastern association for surgery in trauma also known as EAST. But don’t be reassured by normal vitals, especially in the young, who may be compensating well despite being quite ill. New EKG findings requires admission for monitoring.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 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. Intubation for clinical course and pain management need to be addressed with disposition to the operating room. Boating Trauma Download [link] ECG Source = [link]

Shock 52

Shock Emergency Nursing Operations Administration 52

Dr. Smith's ECG Blog

OCTOBER 16, 2023

This ECG was texted to me after the fact with no information. This is the ECG that I used for the post. So I submitted the high quality ECG again (the one at the top of this post), and this is what I got: Notice (upper left) now she says "OMI - High Confidence"!! This is a case I posted Saturday, October 14. What do you think?

EKG/ECG 59

EKG/ECG Operations Wellness 59

Dr. Smith's ECG Blog

DECEMBER 20, 2013

Here is his initial ED ECG: The R-wave in V4 extends to 33 mm, the computerized QTc is 372 ms The only available previous ECG is from one year ago, during the admission when he was diagnosed with pericarditis: 1 year ago ECG, with clinician and computer interpretatioin of pericarditis Normal 0 false false false EN-US X-NONE X-NONE What do you think?

EKG/ECG 52

EKG/ECG Wellness Operations 52

Dr. Smith's ECG Blog

APRIL 6, 2023

Medical history: History of Ischemic Heart Disease History of Congestive Heart Failure Diabetes Mellitus requiring treatment with insulin Pre-operative serum creatinine >2 mg/dL He had this ECG recorded: What do you think? They compared to a previous ECG and thought they were identical. Are these ECGs of similar risk?

EKG/ECG 52

EKG/ECG Operations Documentation/Coding Wellness 52

AED Leader

MAY 5, 2024

Zoll AEDs Zoll is a well-known brand in the AED industry, offering a range of reliable and innovative defibrillators. It features a high-resolution color touchscreen display, making it easy to navigate and operate during an emergency. The Lifepak 1000 includes advanced features such as ECG monitoring and manual override.

CPR 52

CPR EKG/ECG Wellness Operations 52

Dr. Smith's ECG Blog

MARCH 2, 2019

This ECG was recorded on a middle-aged male with sickle cell disease and diffuse pain. Here is a Previous ECG for comparison: Baseline LVH Only minimal ST depression Diffuse ST depression with ST Elevation in aVR Knotts et al. Any hypokalemia that results in clear ECG abnormalities, such as here. What do you think?

EKG/ECG 52

EKG/ECG Operations Seizures Stroke 52

Ziqitza HealthCare Ltd

JULY 14, 2023

These ambulances are equipped with a ventilator, defibrillator, oxygen cylinder, electrocardiography (ECG) machine, and a monitoring device, to address life-threatening situations like cardiac arrests and emergencies that require providing oxygen and respiratory support to critically ill patients. cardiac ambulance service.

Ambulance Services 52

Ambulance Services Basic Life Support Operations Stroke 52

Taming the SRU

OCTOBER 30, 2024

Case #2: Facial Swelling CT imaging has seen a significant increase in the last 20 years. ​ Although there has been an increase in imaging, diagnostic yield has remained relatively stable​ Factors the impact imaging decision includes reliability of the physical exam as well as extrinsic factors such as consultants and admitting services.​

Hospitals 52

Hospitals Emergency Department EKG/ECG Documentation/Coding 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? ECG analysis: T his is a regular wide complex tachycardia. Here is the post cardioversion ECG (texted to me): This what I texted back: "Could be WPW. Antidromic WPW).

EKG/ECG 52

EKG/ECG Shock Operations EMS 52

Dr. Smith's ECG Blog

JANUARY 28, 2023

I am immediately worried that this OMI will not be understood, for many reasons including lack of sufficient STE for STEMI criteria, as well as the common misunderstanding of "no reciprocal findings" which is very common with this particular pattern. Probably not the patient's "baseline" ECG, but it was the prior on file.

EKG/ECG 52

EKG/ECG Operations Wellness 52

ACEP Now

MARCH 14, 2024

1,4-5 Thus, an electrocardiogram (ECG) and cardiac monitoring should be performed for unstable, electrical injury patients. 7 Thus, an ECG is recommended for all electrical injuries. His ECG was unremarkable. Syncope can also occur due to disruption of central nervous tissue.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Dr. Smith's ECG Blog

DECEMBER 13, 2019

On exam the patient was well appearing, with normal vitals signs other than BP 155/82, no murmurs or rubs, normal pulses, no reproducible chest pain. Here is his triage ECG: What do you think? A repeat ECG was performed and cardiology was re-consulted: Roughly unchanged. His first troponin T then resulted elevated at 0.19

EKG/ECG 52

EKG/ECG Operations Ultrasounds Wellness 52

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). Notable Physical Exam: General: Tripoding, severe respiratory distress.

Emergency Department 84

Emergency Department Soft Tissue Injuries Airway Management Operations 84

Taming the SRU

AUGUST 4, 2024

We discussed some practices to push learners outside of their comfort zone and promote learning, based on their level as well as their goals for the shift. The largest retrospective cohort study to date (Beyde et al.) shows that most will improve with empiric antibiotics.

Dislocations 85

Dislocations Emergency Department Documentation/Coding Burns 85

Northwestern EM Blog

MAY 2, 2022

There is lower quality evidence for reduced myocardial infarction and mortality risk as well. Additionally, many chambers are not operated on nights and weekends, and of those available at off hours, many are unable to accommodate intubated patients. However, several factors limit HBOT use.

Burns 52

Burns Poisoning EKG/ECG Operations 52

Dr. Smith's ECG Blog

JULY 30, 2023

Here is her triage ECG during active symptoms: What do you think? Luckily, 45 minutes later, with ongoing pain and a troponin I that resulted at 136 ng/L, the ECG was repeated: What do you think now? In Figure-1 — The ST-T wave abnormality in lead V2 of ECG #1 is obvious. The ED physician read this as "Normal sinus rhythm.

EKG/ECG 52

EKG/ECG Operations Resuscitation Wellness 52

Dr. Smith's ECG Blog

DECEMBER 18, 2022

Here is her ECG on arrival to the ED: What is your differential? The ECG is quickly reviewed and shows sinus rhythm with normal QRS complexes. Importantly, there is also STE in aVL, as well as V1. Her prior ECG on file is shown below: What are your next steps? What are your next steps? Do you activate the Cath Lab?

Ultrasounds 40

Ultrasounds EKG/ECG EMS Radiology 40

ACEP Now

JULY 8, 2024

1 Other, non-transformer-based ML methods can be used on clean, well-structured data sets, but LLMs are frequently capable of feats of unanticipated competence right out of the box. As a mechanism for augmenting clinical operations, this approach may show value in passively collecting and feeding information into other systems.

Emergency Department 52

Emergency Department Operations Documentation/Coding EKG/ECG 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

Pediatrics 52

Pediatrics EKG/ECG Wellness Seizures 52

Emergency Medicine Ireland

JANUARY 28, 2021

The ECG waveform is therefore in an LBBB pattern as if the left bundle isn’t working. Perhaps the most common form of pacing will be in the cardiac ICU where we often receive patients from the operating theatre with epicardial wires and a pacing box hanging from the drip stand.

Documentation/Coding 40

Documentation/Coding Operations EKG/ECG Wellness 40

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. Nachi: Unfortunately this procedure is associated with a relatively high re-operation rate – one study found 20% of patients required removal or revision.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

AED Leader

DECEMBER 2, 2024

By incorporating these training components, AED users become well-equipped to handle cardiac emergencies, ultimately aiding in increasing cardiac arrest victim survival rates. Others have ECG capabilities to help diagnose cardiac rhythms like ventricular fibrillation. Training on AED use is recommended to ensure effective operation.

CPR 52

CPR Basic Life Support Resuscitation Hospitals 52

Rural Doctors Net

AUGUST 30, 2013

Smart retrieval services have a presence in the Emergency Operations Centre and will be ‘on standby’ as the initial ambulance call comes through – a much more proactive approach than the usual sequence of calls from first responder-ambulance-local hospital-doctor-retrieval service. You can make a good argument for early intubation.

Burns 52

Burns Hospitals Ambulance Services Wellness 52

EB Medicine

JUNE 6, 2019

For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: Well that’s scary - I know I’ve already missed a case, but luckily, he returned thanks to good return precautions, which we’ll get to in a few minutes. An EKG and troponin should be considered.

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

EB Medicine

AUGUST 1, 2018

Jeff: Because the current DEA controlled substances schedule designations are based on original chemical names, synthetics have gained popularity as manufacturers are able to produce newer compounds and circumvent DEA designation as well as routine urine drug screening tests. Jeff: And the etiology of CHS is not well understood.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40