Dr. Smith's ECG Blog

NOVEMBER 18, 2019

Here is the ECG: The computer reads a long QT at 449 ms, and a Hodges QTc of 506 ms. Case outcome The Na was 109. This was the etiology of seizures. From EMCrit: Taking control of severe hyponatremia with DDAVP An ECG recorded 2 days later with a K of 4.1: Figure-1: Both ECGs that were done in this case ( See text ).

EKG/ECG 52

EKG/ECG Seizures Stroke Wellness 52

Dr. Smith's ECG Blog

MAY 8, 2014

The preshospital ECG and strips are not available. Here is the first ED ECG: What is the likely diagnosis? There is sinus tachycardia, a prolonged QRS (computer read it as 114 ms, previous ECG with 102 ms). Of 14 with initial QRS of 140 ms or longer, 8 (56%) had seizures. There is a large R-wave in lead aVR.

Seizures 52

Seizures EKG/ECG Administration EMS 52

Mind The Bleep

OCTOBER 29, 2024

Circulation Assess heart rate, blood pressure, peripheral and central CRT, pulses and 3 lead ECG. These systemic effects can include central nervous system (agitation, seizures , and coma), as well as cardiac ( hypotension and dysrhythmias) [10, 11]. Administer high-flow oxygen if indicated and consider arterial blood gas ( ABG ).

Burns 52

Burns Fluid Resuscitation PPE Hyperthermia / Hypothermia 52

Taming the SRU

JUNE 3, 2024

CESAR Trial Published in 2009 Found that even those who didn’t get ECMO, but were transported to a tertiary care center had better outcomes No matter where you go, critical care transport will be part of your life as a sending physician, receiving physician, or both. Benefits of transport are evidenced based.

Shock 91

Shock Seizures Airway Management Stroke 91

Taming the SRU

JANUARY 26, 2024

Wosiski-Kuhn and Stothers BP cuff sizing: Using a cuff too large results in lower SBP, using too small results in higher BP VTE risk with hormonal contraception and NSAIDS Isolated use + and contraception leads to IRR of 7.2 10 or greater days and high or moderate risk hormonal contraception amplifies risk to IRR of 44.8

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

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. What was the outcome?

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

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. What was the outcome?

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

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? Long-term outcome is unknown.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

Dr. Smith's ECG Blog

OCTOBER 6, 2018

At 3:55 AM during that kind of a night shift, this ECG (among many others) was brought from triage for review by my team. We knew only that the ECG belonged to a man in his 50s with chest pain and normal vitals. Here is the computer interpretation: So we have a triage-computer-normal ECG. No prior available.

EKG/ECG 40

EKG/ECG Seizures Documentation/Coding Outcomes 40

Taming the SRU

MARCH 17, 2023

mepivacaine (1-3 h) 1% lidocaine +/- epi (2-3h) 0.25% bupivacaine (2-3 h) 0.25-0.5% mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2 mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2 mg/kg IV Versed: 0.2 mg/kg IM, 0.2 mg/kg IN (may repeat to max of 0.4 mg/kg IN), 0.2

Seizures 40

Seizures Fractures Burns Pediatrics 40

EMDocs

MAY 15, 2024

ECG: Evaluate for ischemia, right heart strain. Causes and outcomes of the acute chest syndrome in sickle cell disease. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS) Underestimates alveolar hypoxemia. Am J Emerg Med. 2022 Aug;58:235-244.

Blood Transfusions 97

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 97

EMDocs

MAY 28, 2024

ECG: Evaluate for ischemia, right heart strain. Causes and outcomes of the acute chest syndrome in sickle cell disease. Infectious: bacterial or viral pneumonia ( M. pneumoniae, C. Based on light absorption from blood flow at the sensor site (using HbA, not HbS). Overestimates arterial oxygen saturation. Am J Emerg Med. PMID: 35717760.

Blood Transfusions 94

Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 94

Taming the SRU

APRIL 13, 2023

stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e. stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

Both of these also cause seizures. Here is the history : Male in 40's who had seizures and was unconscious. There was a good outcome. Suggestions on management: First , examine the ECG very closely for P-waves. due to Na channel blockade. BP 200/100. Pupils dilated. This would treat both SVT or sinus tachycardia.

Seizures 52

Seizures Administration Outcomes Hospitals 52

Taming the SRU

MAY 1, 2023

Patients must have EKG findings and meet one of a few other criteria (ie family history of sudden death, VF or VT episode, syncope, nocturnal agonal respirations) Most common in patients of Southeast Asian descent and the mean age of death from arrhythmia if untreated is in the 4th decade of life.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Taming the SRU

FEBRUARY 22, 2023

doing the little things right, with the understanding that small gains are additive, and that details can be the difference between a good outcome and a poor one. Lesson 11 Find what you love to do and surround yourself with people who make you better at doing it.

Hospice 40

Hospice EKG/ECG Resuscitation Seizures 40

EMDocs

SEPTEMBER 25, 2023

Still, there are those that believe that FPS is more of a physician-centered endpoint that does not fully reflect important patient-centric outcomes (16). Contraindicated seizures or porphyria. Notable Physical Exam: General: Tripoding, severe respiratory distress. Minimal histamine release. Cons: Short duration of action.

Emergency Department 84

Emergency Department Soft Tissue Injuries Airway Management Operations 84

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).

Seizures 84

Seizures EKG/ECG Poisoning Shock 84

ACEP Now

MARCH 11, 2025

It is important that we identify eating disorders in the ED, as the earlier treatment is started, the better the long-term outcomes (similar to schizophrenia), the lower the mortality rate, and the less likely they are to develop serious medical complications. Comorbidity and outcome in eating disorders. Int J Eat Disord.

Emergency Department 52

Emergency Department Psychiatric Dehydration Pediatrics 52

EMDocs

DECEMBER 16, 2023

A 12-lead EKG shows sinus tachycardia but is otherwise normal. As you attempt to examine the patient, he has a generalized, tonic-clonic seizure. Clinical characteristics and outcome of thyroid storm: a case series and review of neuropsychiatric derangements in thyrotoxicosis. 1 Fever is usually < 40C. link] Swee, duS.,

Hyperthermia / Hypothermia 87

Hyperthermia / Hypothermia EMS Stroke Seizures 87

EB Medicine

AUGUST 1, 2018

Jeff: Medicinally, cannabinoids are currently used in the treatment of chronic pain syndromes, complications of multiple sclerosis and paraplegia, weight loss due to appetite suppression in HIV/aids, chemotherapy-induced nausea and vomiting, seizures, and many other neuropsychiatric disorders.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

The Skeptics' Guide to EM

APRIL 9, 2022

The workup can include laboratory testing, EEGs, ECGs, echocardiogram and advanced neuroimaging. Included in this differential is transient epileptic amnesia, transient ischemic attack, stroke, metabolic disorders, psychogenic disorders, and post traumatic amnesia.

Head Injuries 52

Head Injuries Emergency Department Seizures Stroke 52

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. Cardiac Syncope ("True Syncope") Independent Predictors of Adverse Outcomes condensed from multiple studies 1. Abnormal ECG – looks for cardiac syncope.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

EMDocs

NOVEMBER 4, 2024

Pain can be associated with a friction rub on cardiac auscultation, a pericardial effusion on a bedside echocardiogram, or diffuse ST elevations on an EKG. A comprehensive, patient-centered approach to pain management ensures effective treatment across these diverse pain syndromes, ultimately improving patient outcomes. Am J Emerg Med.

Emergency Department 105

Emergency Department Fractures Burns EMS 105

Taming the SRU

AUGUST 25, 2023

patient on AC and remains pharmacologically active rivaroxaban/edoxaban: last dose within 18 hours (or 24 hours if CrCl <50ml/min) apixaban: last dose within 18 hours (or 24 hours if Scr >1.5mg/dL) lab assessment with PT> 16s, anti-Xa level greater of equal to 0.5 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1

Seizures 75

Seizures Fractures EKG/ECG Resuscitation 75

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, 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

Documentation/Coding 64

Documentation/Coding Seizures Psychiatric Wellness 64

Taming the SRU

NOVEMBER 18, 2024

Hiccups in patients with cancer: a multi-site, single-institution study of etiology, severity, complications, interventions, and outcomes. Available at: [link] Ehret CJ, Almodallal Y, Le-Rademacher JG, et al. BMC Cancer. 2022;22:659. doi:10.1186/s12885-022-09760-5 Ergen M, Arikan F, Çetin RF. J Pain Symptom Manage. 2021;62(3).

Stroke 86

Stroke Administration Dehydration COPD 86

Taming the SRU

NOVEMBER 13, 2024

haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., haffner and wright The number of psychiatric emergencies across the U.S., mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 89

Psychiatric Seizures Emergency Department Pediatrics 89

Taming the SRU

FEBRUARY 3, 2025

These can lead to a wide spectrum of emergent complications including but not limited to cardiac dysrhythmias, seizures, and acute renal failure. This can often become significant enough to precipitate dysrhythmias, seizures, and tetany (20). in females and 2.5-7.0 in males) phosphate > 4.5 mg/dl (adults) and > 6.5 Oncologist.

Fluid Resuscitation 56

Fluid Resuscitation Seizures Dehydration Emergency Department 56

EMDocs

FEBRUARY 3, 2025

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). Khan A, Shamim R, Wagan AA, Khan SM, Nazeer Ahmed S, Haroon M. Egypt Rheumatol.

Stroke 64

Stroke EMS Seizures Outcomes 64