Dr. Smith's ECG Blog

MAY 30, 2023

His prehospital ECG was diagnostic of inferior posterior OMI. Here is his ED ECG: There is bradycardia with a junctional escape. We recorded an ECG in which V1-V3 were put in the position of V4R-V6R, and V4-6 were placed in V7-9 to (academically) confirm posterior OMI. The patient was in clinical shock with a lactate of 8.

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Shock EKG/ECG Academics Stroke 78

Broome Docs

MARCH 28, 2024

If you want to see Justin in the video format and his new Youtube series then click here: [link] If you would like to check out my current ultrasound training project then click here: WACHS Ultrasound Otherwise – enjoy the show and see you in a few weeks. Myth 3: The ECG changes from hyperkalemia are predictable and reliable.

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PPE Ultrasounds Resuscitation Administration 107

Taming the SRU

AUGUST 7, 2023

The patient needs a transvaginal ultrasound w/ doppler with gynecology consult and possible laparotomy TVUS is not just for torsion, it can also be used for ectopic pregnancies or pregnancy of unknown location Acute Ischemic Stroke Updates WITH Drs. hours increased the NNT for a good outcome to 20. The expanded window of 3-4.5

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Stroke Outcomes EKG/ECG Research 92

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. He reported a history of “Wolf-Parkinson-White” and “heart attack” but said neither had been treated.

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EKG/ECG EMS Emergency Department Outcomes 86

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

The EKG shows sinus tachycardia with nonspecific changes and no ST segment elevations, Q waves, or hyperacute T waves. Her point-of-care ultrasound (POCUS) shows appropriate-appearing global ejection fraction and no marked wall motion abnormalities. The AHA has a statement with recommendations based on the available data.

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Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Our first 12 lead ECG was then recorded at 0926. What do you think?

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Dr. Smith's ECG Blog

NOVEMBER 15, 2023

She has no previous cardiac history of which she is aware 911 was called and here is her Prehospital ECG: What do you think? link] Case continued She arrived in the ED and here is the first ED ECG. In comparison with the first ECG, I would guess that the artery is reperfusing. I don't know if her pain was getting better or not.

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Dr. Smith's ECG Blog

JUNE 14, 2017

A bedside cardiac ultrasound was normal. An ECG was recorded: Avinash was understandably confused by this ECG. He wrote: "ECG 1 - shows wide ???IVCD I sent it to my friend, Ken Grauer , who is very meticulous in his ECG reading. I labeled ECG. His chest was tender. IVCD type rhythm ??

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EKG/ECG Documentation/Coding Ultrasounds Wellness 52

Sensible Medicine

JUNE 28, 2024

There were no personal crises or untoward patient outcomes. The plan was that she would get a two-week, continuous EKG monitor placed and have a sleep study at this hospital. Last week was one of them. She follows up at a “highly ranked” west coast academic medical center, near where she lives half the year.

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Stroke Academics Hospitals EKG/ECG 82

ACEP Now

OCTOBER 9, 2024

In the emergency department (ED), physicians face the challenge of making rapid decisions that can significantly impact patient outcomes. Collaborating with one of my ultrasound faculty, we conducted a bedside echocardiogram to explore potential cardiac anomalies. Our workup started with an ultrasound and EKG.

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EKG/ECG Fluid Resuscitation Ultrasounds Outcomes 52

Dr. Smith's ECG Blog

JULY 22, 2012

As part of her workup, this ECG was recorded: What do you think? Hemodynamic instability in trauma is usually due to bleeding, but if ultrasound shows poor contractility, then this may be due to cardiac contusion. The finding of RBBB on this ECG is highly suggestive, if not diagnostic, of myocardial contusion.

Head Injuries 52

Head Injuries EKG/ECG Ultrasounds Outcomes 52

EM Curious

JULY 8, 2015

ULTRASOUND GOODIE BAG ULTRASOUND FOR LATE PREGNANCY [PODCAST]: While not a routine exam we perform other than confirming fetal heart tones, definitely some great pearls on more advanced US topic. Consider an ultrasound guided ulnar nerve block. Part 1 here. US GUIDED ULNAR NERVE BLOCK [BLOG]: Boxer's fracture need a reduction?

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Infectious Diseases Disaster Management Sepsis Ultrasounds 52

Dr. Smith's ECG Blog

JANUARY 23, 2023

The screening physician ordered an EKG and noted his ashen appearance and moderate distress. Triage EKG: What do you think? Close up of V3 with baseline in red Close up of V4 with baseline in red This ECG alone is highly suspicious for posterior OMI! This is a very specific marker of posterior OMI. Epub 2021 Nov 15.

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EM Curious

JULY 1, 2015

ULTRASOUND IN CHEST PAIN: [BLOG]: It is never a bad idea to throw an ultrasound probe on your patient with chest pain. ECG PATTERN RECOGNITION CARDIAC ARREST AND ST ELEVATION: [BLOG]: Dr. Smith features a brief cardiac arrest case with an ECG pattern that you must know and be able to recognize! Check out his post here.

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EMS Ultrasounds EKG/ECG Fractures 52

Dr. Smith's ECG Blog

APRIL 12, 2023

Prehospital Conventional algorithm interpretation: ANTERIOR INFARCT, STEMI Transformed ECG by PM Cardio: PM Cardio AI Bot interpretation: OMI with High Confidence What do you think? On arrival, lung ultrasound confirmed pulmonary edema (B lines). Outcome : She was diagnosed with stress cardiomyopathy, though it is not entirely classic.

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EKG/ECG COPD Ultrasounds Outcomes 52

Dr. Smith's ECG Blog

JUNE 20, 2018

The initial tracing (EKG 1) was obtained. Clinician and EKG machine read of acute pericarditis. Paper published: Terminal QRS distortion not found in any ECG of Early Repolarization TQRSD is defined as the absence of BOTH an S-wave and a J-wave in leads V2 or V3. She was reportedly "pacing in her room while holding her chest".

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EKG/ECG Documentation/Coding Wellness Ultrasounds 52

ACEP Now

DECEMBER 7, 2024

A submassive PE does not result in hypotension but does result in right ventricular (RV) dysfunction (as evidenced by CT or ECG) and/or signs of myocardial injury, such as elevated B-type natriuretic peptide, elevated troponin, or new ECG changes. 6 The second common catheter-directed approach is mechanical thrombectomy.

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Ultrasounds Radiology Radiology EKG/ECG 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He had the following EKG recorded: Low voltage, suggests effusion. A bedside cardiac ultrasound was normal, with no effusion. He was started on Extracorporeal Life Support ("VA ECMO") Here is the ECG on ECMO: Very low voltage On Day 3, the EF recovered (that seems quick!) He was moderately hypoxic. 3–8 Shi et al.

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Shock EKG/ECG Outcomes Hospitals 52

EB Medicine

MARCH 1, 2019

Again, no standard definition exists, with some diagnostic criteria including simply chest pain and increasing cardiac enzymes, and others including cardiac dysfunction, ecg abnormalities, wall motion abnormalities, and an elevation of cardiac enzymes. New EKG findings requires admission for monitoring. of those patients.

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Emergency Department EKG/ECG Operations Fractures 40

EMDocs

MAY 15, 2024

ECG: Evaluate for ischemia, right heart strain. Ultrasound Sensitivity 88-100%, specificity 68-94% Positive likelihood ratio of 14.6 (95% Markers for severe disease include hypoxemia, increasing respiratory rate or work of breathing, decreasing platelet count and/or Hb, and multilobar involvement on chest radiograph or lung ultrasound.

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Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 78

Taming the SRU

AUGUST 25, 2023

wrist in extension clavicle tibial pediatric forearm Most likely injuries to need an x-ray? bicarb <18mEq/L) ketosis (preferably serum beta-hydroxybutyrate >3mmol/L) Risk factors SGLT2 inhibitor use fasting state ketogenic diet intra-abdominal pathology (AGE, pancreatitis, etc.) to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1

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Seizures Fractures EKG/ECG Resuscitation 74

Dr. Smith's ECG Blog

APRIL 12, 2013

Here is his prehosptial ECG: There are inferior Q-waves with ST elevation T-wave inversion. He had diffuse crackles on exam and B-lines on chest ultrasound, and chest x-ray also confirmed pulmonary edema. Here is his ED ECG: There is sinus tachycardia. He had no chest pain. There is reciprocal ST depression in aVL and I.

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EKG/ECG Ultrasounds Wellness EMS 52

EMDocs

MAY 11, 2024

Semin Ultrasound CT MR. 2013 Apr;34(2):131-41. Endovascular and Clinical Outcomes of Vertebrobasilar Intracranial Atherosclerosis-Related Large Vessel Occlusion. Reference article, Radiopaedia.org (Accessed on 28 Aug 2023) [link] Ortiz de Mendivil A, Alcalá-Galiano A, et al. doi: 10.1053/j.sult.2013.01.004. 2013.01.004. PMID: 23522778.]

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Stroke EMS EKG/ECG Radiology 89

ACEP Now

OCTOBER 29, 2024

Does that normal troponin and ECG obviate the need for cardiology consultation for my patient with a concerning story for acute coronary syndrome? 4 However, emergency physicians rely on gestalt to predict outcomes well. The “bundling” heuristic—if I send a troponin, then an ECG is needed. Urology took him for orchiopexy.

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Dr. Smith's ECG Blog

JULY 18, 2014

Here is his ECG: What is your interpretation? such Q-waves are associated with larger MI and worse outcomes (2. This was the 12-lead ECG. This remains consistent with PIRP, as was the first ECG. If detected early by ultrasound, the patient can be saved. Exact pain history was difficult to ascertain. Very unlikely.

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EKG/ECG Shock Ultrasounds Wellness 52

Dr. Smith's ECG Blog

JANUARY 6, 2023

F Triage ECG: ECG Interpretation: Sinus rhythm with normal QRS. I do not think this ECG is by itself diagnostic of OMI (full thickness, subepicardial ischemia ), b ut comparison to a previous might reveal this ECG as diagnostic of OMI. Cardiology interpretation of the initial ECG: “ST depressions laterally.”

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EKG/ECG Wellness Academics Ultrasounds 52

EMDocs

MAY 28, 2024

ECG: Evaluate for ischemia, right heart strain. Ultrasound Sensitivity 88-100%, specificity 68-94% LR+ of 14.6 (95% Markers for severe disease include hypoxemia, increasing respiratory rate or work of breathing, decreasing platelet count and/or Hb, and multilobar involvement on chest radiograph or lung ultrasound. N Engl J Med.

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Blood Transfusions Fluid Resuscitation Dehydration Ultrasounds 75

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.

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Shock Seizures Airway Management Stroke 90

Dr. Smith's ECG Blog

FEBRUARY 23, 2023

It is unclear whether he had active pain at the time of the first ECG: What do you think? 0.20 (above which, the ECG likely represents OMI). The team was concerned about possibly ischemic ST elevations on the ECG above, so they took it to Dr. Nossen for consultation. Vitals were within normal limits.

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EKG/ECG Ultrasounds Outcomes Hospitals 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

Here is his ECG: The resident was alarmed at the "ST elevation in III with reciprocal ST depression in aVL" Are you alarmed? An elderly patient with a ruptured abdominal aortic aneurysm: Formal ECG Interpretation (final read in the chart!) : "Inferior ST elevation, lead III, with reciprocal ST depression in aVL." What do you think?

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EKG/ECG CPR Resuscitation Outcomes 40

Dr. Smith's ECG Blog

NOVEMBER 3, 2017

Beware of using it to reverse your prior opinion that the ECG represents LAD occlusion. I recommend using it when you are worried that an ECG with apparent normal ST Elevation might be LAD occlusion. Case 3 I was reading a stack of ECGs yesterday, and saw this one, with no clinical information. Sensitivity is not perfect.

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EKG/ECG Outcomes Emergency Department Ultrasounds 52

Dr. Smith's ECG Blog

NOVEMBER 4, 2022

What is your ECG interpretation and what would you do next? This ECG shows a normal sinus rhythm with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, late R wave progression (and misplaced V2), normal voltages, ST-elevation in aVR and global ST-depressions. BP was 110 and oxygen saturation was normal.

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Dr. Smith's ECG Blog

JUNE 27, 2021

Medics recorded this ECG: There is a lot of artifact, but you can clearly see ST depression in V2 and V3. Here is the first ED ECG (there was no previous ECG on file for comparison): Sinus rhythm and LVH There is some (less than 1 mm) of STD in V3 and V4. There is no significant ST Elevation. This was not recognized.

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Dr. Smith's ECG Blog

OCTOBER 24, 2019

The ECGs An initial ECG was obtained as the pain was rapidly resolving: Minimal upsloping ST Elevation in III, with a steeply biphasic T wave, and with reciprocal ST depression in leads I and aVL. Often, intravascular ultrasound or intravascular optical coherence tomography is requeried to make the diagnosis. Lobo et al.

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EKG/ECG Wellness Shock Ultrasounds 52

AED Leader

OCTOBER 25, 2023

VF is a critical medical emergency, demanding prompt treatment to ensure the best possible outcome. These tests can include: Electrocardiogram (Resting ECG). Typically, ECG results appear normal during rest periods. Exercise Stress Test with ECG. Continuous Portable ECG Monitoring. Event Monitoring. Echocardiogram.

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EKG/ECG Shock Ultrasounds Research 52

AED Leader

OCTOBER 25, 2023

VF is a critical medical emergency, demanding prompt treatment to ensure the best possible outcome. These tests can include: Electrocardiogram (Resting ECG). Typically, ECG results appear normal during rest periods. Exercise Stress Test with ECG. Continuous Portable ECG Monitoring. Event Monitoring. Echocardiogram.

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EKG/ECG Shock Ultrasounds Research 52

Dr. Smith's ECG Blog

JANUARY 9, 2023

Meyers ECG Interpretation: Easily diagnostic of LAD occlusion. The ECG easily meets STEMI criteria in all leads V2-V6, as well. I sent this ECG to Dr. Smith, with the only information that it is a 17 year old with chest pain. The ECG was interpreted as "benign early repolarization." Beware a negative Bedside ultrasound.

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EKG/ECG Wellness Ultrasounds Outcomes 52