The Skeptics' Guide to EM

NOVEMBER 25, 2023

She is the cofounder of FOAMcast and a pulmonary embolism and implementation science researcher. Dr. Westafer serves as the Social Media Editor and a research methodology editor for Annals of Emergency Medicine. Upon EMS arrival, they find the patient is sweaty with normal vital signs.

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EMS EKG/ECG Research Hospitals 133

Emergency Medicine Journal

NOVEMBER 28, 2023

Introduction The ECG is one of the most frequently performed diagnostic tests in Emergency Medicine. High quality research is lacking and therefore this unique study aims to investigate the ECG features that are statistically significant for the presence of RA-LA misplacement. R waves were identified in lead aVR in 113 (79%).

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EKG/ECG Emergency Department Research 71

Dr. Smith's ECG Blog

JUNE 1, 2022

Here is his ECG: There is no clear evidence of OMI or ischemia. I showed conclusively that this is a common finding in normal ECGs, though it is more common in LAD Occlusion than in norml variant STE. Studies of normal ECGs show that the T-wave in V1 taller than T-wave in V6 is within the normal range. Cath lab was activated.

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EKG/ECG Research 52

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?

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EKG/ECG EMS Emergency Department Outcomes 108

The Skeptics' Guide to EM

OCTOBER 5, 2024

She is the co-founder of FOAMcast and a pulmonary embolism and implementation science researcher. Dr. Westafer serves as the Social Media Editor and a research methodology editor for the Annals of Emergency Medicine. Comparison: The Los Angeles Motor Scale (LAMS).

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Stroke EMS Outcomes Research 115

Dr. Smith's ECG Blog

AUGUST 3, 2023

OMI Pocket Guide The OMI Pocket Guide ( [link] ) is a user-friendly online resource designed to help healthcare professionals learn how to recognize subtle signs of acute coronary occlusion on the ECG which represent occlusion myocardial infarctions (OMI). Smith and Meyers ( that are well known to readers of this Blog ).

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EKG/ECG Wellness Research Hospitals 91

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

I was reading EKGs on the system and saw this one. There was an EKG from 5 years prior: I went to check on the history: History : It was the middle of the night. This EKG was recorded as part of a standing order for critical care. This EKG was recorded as part of a standing order for critical care. He awoke with naloxone.

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EKG/ECG Research 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

I remember Allie well from her days in the Research volunteer program at Hennepin. An initial EKG was obtained: Computer read: sinus tachycardia, early acute anterior infarct. Here is her prior EKG: When compared to the old EKG – Q waves present before, TWI in aVR present before, but all other changes are new.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

Sensible Medicine

FEBRUARY 12, 2024

The AF episodes we see on an ECG were simply manifestations of atrial disease. Along with a team of researchers at numerous hospitals, they randomized ≈1000 patients who had had stroke of unknown cause and evidence of atrial cardiopathy to either treatment with an oral anticoagulant (apixaban) vs aspirin. (If

Wellness 133

Wellness Stroke EKG/ECG Academics 133

Medagadget

JULY 19, 2023

Researchers at UCLA have developed a wearable patch that can measure muscle movements in underlying tissues. The researchers hope that the technology will be useful in assessing muscle injuries and in developing personalized physical rehabilitation programs for patients. So far, the technology has been shown to be very sensitive.

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EKG/ECG Research Wellness 68

RebelEM

JUNE 1, 2023

Control: Standard approach to diagnosis post-arrest but would be eligible for SDCT. CT scanning was common in the standard care cohort (84% received at least one CT – usually NCHCT) Critical Findings: Standard Care Group SDCT Group Diagnosis (Primary Outcome) 75% (107/143) 92% (96/104) Statistically Significant Time to Diagnosis 14.1 (IQR

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Outcomes Resuscitation Hospitals CPR 144

Taming the SRU

OCTOBER 5, 2023

morbidity and mortality - quality improvement - research grand rounds - r1 clinical knowledge: pres/rcvs - r4 case follow-up: compartment syndrome Morbidity and Mortality WITH dr. finney Takotsubo Cardiomyopathy with COVID-19 Increasing incidence of Takotsubo Cardiomyopathy with the COVID-19 pandemic Morbidity and mortality is similar to that of ACS (..)

Stroke 91

Stroke EKG/ECG Seizures CPR 91

Advanced Medical Reviews

OCTOBER 24, 2018

In addition to collecting and transmitting patient data to a healthcare provider, wearable technology offers enhanced patient engagement, more accurate data analytics, timely interventions, improved medical research and reduced healthcare costs. This can save both patients, providers—and even insurance companies—time and money. Apple Watch 4.

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EKG/ECG Research Administration Hospitals 51

Dr. Smith's ECG Blog

APRIL 21, 2023

Written by Jesse McLaren, with comments from Smith A 50-year old patient on the medical wards developed acute chest pain, with an ECG labeled (see computer interpretation at the top) and confirmed as normal. I sent the ECG to Dr. Meyers without any other information. What do you think? This is diagnostic of inferoposterior OMI.

EKG/ECG 52

EKG/ECG Outcomes Research Hospitals 52

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. Figure-1: The initial ECG in today's case.

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EKG/ECG Ultrasounds Wellness Stroke 110

Don't Forget the Bubbles

NOVEMBER 22, 2023

On the other hand, duration-related PRIS signs tend to occur because of long duration regardless of dose, where children experience arrhythmias and other ECG changes ( Brugada-like pattern , RBBB, arrhythmia, heart block). Why does PRIS occur? The Lancet. 2001;357(9256):606-7.

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Pediatrics EKG/ECG Research Operations 126

Mind The Bleep

NOVEMBER 12, 2023

12 lead ECG: variable findings but LVH, pathological Q waves, ST and T wave abnormalities are common. The following are possible ECG changes you may expect to see: Figure 3 : An ECG illustrating the changes in HCM. ECG example (3): Figure 4 : ECG illustrating the changes in non-ischaemic dilated cardiomyopathy.

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EKG/ECG Research Outcomes 96

EMDocs

SEPTEMBER 14, 2024

2: Human, Take this Patient to the Cath Lab – AI and STEMI Detection Spoon Feed These researchers developed and trained a deep ensemble artificial intelligence (AI) model to classify ECGs as STEMI versus non-STEMI. DOI: 10.1016/j.annemergmed.2024.03.007. 2024.03.007. PMID: 39032988. #2:

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Emergency Department Resuscitation Pediatrics EKG/ECG 90

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

Our first 12 lead ECG was then recorded at 0926. Another ECG was recorded 5 minutes later just before arrival at the hospital: Similar The patient was transported to a nearby suburban hospital with PCI capabilities while my partner cared for her. Smith: this ECG and clinical presentation is diagnostic of LAD Occlusion.

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EKG/ECG Emergency Department Ultrasounds Hospitals 52

Dr. Smith's ECG Blog

JUNE 28, 2018

This ECG (ECG #3) was recorded immediately after the last episode of pain spontaneously resolved. Angiographic and clinical characteristics of patients with unstable angina showing and ECG pattern indicating critical narrowing of the proximal LAD coronary artery. Here is the first post-cath ECG (ECG #4).

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EKG/ECG Burns Research Outcomes 52

Taming the SRU

AUGUST 7, 2023

Research Grand rounds WITH Drs. Recent Updates - There are many trials coming up or active to continue to broaden acute ischemic stroke care. This include increasing EVT scope for smaller vessel lesions, treatment of large core strokes, treatment of patients with low NIHSS, and those with previous disabilities.

Stroke 93

Stroke Outcomes EKG/ECG Research 93

The Skeptics' Guide to EM

FEBRUARY 11, 2024

The ECG shows sinus tachycardia with non-specific ST-T changes. 20] A retrospective observational study from Canadian researcher, Dr. Robert Ohle was published in CJEM in 2023. She is bradycardic, hypotensive, and tachypneic. She is received in the resuscitation room. The chest x-ray is unremarkable. per 100,000. [4-8]

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Emergency Department Resuscitation Hospitals EKG/ECG 130

Sensible Medicine

AUGUST 21, 2023

On yesterday’s podcast , I talked with Bobby Yeh, an academic cardiologist who made a compelling case for enhancing credibility of observational research. The reasons are multiple, but I will articulate a few: Most epidemiological studies are done from large data sets that are not collected for the purpose of research.

Administration 98

Administration Outcomes Research COPD 98

RebelEM

MAY 27, 2024

It is the first research paper to explore the synergistic effects of combining MVM and IV Adenosine in treating PSVT. Using a specialist cardiologist to confirm PSVT via a 12-lead ECG does not reflect standard emergency practices, potentially limiting the study’s findings’ practicality and applicability.

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Outcomes Research Operations Hospitals 134

EMDocs

MAY 24, 2023

The EKG and troponin are normal. You should have done some research and followed up on it. Exam is unremarkable. D-dimer is elevated at 1.6. A CT angiogram to rule out PE is reported by offsite “nighthawk” radiologist as showing “a 3.7 cm anterior mediastinal mass which appears to contain calcium.

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Radiology Radiology EKG/ECG Patient Safety 82

Dr. Smith's ECG Blog

AUGUST 26, 2009

He called 911 and paramedics recorded a prehospital 12 lead ECG which showed a clear inferior STEMI (not shown, tracing could not be found). On arrival, the following ECG was recorded. To diagnose inferior MI, there must always be reciprocal ST depression or T-wave inversion or both in lead aVL (see abstract of our research below).

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EKG/ECG Documentation/Coding Research Academics 52

Stop and Think

DECEMBER 29, 2023

The doctor would do an ECG and that would diagnose AF. The trials have shown us that old-school AF, wherein it is detected due to symptoms, in a doctor’s office, and by a standard ECG, is different from short duration AF detected on a device. JMM P.S. This newsletter is often critical of industry-related research.

Stroke 92

Stroke EKG/ECG Research Wellness 92

JournalFeed

SEPTEMBER 14, 2024

Friday Spoon Feed : These researchers developed and trained a deep ensemble artificial intelligence (AI) model to classify ECGs as STEMI versus non-STEMI. While most cases can be treated and released from the ED, water bead injury can be serious and even deadly. The AI performed well in both accuracy and in improving sensitivity.

EKG/ECG 52

EKG/ECG Research Wellness 52

Dr. Smith's ECG Blog

MARCH 3, 2023

can cause ST-segment elevation (STE) on electrocardiogram (ECG), the distinction between them may be hard and complicated. Furthermore, some ECGs may not meet the STEMI criteria but may still be diagnostic for acute coronary occlusion (ACO). The majority of the ECGs are from Stephen W. Mar for atrial activity ECG).

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EKG/ECG Research Hospitals Wellness 52

Emergency Medicine Cases

APRIL 6, 2021

What are some key ECG patterns that are sometimes missed by ED docs that can have devastating consequences? How do we figure out when bradycardia is due to a medical illness and when it is a primary cardiac problem? How can we better understand Torsades de Pointes by understanding AV blocks? What is BRASH syndrome and how can we recognize it?

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EKG/ECG Research Hospitals Resuscitation 52

The Skeptics' Guide to EM

APRIL 21, 2018

The EKG and laboratory tests are normal. Robert is a practicing emergency medicine physician and Director of Research for emergency medicine at Health Science North in Sudbury, Ontario. His research program focuses on improving recognition and. Blood pressure is elevated, and his pain was sudden in onset.

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Emergency Department Academics EKG/ECG Research 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

The following 12-lead ECG was recorded at 11 minutes after ROSC. at the time of the ECG. Here is the annotated ECG from above, with lines drawn. Here is an article I wrote: Updates on the ECG in ACS. The last section is a detailed discussion of the research on aVR in both STEMI and NonSTEMI. Mg was 1.6.

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EKG/ECG CPR Resuscitation Research 52

Cook County EM Blog

APRIL 27, 2022

of patients had an ECG in the prior 6 months, 4% had a QTc >500 msec 26.4% of patients had an ECG within 24 hours of droperidol administration, 3% had a QTc >500 msec No clinically significant arrhythmias observed Discussion The article provides support for the safety of droperidol in low doses in the ED.

Administration 52

Administration EKG/ECG Emergency Department EMS 52

Dr. Smith's ECG Blog

MAY 19, 2020

A followup ECG was recorded 2 days later: No definite evidence of infarction. Additional research about MINOCA is needed to determine the efficacy of medications aimed at secondary prevention of AMI. Smith — “ S hark F in” m orphology was noted on the initial monitoring strip, and initial 12-lead ECG. What is Type 2 MI?

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

The Skeptics' Guide to EM

JULY 2, 2022

His symptoms are moderately suspicious, he has a normal EKG, and a history of hypertension. However, all this recent research into clinical decision tools and pathways to risk-stratify these patients is reducing admissions and therefore ED and hospital overcrowding [1-5]. His father had a minor heart attack at the age of 63.

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EKG/ECG Academics Emergency Department Hospitals 40

Dr. Smith's ECG Blog

MARCH 9, 2023

Here is his triage ECG at 0343: What do you think? Annals of Emergency Medicine Cardiology was called to evaluate the patient immediately for emergent cath, but they stated that the ECG did not meet STEMI criteria and elected to wait for further information before proceeding with cath. Vitals were within normal limits.

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EKG/ECG Outcomes Emergency Department Research 52

AENJ: Current Issue

SEPTEMBER 30, 2023

The purpose of this research study was to determine the content validity of the Bjorklund Tool. This research contributes to establishment of content validity of a skin risk assessment instrument which can be used in the unique ED setting. The Bjorklund 25-item ED Skin/Risk Assessment Tool was selected.

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Emergency Department Patient Safety Documentation/Coding Research 74