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? I do not have the EKG, but it was described as "non-diagnostic" (that probably means that the physician did not know how to diagnose it). Medics recorded the above ECG and called a STEMI alert.

EKG/ECG 71

EKG/ECG Resuscitation Hospitals EMS 71

Don't Forget the Bubbles

OCTOBER 7, 2024

Was the patient thrown from the source (suggestive of DC shock and may result in further blunt force trauma)? Children, especially toddlers, may insert objects into outlets, leading to shocks or burns. Electrical devices used near water sources can cause severe shocks. Was the voltage high or low (as below)?

Burns 78

Burns Fluid Resuscitation Shock Resuscitation 78

EMDocs

OCTOBER 29, 2024

A 43-year-old male with a history of mitral valve regurgitation s/p valvular replacement, hypertension, hyperlipidemia was evaluated in the ED for septic shock secondary to a pyelonephritis with a renal abscess. This series provides evidence-based updates to previous posts so you can stay current with what you need to know.

Shock 87

Shock EMS Sepsis Resuscitation 87

Dr. Smith's ECG Blog

JUNE 11, 2023

He states that he has a heart condition which he does not know the name of and that he has felt his heart race like this once before and needed to be shocked. Here is his triage ECG: He had several more ECGs taken in the resuscitation bay over the next few minutes: What do you think?

EKG/ECG 91

EKG/ECG Resuscitation Shock EMS 91

Dr. Smith's ECG Blog

OCTOBER 10, 2022

Initial ROSC was obtained, during which this ECG was obtained: What do you think? I sent it to 2 of my ECG nerd colleagues with no clinical information whatsoever, who instantly said: "Looks like afib with subendocardial ischemia and right heart strain pattern." "I CPR was initiated immediately. The rhythm is atrial fibrillation.

EKG/ECG 52

EKG/ECG Resuscitation Ultrasounds CPR 52

ACEP Now

JULY 7, 2023

However, between four and five percent of cases of VT or VF will be refractory to standard management, with nonperfusing arrhythmia persisting despite repeated shocks. Initial guidelines defined “refractory” as VT or VF occurring despite three shocks from a cardiac defibrillator. Resuscitation. Resuscitation. Circulation.

Resuscitation 98

Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

She was in shock with thready pulses. A prehospital ECG was recorded: Limb leads: Precordial Leads What is the therapy? The rate is not fast enough to be causing shock, so if it is VT, the priority is still to treat hyperK and secondarily to cardiovert. They thought it was VT, but did not shock. The K returned at 7.4

Shock 52

Shock EKG/ECG Resuscitation Ultrasounds 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He had the following EKG recorded: Low voltage, suggests effusion. He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. Assessment was severe sudden cardiogenic shock. He remained hypotensive and in shock. He was moderately hypoxic.

Shock 52

Shock EKG/ECG Outcomes Hospitals 52

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. This case provides an opportunity to practice identification and treatment of multiple sources of blood loss in hemorrhagic shock.

Shock 52

Shock Emergency Nursing Operations Administration 52

AED Leader

JULY 10, 2024

It offers advanced features such as ECG monitoring and multiple rescue capabilities. Their Lifeline series includes the Lifeline DCF-100, Lifeline View, and Lifeline ECG. The Lifeline ECG is a professional-grade AED that offers the added benefit of ECG monitoring. Are AEDs safe to use? How long do AED batteries last?

CPR 52

CPR EKG/ECG Shock Pediatrics 52

Mind The Bleep

DECEMBER 19, 2023

ECG: to monitor T wave changes due to hypokalaemia. ECG features of Hypokalaemia: Increased P wave amplitude (peaked P waves) Prolonged PR interval Widespread ST depression T wave flattening or inversion Prominent U waves (most noticeable in the precordial leads) Figure 2 : ECG of a patient with serum K+ of 1.9

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

Taming the SRU

JULY 31, 2024

morbidity and mortality - faculty case follow-up - R4 Capstone - high-risk, low prevalence diseases in pediatrics morbidity and mortality WITH dr. moulds Syncope Complete heart block is a rare but important cause of syncope P waves outnumbering QRS complexes should clue to you to high grade heart block Triage EKGs are often obtained to screen for cardiac (..)

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

EMDocs

OCTOBER 8, 2024

Glucose POC ECG: Is this actually sinus tachycardia? Looking at the initial or even repeating the ECG will be helpful here. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us? Poor waveforms more often indicate decreased perfusion than hypoxia. Do they have edema?

Shock 95

Shock Emergency Department Pediatrics EKG/ECG 95

Dr. Smith's ECG Blog

MAY 5, 2022

Fluid resuscitation was initiated. Here is the initial ED ECG: What do you think? The ECG shows peaked T waves, QRS widening, a coved-type ST segment with inverted T waves most prominent in V1 and V2 consistent with Brugada pattern. They opined that the ECG could instead be "metabolic." Creatinine elevated at 3.09

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

Northwestern EM Blog

JANUARY 24, 2022

Written by: Elizabeth Stulpin, MD (NUEM ‘23) Edited by: Aaron Wibberly, MD (NUEM ‘22) Expert Commentary by : Joshua Zimmerman, MD (NUEM ‘17) Non-Response to Vasopressors Shock is defined as a state of cellular and tissue hypoxia resulting in end organ dysfunction. And for most forms, EM physicians are not typically shocked by shock.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 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.

EKG/ECG 52

EKG/ECG Shock Sepsis Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

Here is his triage ECG: PM Cardio version: With no other information at all, I sent this ECG to Dr. Smith, who replied: "I think it is real. In other words, this ECG shows sinus rhythm, normal QRS complex, and: --Inferior OMI: STE in III, hyperacute T waves in lead III, reciprocal STD and TWI in aVL. STD in V4-5 too."

EKG/ECG 52

EKG/ECG Shock CPR Outcomes 52

Dr. Smith's ECG Blog

AUGUST 9, 2019

Some total LAD occlusion manifest on the ECG similarly to some left main occlusions. Depending on where the STE vector of the LM occlusion shows up on the ECG, there may be either STE, or STD, or neither in aVR, and lead aVR will not be the important part of the ECG interpretation in these cases.

EKG/ECG 52

EKG/ECG Shock Emergency Department Wellness 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

An immediate 12-lead EKG was obtained: There is ST elevation in leads aVR and V1, with marked ST depression in I, II, III, aVF, V3-V6. In addition, the patient received 750 mL of fluid resuscitation with transient improvement of blood pressure. Authors' commentary: Cardiogenic shock in the setting of severe aortic stenosis.

EKG/ECG 52

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 52

Dr. Smith's ECG Blog

NOVEMBER 11, 2022

A 12 lead ECG was obtained by EMS and is shown below: What do you think? The ECG is diagnostic of LAD occlusion (or even left main occlusion possibly), with the classic pattern of RBBB and LAFB with huge concordant STE in V1-V2, I, and aVL, with reciprocal depression in most other leads (and/or a component of subendocardial ischemia pattern).

EKG/ECG 52

EKG/ECG Shock EMS Documentation/Coding 52

EMDocs

JANUARY 8, 2024

Emergent coronary angiography is not recommended over a delayed or selective strategy in patients with ROSC after cardiac arrest in the absence of ST-segment elevation, shock, electrical instability, signs of significant myocardial damage, and ongoing ischemia (Level 3: no benefit). o C recommended (Level 1: strong). COR 2a, LOE B-NR.

Seizures 83

Seizures Shock CPR Hyperthermia / Hypothermia 83

RebelEM

MARCH 30, 2023

However, there are no clear guidelines for management in post-cardiac arrest patients without ST-segment elevations on ECG. Clinical Question : In patients who suffer an OHCA without ST-segment elevation on the post-resuscitation ECG, will early coronary angiogram (CAG) vs. delayed CAG improve outcomes?

Hospitals 83

Hospitals Outcomes EKG/ECG Resuscitation 83

ACEP Now

MARCH 14, 2024

Electrical injuries—excluding lightning injuries—account for roughly 10,000 nonfatal shock incidents a year and 500 deaths a year. 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.

Burns 52

Burns Fluid Resuscitation EKG/ECG EMS 52

Mind The Bleep

OCTOBER 29, 2024

Circulation Assess heart rate, blood pressure, peripheral and central CRT, pulses and 3 lead ECG. Establish IV access and begin fluid resuscitation with 250ml boluses of 0.9% Sodium Chloride or Hartmanns if indicated, monitoring for signs of shock.

Burns 52

Burns Fluid Resuscitation PPE Resuscitation 52

Dr. Smith's ECG Blog

OCTOBER 26, 2010

He had this ECG recorded. He was rushed by residents into our critical care room with a diagnosis of STEMI, and they handed me this ECG: There is sinus tachycardia with ST elevation in II, III, and aVF, as well as V4-V6. But, remember, we do not evaluate and treat ECGs, we evaluate and treat patients. Are the lungs clear?

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

Dr. Smith's ECG Blog

JULY 3, 2020

This ECG was done in a middle aged woman who was in a motor vehicle collision in which her vehicle "T-boned" another, so there was trauma to the anterior chest. ng/mL, and an ECG was recorded: There are no P-waves visible. Based on this ECG, we drew another sample for Ca measurement and gave 3 g Ca gluconate empirically.

Blood Transfusions 52

Blood Transfusions EKG/ECG Shock Fractures 52

Taming the SRU

NOVEMBER 29, 2023

Complex trauma resuscitations Blunt cardiac injury represents a range of conditions from clinically silent to fatal injuries. Workup with a negative troponin and EKG reliably rules out BCI. Hemorrhagic shock is the most common etiology of instability in trauma and should always be highest on the differential.

Stroke 53

Stroke EKG/ECG Resuscitation Shock 53

Dr. Smith's ECG Blog

MAY 19, 2020

In this case, profound shock for 1 hour would result in the same degree of infarction. A followup ECG was recorded 2 days later: No definite evidence of infarction. The Type 2 MI would then have been a result of the prolonged severe shock while in arrest. For clarity — I’ll again show the initial ECG done in the ED in Figure-1.

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

PHEM Cast

APRIL 10, 2016

It is worth noting, that with “Sepsis 3” many of these terms will become out-of-date – but validation work is required… The Rivers’ paper can be accessed here: [link] It was a single centre study which compared standard care with protocolised resuscitation packaged together as early goal-directed therapy (EGDT).

Sepsis 52

Sepsis Fluid Resuscitation Resuscitation Emergency Department 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 67

Operations Radiology Radiology Fluid Resuscitation 67

EB Medicine

NOVEMBER 1, 2018

Thankfully, that gentleman was successfully resuscitated despite no bystander CPR, and if you listen carefully, we hope to arm you with the tools to do so similarly. Nachi: Each year, in the US, approximately 10,000 patients present with electrical burns or shocks. Thankfully, fatalities are declining, with just 565 in 2015.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

EMDocs

APRIL 22, 2024

However, as shock resolved and hemodynamic stability improved, RV strain and underfilling of the LV remained apparent 30 minutes after ROSC (Vid 4). During this resuscitation two different ultrasound machines were used to capture images due to a malfunction with the first machine after initial images were captured. EKG RV strain.

Ultrasounds 82

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Resuscitation 82

EB Medicine

MARCH 1, 2019

Consider valvular injury in any patient who appears to be in cardiogenic shock, has hypotension without obvious hemorrhage, or has pulmonary edema. In those with severe injury, you may note refractory hypotension secondary to cardiogenic shock. New EKG findings requires admission for monitoring. of those patients.

Emergency Department 40

Emergency Department EKG/ECG Operations Fractures 40

Dr. Smith's ECG Blog

JUNE 1, 2020

== MY Comment by K EN G RAUER, MD ( 6/1 /2020 ): == YOU are asked to interpret the ECG shown in Figure-1. Figure-1: The initial ECG in the ED. MY THOUGHTS on ECG #1: My initial impression on looking at the ECG in Figure-1 — was that the rhythm was either rapid AFib in a patient with WPW — or — PMVT ( P oly M orphic VT ).

EKG/ECG 52

EKG/ECG Resuscitation Shock Outcomes 52

Dr. Smith's ECG Blog

APRIL 19, 2012

A 72 year old male presented in shock. Here is his initial ECG: There is a wide complex at 194 ms, with RBBB. Here is his baseline ECG, also with RBBB: There is sinus tach with otherwise normal RBBB; the QRS is 129 ms, average for RBBB. The patient had urosepsis with renal failure, was resuscitated and dialyzed.

EKG/ECG 52

EKG/ECG Resuscitation Shock Hospitals 52

Dr. Smith's ECG Blog

NOVEMBER 28, 2022

Given her reported chest pain, shortness of breath, and syncope, an ECG was quickly obtained: What do you think? Given her tachycardia and episodes of syncope, the patient was judged to be in compensated obstructive shock with very high risk of imminent decompensation. For clarity in Figure-1 — I've reproduced her initial ECG.

EKG/ECG 52

EKG/ECG Ultrasounds Documentation/Coding COPD 52

EMDocs

JANUARY 11, 2024

Cardiac Management Takeaway : Perform an echo as soon as you can to guide resuscitation. Individualize the choice of using inotropes, vasopressors, or fluids to treat post-CA hypotension and to target the likely cause(s) contributing to the shock and hemodynamic state (100%, 23/23). There are no hard MAP recommendations.

Seizures 75

Seizures Shock Infectious Diseases CPR 75