Dr. Smith's ECG Blog

MARCH 11, 2012

A young man presented after a prolonged seizure. Here was his initial ECG: Regular Wide Complex Tachycardia. Here is the same ECG with some annotation (lines): The first line is drawn at the onset of the QRS in V2, which is clear. Here is the subsequent ECG: This is clearly sinus tach. The patient was unconscious.

Seizures 52

Seizures Shock EKG/ECG Outcomes 52

RebelEM

SEPTEMBER 27, 2023

REBEL Core Cast 109.0 – Na Channel Blocker Poisoning Click here for Direct Download of the Podcast Definition and Physiology Standard definition of a wide QRS is anything > 120 msec (3 small boxes on the ECG) In the context of poisoning, a “wide QRS” is anything greater than 100 milliseconds. Boehnert 1985 ). N Engl J Med.

Poisoning 104

Poisoning Seizures Administration EKG/ECG 104

JournalFeed

AUGUST 7, 2021

We cover GRACE-1, communicating stats better, managing seizures after initial control, POCUS for intussusception, and reading STEMI on ECG with a paced rhythm. It’s the JournalFeed Podcast for the week of August 2-6, 2021.

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Seizures EKG/ECG 40

EMergucate

MAY 21, 2019

The ECG below is taken from an 83 year old man with a seizure history for the past 8 years. He presents after two 10 minute generalised tonic-conic seizures at home 10 days after self ceasing his C…

EKG/ECG 52

EKG/ECG Seizures 52

EMergucate

MAY 21, 2019

The ECG below is taken from an 83 year old man with a seizure history for the past 8 years. He presents after two 10 minute generalised tonic-conic seizures at home 10 days after self ceasing his C…

EKG/ECG 52

EKG/ECG Seizures 52

EMDocs

JANUARY 8, 2024

Avoid routine seizure prophylaxis in adult survivors of cardiac arrest (Level 3: no benefit), but treat seizures if they occur (Level 1: strong). Editorial Comment : Yes to PCI after arrest with STEMI on ECG. Treatment of nonconvulsive seizures (diagnosed by EEG only) is reasonable in adult survivors of cardiac arrest.

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Seizures Shock CPR Hyperthermia / Hypothermia 98

EMDocs

JANUARY 11, 2024

The neurologic section was divided into (1) brain oxygenation, perfusion, edema, and intracranial pressure (ICP); (2) seizures and the ictal-interictal continuum (IIC); and (3) sedation and analgesia. EEG Monitoring and Seizures Statements Takeaway: If possible, obtain an EEG to evaluate for seizure activity.

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Seizures Shock Infectious Diseases CPR 98

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. 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 ). What do you think?

EKG/ECG 52

EKG/ECG Seizures Stroke Wellness 52

EMDocs

APRIL 10, 2024

She reportedly received a landmark guided peripheral nerve block with bupivacaine and shortly thereafter developed generalized seizures. 1,5] CNS symptoms include: Seizure, coma, altered mental status. [1] 1-3,5,7,9] All patients developing symptoms of LAST should be placed on a continuous cardiac monitor and have an ECG performed. [2]

Advances Cardiac Life Support (ACLS) 111

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 111

Dr. Smith's ECG Blog

JUNE 26, 2023

Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). As I discuss in detail in My Comment at the bottom of the page in the May 24, 2020 post in Dr. Smith's ECG Blog — AV dissociation is not the same as AV block. How would YOU interpret this tracing?

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EKG/ECG Seizures Sepsis Operations 97

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.

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EKG/ECG Seizures Stroke Operations 52

Dr. Smith's ECG Blog

MARCH 30, 2014

The minute this medical student saw the first ECG, he knew the diagnosis without any further information. Reading ECGs is hard, but can be done with commitment to learning, which comes from an awareness of its importance. You need to be interested and understand the value of the ECG. She had this ECG recorded: ECG 1: QTc is 484.

EKG/ECG 52

EKG/ECG Outcomes Shock Sepsis 52

EMergucate

SEPTEMBER 14, 2022

A 64 year old male presents to ED after multiple seizure episodes that day. It was reported that the patient would have 20 seconds of seizure activity and then make a full recovering. The patient h…

Seizures 52

Seizures EKG/ECG 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

EMergucate

SEPTEMBER 15, 2020

You have been handed over a 58 year old male patient who presented yesterday with a seizure on a background history of alcohol dependence. He also has a history of depression and GORD. He has never…

Seizures 52

Seizures EKG/ECG 52

EMergucate

SEPTEMBER 15, 2020

You have been handed over a 58 year old male patient who presented yesterday with a seizure on a background history of alcohol dependence. He also has a history of depression and GORD. He has never…

Seizures 52

Seizures EKG/ECG 52

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 92

Stroke EKG/ECG Seizures CPR 92

EB Medicine

JUNE 1, 2021

Cardiac Differentiating syncope from seizure Features that point to seizure Urinary incontinence Number of jerks Age? Glucose ECG ED History - table 4 History of similar Prodrome Associated symptoms (chest pain, neuro symptoms, etc) Falls Pre-syncope ? ECG Brugada, blocks, VT, ST changes, etc Labs BNP, delta bnp ?

Seizures 52

Seizures Emergency Department EKG/ECG Hospitals 52

Emergency Medicine Cases

AUGUST 2, 2022

David Carr joins Anton to give us his simplified approach to syncope based solely on history, physical and ECG to help guide disposition decisions. We answer questions such as: What features have the best likelihood ratios to help distinguish syncope from seizure?

Seizures 52

Seizures EKG/ECG EMS 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

EMergucate

SEPTEMBER 13, 2022

A 64 year old male presents to ED after multiple seizure episodes that day. It was reported that the patient would have 20 seconds of seizure activity and then make a full recovering. The patient h…

Seizures 40

Seizures EKG/ECG 40

Dr. Smith's ECG Blog

AUGUST 13, 2020

Then I looked into the patient's chart and found an old EKG: This shows a previous QR-wave in V2, diagnostic of old anterior MI. I wrote back: "I am looking at his old EKG. The cath lab had been activated and then they sent me the ECG. They agreed that the ECG findings were due only to old MI and tachycardia.

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EKG/ECG Shock Stroke Seizures 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 ).

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Burns Fluid Resuscitation PPE Resuscitation 52

Taming the SRU

JUNE 3, 2024

If you or your patient do not have a watch capable of providing you with an ECG, consider asking those on board to allow you to borrow theirs. Get a blood gas when possible to help guide your ventilation. Some newer AED's have the capability of providing you with a rhythm strip.

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Shock Seizures Airway Management Stroke 92

EB Medicine

MARCH 7, 2022

Fever and infection (labs, imaging – US or CT, antibiotics) Cardiopulmonary complaints (labs, imaging, ECG) 11.Treatment Treatment Hemorrhage Headache (CVT) Infection (mastitis, endometritis, wound Infection) Preeclampsia, eclampsia, HELLP, seizures Cardiomyopathy 12.What What about breastfeeding mothers?

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Emergency Department Seizures EMS EKG/ECG 52

Dr. Smith's ECG Blog

JULY 14, 2010

Before EMS arrived, she had "seizure activity" and became unresponsive. She arrived comatose and in cardiogenic shock and the following ECG was recorded. A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. She was intubated. She was bradycardic and hypotensive.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Seizures EKG/ECG EMS 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? Atrial flutter was recognized at this time.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

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. So this was the patient's baseline ECG.

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. So this was the patient's baseline ECG.

EKG/ECG 52

EKG/ECG Seizures EMS Outcomes 52

Dr. Smith's ECG Blog

OCTOBER 22, 2017

This was sent by a recent ultrasound fellow, asking for my ECG diagnosis. These ECGs, in my experience, are not seen in ACS. This patient presented with altered mental status and seizure, so the diagnosis of Takotsubo can be made without angiography or even echo. There is ST elevation in I, II, III, aVF, V2, V3, V4, V5, and V6.

Seizures 52

Seizures EKG/ECG Ultrasounds 52

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

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Seizures Fractures Burns Pediatrics 40

ACEP Now

FEBRUARY 11, 2024

Patient C, a 27-year-old female with a history of epilepsy, taking valproate and endorsing adherence, is then brought in by ambulance for a witnessed seizure. This is her first seizure in six years. This patient had her first seizure in years despite adherence to her valproate for management of her epilepsy.

Seizures 52

Seizures Fluid Resuscitation Poisoning EKG/ECG 52

RebelEM

OCTOBER 5, 2022

mg/dL 10.5 – 12.0

Dehydration 52

Dehydration Psychiatric Administration EKG/ECG 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

Mind The Bleep

MAY 16, 2023

Some important causes to consider include reflux (very common), seizures, and maltreatment/NAI. Other tests: At most, guidelines suggest that an ECG and pertussis test may be undertaken. An event cannot be said to be unexplained unless you have tried to explain it.

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Basic Life Support Seizures CPR Wellness 52

EMDocs

NOVEMBER 1, 2023

1 , 2 The most common non-iatrogenic cause is spontaneously due to increased intraesophageal pressure, Boerhaave syndrome, from forceful retching, coughing, straining, seizures, or even childbirth (15% of cases). upper endoscopy, transesophageal echo, etc.). Abdomen: Evidence of peritonitis if intra-abdominal rupture.

Operations 96

Operations Radiology Radiology Fluid Resuscitation 96

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. EtOH, amphetamines, or cocaine) Prescription drugs (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52