Dr. Smith's ECG Blog

DECEMBER 9, 2023

He had a prehospital ECG. They recorded a prehospital ECG: What do you think? The Queen of Hearts interprets it blinded also (no clinical information and no previous ECGs or serial ECGs). And that is what we see in the presenting 2 ECGs at the top. A 50-something had syncope while driving. Learning Points: 1.

EKG/ECG 115

EKG/ECG Seizures Wellness EMS 115

EMDocs

NOVEMBER 19, 2024

1 Seizures may occur due to lowered seizure threshold. 6 Seizures have been observed and are dose-dependent. Recommend obtaining multiple EKGs to aid in the diagnosis of cardiotoxic effects such as dysrhythmias or interval widening, even if not apparent immediately after the overdose. 8 Hypersalivation can occur.

Poisoning 90

Poisoning Hyperthermia / Hypothermia EKG/ECG Seizures 90

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 105

Poisoning Seizures Administration EKG/ECG 105

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.

Seizures 40

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

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

EMDocs

SEPTEMBER 24, 2024

Episode 107: Eclampsia Definition: Severe hypertensive disease of pregnancy (HDP) with new onset tonic-clonic, focal, or multifocal seizures or unexplained altered mental status in a patient who is pregnant or postpartum and there’s no other causative etiologies. Approximately one third have no findings of preeclampsia before the seizure.

Seizures 83

Seizures Stroke EKG/ECG 83

Dr. Smith's ECG Blog

JANUARY 15, 2024

Colin is an emergency medicine resident beginning his critical care fellowship in the summer with a strong interest in the role of ECG in critical care and OMI. An ECG was obtained shortly after arrival: ECG 1 What do you think? The ECG has a lot of artifact, and the amplitude is very small, making interpretation challenging.

EKG/ECG 67

EKG/ECG Wellness Point-of-Care Testing Shock 67

Dr. Smith's ECG Blog

OCTOBER 7, 2019

This is by one of our outstanding 3rd year residents , Aaron Robinson, with some edits and comments by Smith EMS responded to a reported seizure in a 42 year old male. He reports no personal or familial history of seizures. The physicians quickly recognized that this was not a seizure and likely cardiac in nature.

Seizures 40

Seizures EKG/ECG Shock EMS 40

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.

Seizures 83

Seizures Shock CPR Hyperthermia / Hypothermia 83

EMDocs

SEPTEMBER 19, 2023

Episode 86: Tricky Cases Part 2 Case 3: 56-year-old female with history of seizures, actively seizing, EMS called. On ED arrival GCS is 3, there are rapid eye movements to the right but no other apparent seizure activity. Check glucose, obtain imaging, stop the seizure. They administer two doses of 10 mg midazolam IM.

Seizures 72

Seizures Documentation/Coding EKG/ECG Emergency Department 72

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

DECEMBER 18, 2024

fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold fold higher risk of NSTI than the control group 12 For those without comorbidities , AUD exhibited a 15.2-fold

Seizures 61

Seizures Emergency Department Hyperthermia / Hypothermia EMS 61

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.

EKG/ECG 52

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

EMDocs

JUNE 22, 2024

Eclampsia (B) is characterized by the onset of seizures in a woman with preeclampsia (hypertension and proteinuria), but it typically does not present with the sudden onset of respiratory distress and profound hypotension described here. If AFE occurs during labor, immediate delivery is recommended.

EMS 96

EMS Resuscitation Blood Transfusions Seizures 96

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.

Seizures 75

Seizures Shock Infectious Diseases CPR 75

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) 93

Advances Cardiac Life Support (ACLS) Seizures EMS Poisoning 93

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

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?

EKG/ECG 86

EKG/ECG Seizures Sepsis Operations 86

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

SEPTEMBER 24, 2023

Patients with a history of seizures, supratentorial structural brain pathologies, post-arrest, or unexplained altered mental status should prompt suspicion for NCSE. However, Ceribell is a useful technology to help detect seizure activity and affect disposition. Two main theories behind the development of PRES. (1)

Seizures 52

Seizures EKG/ECG Emergency Department Shock 52

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

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 90

Stroke EKG/ECG Seizures CPR 90

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.

EKG/ECG 52

EKG/ECG Shock Stroke Seizures 52

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?

Emergency Department 52

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

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.

Shock 91

Shock Seizures Airway Management Stroke 91

Taming the SRU

JANUARY 26, 2024

Yates Case 1: Stroke and Stroke Mimics Early diagnosis of stroke improves stroke outcomes, where misdiagnosis is associated with an upwards of 4-time higher likelihood of mortality Missed strokes most often occur with atypical symptoms, in younger aged patients, those with posterior strokes, and those with lower NIH scores It can be difficult to discern (..)

Stroke 59

Stroke EKG/ECG Outcomes Seizures 59