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.

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EKG/ECG Point-of-Care Testing Wellness Shock 66

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.

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Seizures EKG/ECG Shock EMS 40

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?

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EKG/ECG Seizures Stroke Wellness 52

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 94

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.

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EKG/ECG Outcomes Shock Sepsis 52

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

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.

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EKG/ECG Stroke Administration Seizures 52

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. It looks like he has an old anterior lateral MI as well. The cath lab had been activated and then they sent me the ECG. Cath lab was cancelled.

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EKG/ECG Shock Stroke Seizures 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.

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EKG/ECG Seizures Documentation/Coding Outcomes 40

Dr. Smith's ECG Blog

JUNE 17, 2016

He had a seizure this morning and rolled out of bed unable to get up. There were no injuries and no chest pain and he appeared well. The medics recorded a prehospital ECG: The computerized QTc is 397 ms Jason writes: " What's your thoughts Steve?" But this measurement was at the J-point, which on this ECG is 4 mm.

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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. There were no injuries and no chest pain and he appeared well. The medics recorded a prehospital ECG: The computerized QTc is 397 ms Jason writes: " What's your thoughts Steve?" But this measurement was at the J-point, which on this ECG is 4 mm.

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EKG/ECG Seizures EMS Outcomes 52

Mind The Bleep

MAY 16, 2023

It also requires exclusion; even though the child in front of you appears well they still need a thorough history and examination to make sure there isn’t something more concerning going on. Some important causes to consider include reflux (very common), seizures, and maltreatment/NAI.

Basic Life Support 52

Basic Life Support Seizures CPR Wellness 52

Taming the SRU

FEBRUARY 23, 2024

Total RBC count (<500 RBCs in last tube), as well as clearance by the last tube (decrease in RBC count by at least 70% by the last tube), can be used to differentiate between traumatic taps and a SAH. If assessing for SAH, xanthochromia may not appear until 12 hours after onset, though may appear after 2-4 hours.

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Pediatrics Ultrasounds Fractures Wellness 75

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). Caution with use of NIPPV – positive pressure can worsen injury as well as increase subcutaneous emphysema.

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Operations Radiology Radiology Fluid Resuscitation 86

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.

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Seizures Fluid Resuscitation Poisoning 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?

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EKG/ECG Operations Seizures Stroke 52

PEMBlog

MARCH 27, 2024

Or, well, the ringer called me. They include neurologic dysfunction, which is one of the most common that includes things like developmental delay, regression, AKA loss of developmental milestones, hypotonia, encephalopathy, or seizures. And you’re thinking, hey! Brad’s not a pediatric medical geneticist. No, I’m not.

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Pediatrics Seizures Emergency Department Sepsis 59

PEMBlog

SEPTEMBER 6, 2023

There is abundant evidence showing that routine lab tests in such patients have a very low yield and are not indicated, in adults as well as in children. These labs were not truly indicated, but it was common practice and viewed as “not a big deal.” Acute onset psychosis is relatively rare.

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Psychiatric Pediatrics Emergency Department EKG/ECG 52

Pediatric Emergency Playbook

JUNE 1, 2017

This child is at risk for expected complications, as well as overdiagnosis and iatrogenia. These children depend on their preload to run blood passively into the pulmonary circuit; afterload reduction is also important to compensate for a poor left ejection fraction, as well as to avoid the development of pulmonary hypertension.

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Pediatrics EKG/ECG Wellness Seizures 52

Dr. Smith's ECG Blog

APRIL 23, 2019

This is 50-something who presented after a seizure and was unconscious and tachycardic: There is a wide complex, followed by a narrow complex, followed by a wide complex. For clarity — I’ve reproduced and labeled the initial ECG in this case ( Figure-1 ). Figure-1: The initial ECG in this case. What is the diagnosis?

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EKG/ECG Seizures Wellness 52

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. 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.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Mind The Bleep

OCTOBER 29, 2024

Alkali burns result in liquefaction necrosis, allowing for deeper tissue injury as well as vascular injury that can lead to both local and systemic toxicity [1]. 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%

Burns 52

Burns Fluid Resuscitation PPE Hyperthermia / Hypothermia 52

Taming the SRU

MAY 1, 2023

Patients must have EKG findings and meet one of a few other criteria (ie family history of sudden death, VF or VT episode, syncope, nocturnal agonal respirations) Most common in patients of Southeast Asian descent and the mean age of death from arrhythmia if untreated is in the 4th decade of life.

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Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2015

Both of these also cause seizures. Here is the history : Male in 40's who had seizures and was unconscious. Suggestions on management: First , examine the ECG very closely for P-waves. Wells, P.J. due to Na channel blockade. BP 200/100. Pupils dilated. They had already given adenosine 6 mg and 12 mg without effect.

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Seizures Administration Outcomes Hospitals 52

Taming the SRU

FEBRUARY 22, 2023

Team Environment Own the Resuscitative Real Estate Set up how you want the resuscitation to go Organize your space in the way that will wrok best for you and the patient Patient Special circumstances Peds Pregnant Mechanical circulatory support Update Partner Priorities Clear and well defined Lesson 2 Lead with kindness Being liked is a powerful tool (..)

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Hospice EKG/ECG Resuscitation Seizures 40

EMDocs

SEPTEMBER 25, 2023

They increase the risks of hypoxia and acidosis during the apneic period as well as hypotension and hypoperfusion caused by the abrupt transition from negative-pressure to positive-pressure ventilation (10). Contraindicated seizures or porphyria. Notable Physical Exam: General: Tripoding, severe respiratory distress.

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Emergency Department Soft Tissue Injuries Airway Management Operations 84

Mind The Bleep

DECEMBER 31, 2023

Damaged kidneys don’t handle drugs well Or fluids! or the patient is symptomatic or shows signs of hypokalaemia (ECG changes, weakness, arrhythmias). Acutely, the first step is to ensure there are no ECG changes caused by low calcium. If the patient is an outpatient, they should be called to check they are well.

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Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

EMDocs

JANUARY 4, 2024

3 Bupropion blocks the reuptake of dopamine and norepinephrine, as well as antagonizes acetylcholine at nicotinic receptors. Bupropion lowers the seizure threshold and even at therapeutic doses patients can have seizures. 6 In one study, almost all patients who went on to develop seizures had tachycardia prior to the seizure.

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Seizures EKG/ECG Poisoning Shock 84

Critical Care Now

JUNE 21, 2022

His coach and fellow players witnessed a seizure-like activity immediately after collapsing. The first prehospital EKG showed Polymorphic Ventricular Tachycardia (PVT) that responded to defibrillation. A normal baseline EKG (if obtained while at rest) will exclude conditions like short or long QT syndromes, Brugada or WPW.

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Seizures EKG/ECG CPR Shock 52

EB Medicine

AUGUST 1, 2018

Jeff: Medicinally, cannabinoids are currently used in the treatment of chronic pain syndromes, complications of multiple sclerosis and paraplegia, weight loss due to appetite suppression in HIV/aids, chemotherapy-induced nausea and vomiting, seizures, and many other neuropsychiatric disorders.

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Seizures Hyperthermia / Hypothermia Administration Dehydration 40

ACEP Now

MARCH 11, 2025

I recommend an order set that includes ECG, glucose, creatinine, liver enzymes, lipase, amylase, electrolytes including calcium, magnesium, and phosphate ketones, and urinalysis. 16 An elevated amylase suggests repetitive vomiting as well. 16 An elevated amylase suggests repetitive vomiting as well.

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Emergency Department Psychiatric Dehydration Pediatrics 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

As part of the workup, she underwent an ECG. Thus, Brugada is the likely diagnosis _ A very nice explanation of this is given in the document quoted below on current ECG criteria for Brugada pattern. We repeated the ECG: Brugada pattern is mostly resolved. Is this Type 2 Brugada syndrome/ECG pattern? And another finding.

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EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

The Skeptics' Guide to EM

APRIL 9, 2022

He remained completely awake and alert and otherwise appeared well. The workup can include laboratory testing, EEGs, ECGs, echocardiogram and advanced neuroimaging. There was no history of recent trauma, infectious symptoms, or any other illness.

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Head Injuries Emergency Department Seizures Stroke 52

Dr. Smith's ECG Blog

JANUARY 21, 2023

The patient had a witnessed generalized tonic-clonic seizure leading to GCS 4. In the resuscitation room, the patient had another seizure that stopped after IV Lorazepam. ECG met STEMI criteria and was labeled STEMI by computer interpretation. ECG met STEMI criteria and was labeled STEMI by computer interpretation.

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Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

Dr. Smith's ECG Blog

APRIL 8, 2015

First: Are you sure it was syncope, and not SEIZURE? Conversely , frequently syncope has a short episode of tonic-clonic activity that mimics seizure. Abnormal ECG – looks for cardiac syncope. If no previous ECG was available, ECG was classified as abnormal if any abnormality was present.

Emergency Department 52

Emergency Department EKG/ECG Outcomes Seizures 52

Taming the SRU

AUGUST 25, 2023

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 1 mcg/kg over 10 minutes followed by continuous infusion: 0.2

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Seizures Fractures EKG/ECG Resuscitation 75

EMDocs

NOVEMBER 4, 2024

Pain can be associated with a friction rub on cardiac auscultation, a pericardial effusion on a bedside echocardiogram, or diffuse ST elevations on an EKG. She denies any trauma, swelling, or redness in the joints, as well as fever or weight loss. Up to two-thirds of rib fractures are missed on initial chest radiographs.

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Emergency Department Fractures Burns EMS 105