EB Medicine

FEBRUARY 1, 2024

Eckler MD interview Nick Harrison, MD and Daniel Brenner, MD, two of the authors of the February 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Right Heart Failure Pathophysiology Presenting Symptoms Differential Diagnosis Specific Acute Causes PE Sepsis RVMI PPV ARDS COVID-19 Specific Chronic Causes CTEPH (..)

Emergency Department 97

Emergency Department Sepsis EKG/ECG 97

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The ECG below was recorded about 20 minutes after he regained consciousness. ECG #1 The above ECG shows sinus rhythm at about 60 bpm. Figure A It now becomes apparent that there is ST segment depression in almost every lead of the ECG (V1-V6, I, II, aVL and aVF). sepsis, anemia, hypoxemia, severe hypotension etc.,

EKG/ECG 124

EKG/ECG Shock Emergency Department Ambulance Services 124

EMDocs

APRIL 2, 2024

Check the pulse RSI= Resuscitation Sequence Intubation Hypoxia, Hypotension, and Acidosis are the reason patients code during/post intubation These patients are super high risk for all 4 Optimize first pass success – Induction agent + paralytic Unconscious patients will still have muscle tone Induction Ketamine or Etomidate at half doses (i.e.,

Documentation/Coding 92

Documentation/Coding CPR EKG/ECG Sepsis 92

RebelEM

SEPTEMBER 21, 2023

ECG shows a regular, narrow-complex, tachycardia at 190 bpm consistent with SVT. Type 2 MI is common in the ED and can result from vigorous exercise (common in athletes after marathons), sepsis, trauma and tachydysrhythmias including SVT. After conversion to sinus rhythm, do a good history, physical and analysis of the ECG.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

Taming the SRU

JUNE 26, 2024

Patients with AML and sepsis have a higher mortality than their otherwise healthy counterparts. Gut translocation is a common etiology of sepsis in patients with AML. Gram positive sepsis is more common, but gram negative sepsis carries higher morbidity/mortality.

Blood Transfusions 85

Blood Transfusions Sepsis CPR EKG/ECG 85

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. The K returned at 6.9

EKG/ECG 52

EKG/ECG Dehydration Fluid Resuscitation Sepsis 52

EMergucate

OCTOBER 19, 2021

The ECG below is from a 66 year old diabetic man who has presented with sepsis. Interpretation Rate: 72 Rhythm: … Continue reading →

EKG/ECG 52

EKG/ECG Sepsis 52

Dr. Smith's ECG Blog

JULY 21, 2024

The below ECG was recorded. The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. This ECG does not have the typical ST-vector of an LAD occlusion. See below for Ken Grauer Comment on the initial ECG: == On arrival, another ECG was recorded: There appears to have been quite a bit of spontaneous reperfusion!

EKG/ECG 117

EKG/ECG Shock Hospitals Sepsis 117

Emergency Medicine Cases

OCTOBER 11, 2022

In this month's ECG Cases blog Dr. McLaren explains the PACER mnemonic approach to patients with pacemakers: Pacemaker spike: is it appropriately presence/absent, is there pacemaker-mediated tachycardia (apply magnet) or is there failure to pace (apply magnet to stop sensing, cardio consult)?

EKG/ECG 52

EKG/ECG Dehydration Sepsis EMS 52

Dr. Smith's ECG Blog

OCTOBER 12, 2023

B elow are 4 ECGs from the same patient. Accompanying the ECGs is some clinical information. Look at the ECGs and consider the timeline and other information. Which one do you think fits better with the ECGs and their timeline? As part of her work up in the ED an ECG was recorded. ECG#2 - day 4.

EKG/ECG 99

EKG/ECG Hospitals Sepsis Wellness 99

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

EMDocs

JANUARY 1, 2025

ECG Pointers: A Dynamic Approach to Tachydysrhythmias Part 2 Lloyd Tannenbaum, Mai Saber, and Rachel Bridwell cover narrow and irregular tachydysryhtmias. Guideline Updates: Corticosteroids in Sepsis, ARDS, Community-Acquired Pneumonia This post covers the SCCM guideline updates on steroids in sepsis, ARDS, and community-acquired pneumonia.

Sepsis 62

Sepsis EMS EKG/ECG Hospitals 62

Dr. Smith's ECG Blog

MARCH 13, 2024

He went to urgent care and had an ECG (not available) which was interpreted as normal, and was sent home. His ECG is shown: What do you think? Here is the Queen's verdict and translator: For me, it is hard to make much of this ECG. Smith : at this point, the ECG becomes irrelevant. Activate the cath lab!

EKG/ECG 85

EKG/ECG Urgent Care Sepsis Wellness 85

EMergucate

OCTOBER 19, 2021

The ECG below is from a 66 year old diabetic man who has presented with sepsis. Interpret the ECG How … Continue reading →

EKG/ECG 40

EKG/ECG Sepsis EMS 40

EMDocs

JANUARY 23, 2024

An inciting event will typically push them over the edge into BRASH syndrome: Dehydration Hypotension from sepsis or another condition GI illness Dosage increase of a chronic medication (e.g., With BRASH, the major ECG change is mainly bradycardia and not all the typical hyperkalemia changes. beta blocker) New medication (e.g.,

Shock 87

Shock Dehydration Sepsis EKG/ECG 87

ALiEM

FEBRUARY 9, 2024

Applying the 2022 ACC guideline Before delving into the specifics of the hs-cTn pathways, start with the ECG. The ACC 2022 pathway has a section dedicated to ECGs in ischemia [1], and FOAMcast has a great visual summary. below limit of detection) AND the chest pain onset is >3 hours ago AND the ECG is non-ischemic.

EKG/ECG 110

EKG/ECG Emergency Department Burns Wellness 110

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

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 74

EKG/ECG Seizures Sepsis Operations 74

Thinking Critical Care

MAY 20, 2023

With help from the usual suspects (Rory Spiegel, Andre Denault, Korbin Haycock) we are focusing on some core areas in acute and critical care – sepsis, arrest and respiratory failure are perennials, but this year we are also adding neurocrit as a core component, which I think is a bit underserved and certainly deserving of more.

Airway Management 95

Airway Management Resuscitation EKG/ECG CPR 95

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

EMDocs

JUNE 22, 2024

“Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” “Amniotic fluid embolism: diagnosis and management.” ” Am J Obstet Gynecol 215(2): B16-24. link] j.ajog.2016.03.012 2016.03.012 Patel, P., ” Clin Appl Thromb Hemost 25: 1076029619843338.

EMS 96

EMS Resuscitation Blood Transfusions Seizures 96

EM Curious

JULY 8, 2015

CARDIOLOGY NUGGETS CASE OF A 59 Y/O M APPEARING UNWELL [BLOG]: You must learn to recognize these ecg patterns, and have a practical ecg reading algorithm. BENIGN EARLY REPOLARIZATION [BLOG]: Have a quick skill brush-up on this common ECG finding that could be looking quite concerning if you are not familiar with it.

Infectious Diseases 52

Infectious Diseases Disaster Management Sepsis Ultrasounds 52

ACEP Now

OCTOBER 29, 2024

For example, experienced emergency physicians have great clinical gestalt and accuracy to predict sepsis in critically ill patients at just 15 minutes from patient arrival—more so than scoring tools like the qSOFA, MEWs, and even machine-learning trained artificial intelligence models. Gut feelings: the intelligence of the unconscious.

Emergency Department 59

Emergency Department Mass Casualty Incidents Documentation/Coding Sepsis 59

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. DISCUSSION: The 12-lead EKG EMS initially obtained for this patient showed severe ischemia, with profound "infero-lateral" ST depression and reciprocal ST elevation in lead aVR. What should be done?

EKG/ECG 40

EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Dr. Smith's ECG Blog

FEBRUARY 12, 2023

I was reading EKGs on the system before a shift, and saw this one: What do you think? I went to the chart and found that the patient was a sepsis patient with hypotension and a K of 3.0. So I thought it probably is not posterior OMI and I just moved on and kept reading EKGs. There was no chest pain.

EKG/ECG 40

EKG/ECG Sepsis Ultrasounds 40

EMDocs

NOVEMBER 27, 2023

ESR & CRP – nonspecific and typically elevated Blood culture – if presenting with sepsis Imaging: Consider a chest radiograph in patients with pulmonary symptoms to evaluate for associated pneumonitis, pleural effusions, cardiomegaly. Obtain EKG if patient is presenting with chest pain.

EMS 71

EMS Sepsis Burns EKG/ECG 71

Dr. Smith's ECG Blog

NOVEMBER 9, 2012

On arrival, here is his initial ED ECG, and is identical to the prehospital ECG and at the same rate: There is a regular, wide complex. The patient ' s baseline ECG looks exactly the same, except that it is slower (93) and the p-waves are obvious. Maybe the patient has dehydration, sepsis, hemorrhage, or PE.

EKG/ECG 52

EKG/ECG Dehydration Sepsis Shock 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

Seizures 87

Seizures Emergency Department Hyperthermia / Hypothermia EMS 87

EMDocs

OCTOBER 10, 2024

EKG shows atrial fibrillation with a rate of 169. Sepsis is diagnosed and antibiotics started for the first time. High level amputation is considered, but she dies of sepsis and multiorgan failure on hospital day 7. Her R anterior thigh, knee and posterior calf are tender, swollen and ecchymotic. Glucose is 490, CO2 8, and pH 7.26

Documentation/Coding 74

Documentation/Coding Hospitals Sepsis Infectious Diseases 74

Dr. Smith's ECG Blog

JANUARY 1, 2013

A middle aged male with no h/o CAD presented with one week of crescendo exertional angina, and had chest pain at the time of the first ECG: Here is the patient's previous ECG: Here is the patient's presenting ED ECG: There is isolated ST depression in precordial leads, deeper in V2 - V4 than in V5 or V6. See the list below.

EKG/ECG 52

EKG/ECG Sepsis 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

Seizures 74

Seizures Fractures EKG/ECG Resuscitation 74

EMDocs

OCTOBER 8, 2024

The full differential diagnosis of sinus tachycardia in isolation is extensive ranging from benign etiologies such as anxiety to severely life threatening etiologies such as sepsis. Glucose POC ECG: Is this actually sinus tachycardia? Looking at the initial or even repeating the ECG will be helpful here.

Shock 94

Shock Emergency Department Pediatrics EKG/ECG 94

EMDocs

OCTOBER 25, 2024

ESR & CRP – nonspecific and typically elevated Blood culture – if presenting with sepsis Imaging: Consider a chest radiograph in patients with pulmonary symptoms to evaluate for associated pneumonitis, pleural effusions, cardiomegaly. Obtain EKG if patient is presenting with chest pain.

Sepsis 72

Sepsis Burns EKG/ECG EMS 72

Dr. Smith's ECG Blog

APRIL 15, 2019

A prehospital ECG was recorded (not shown and not seen by me) which was worrisome for STEMI. Here was his initial ED ECG: There is sinus tachycardia at a rate of about 140 There is profound ST Elevation across all precordial leads, as well as I and aVL. A near 60 year old male called 911 for increasingly severe fever and SOB.

EKG/ECG 40

EKG/ECG Sepsis Documentation/Coding Shock 40

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

MAY 19, 2020

A followup ECG was recorded 2 days later: No definite evidence of infarction. pulmonary embolism, sepsis, etc.), Smith — “ S hark F in” m orphology was noted on the initial monitoring strip, and initial 12-lead ECG. For clarity — I’ll again show the initial ECG done in the ED in Figure-1. myocarditis). Did YOU see them?

CPR 52

CPR EKG/ECG Shock Ultrasounds 52

Dr. Smith's ECG Blog

JANUARY 5, 2020

Here is the ECG: What do you think? A study of 2298 ECGs from 1085 patients which had a computerized interpretation of AF found that in 442 (19%) of these ECGs, from 382 patients (35%), the interpretation was incorrect, and that, in 92 of these 382 patients, the physician had failed to correct it. Among, 2447 ECGs, Mant et al.

EKG/ECG 52

EKG/ECG COPD Wellness Sepsis 52