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 107

EKG/ECG Urgent Care Sepsis Wellness 107

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 113

Shock Dehydration Sepsis EKG/ECG 113

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

Northwestern EM Blog

MARCH 1, 2025

There are several etiologies including viral pneumonia, bacterial pneumonia, sepsis, trauma, and pancreatitis. In this study, they found that prone positioning resulted in significant improvement in oxygenation, as well as a 50% decrease in mortality at 28 days (Guerin et. Remove ECG leads and patches. Suction as needed.

Emergency Department 52

Emergency Department Fractures EKG/ECG Wellness 52

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

EMDocs

NOVEMBER 1, 2023

1 , 4 If presenting later in course or with an intra-abdominal perforation, patients are more likely to show signs of sepsis and hemodynamic instability. VBG with lactate 4 – may show low pH with elevated lactate Cardiac biomarkers – to evaluate for cardiac etiology in those presenting with chest pain or type II NSTEMI in those with sepsis.

Operations 92

Operations Radiology Radiology Fluid Resuscitation 92

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

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

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

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

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

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.

Fluid Resuscitation 52

Fluid Resuscitation Hospitals Sepsis EKG/ECG 52

EB Medicine

JULY 8, 2019

Jeff: Well that’s kind worrisome. Which again reiterates why this is such an important topic for us as EM clinicians to be well-versed in. For the sake of completeness, just be aware that there is also the biliopancreatic diversion with or without a duodenal switch, as well as a vertical banded gastroplasty.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40

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 105

Seizures Hyperthermia / Hypothermia Emergency Department EMS 105

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 127

EKG/ECG Shock Emergency Department Ambulance Services 127

RebelEM

SEPTEMBER 21, 2023

ECG shows a regular, narrow-complex, tachycardia at 190 bpm consistent with SVT. Troponins are highly specific to cardiac myocytes but do exist in other muscle types as well. 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.

EKG/ECG 143

EKG/ECG Sepsis EMS Outcomes 143

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

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 130

EKG/ECG Shock Hospitals Sepsis 130

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 96

EMS Sepsis Burns EKG/ECG 96

EMDocs

JUNE 22, 2024

The newborn is doing well, but the mother is complaining of shortness of breath and chest pain. “Markers of Inflammation and Infection in Sepsis and Disseminated Intravascular Coagulation.” A 37-year-old G5P4 at 33 weeks presents to the ED after being brought in by ambulance. RR 28, SpO2 89% on 6L NC. link] j.ajog.2016.03.012

EMS 111

EMS Resuscitation Seizures Blood Transfusions 111

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 98

Sepsis Burns EKG/ECG EMS 98

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

EB Medicine

NOVEMBER 1, 2018

Jeff: And unlike past issues covering more common pathologies, like, say, sepsis, this month’s team reviewed much more literature than just the past 10 years. Jeff: Vascular injuries include coagulation necrosis as well as thrombosis. Those with low voltage injuries and a normal EKG do not require monitoring.

Emergency Department 40

Emergency Department Burns EKG/ECG Shock 40

Northwestern EM Blog

JANUARY 24, 2022

Due to its extremely high morbidity and mortality as well as high healthcare costs, the prompt recognition, diagnosis and resuscitation of shock is key. Acidosis Acidosis in shock states can present from multiple different sources, including sepsis, hypoxemia, ingestions, hyperlactatemia from hypoperfusion, amongst others. 3) Farkas J.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

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. Tachycardia may be present both from many medications or drugs, as well as withdrawal. Glucose POC ECG: Is this actually sinus tachycardia?

Shock 106

Shock Emergency Department Pediatrics EKG/ECG 106

PEMBlog

MARCH 27, 2024

Or, well, the ringer called me. However, sometimes you might hear of siblings or other relatives who had early onset neurologic or GI dysfunction or died early in life, and this can often be attributed to sepsis or sudden infant death syndrome because the symptoms of these overlap with IEMs. And you’re thinking, hey!

Pediatrics 59

Pediatrics Seizures Emergency Department Sepsis 59

EB Medicine

JUNE 6, 2019

For example, patients with misdiagnosed disease has less RLQ pain and tenderness as well as diminished anorexia, nausea, and vomiting. Jeff: Well that’s scary - I know I’ve already missed a case, but luckily, he returned thanks to good return precautions, which we’ll get to in a few minutes. In one study, a SI > 0.7

Ultrasounds 40

Ultrasounds Radiology Radiology Sepsis 40

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.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Seizures Emergency Department 52

Dr. Smith's ECG Blog

APRIL 6, 2025

The PMCardio Queen of Hearts AI Model thinks it is a reperfused OMI: Case continued: Initial EKG demonstrated ST depression in V1-V4, concerning for posterior OMI. He was given vancomycin and cefepime empirically, though we overall had low concern for sepsis as the etiology of his presentation. Cardiology was consulted.

EKG/ECG 110

EKG/ECG CPR Shock Sepsis 110

Dr. Smith's ECG Blog

DECEMBER 27, 2024

His clinic ECG is shown. In an elderly patient complaining of palpitations, we have an ECG with heart rate 140 bpm. Repeat ECG obtained in ER: Fortunately for the patient, his ventricular tachycardia spontaneously resolved. The current ECG shows sinus tachycardia with old inferior infarct. What do you think?

EKG/ECG 120

EKG/ECG Hospitals Sepsis Documentation/Coding 120

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9, then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 65

Documentation/Coding Seizures Psychiatric Wellness 65

Taming the SRU

NOVEMBER 13, 2024

mg/kg (of 0.1 mg/kg (of 0.1 2x maintenance rate

Psychiatric 90

Psychiatric Seizures Emergency Department Pediatrics 90

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 76

Seizures Fractures EKG/ECG Resuscitation 76

Mind The Bleep

NOVEMBER 2, 2024

Babies in the neonatal unit will typically wait until they are well enough for the examination e.g. NIPE is not performed for baby’s who are ventilated, on CPAP or have lots of different lines inserted. Other important questions to ask: Have they been feeding well? Request an ECG for the baby if ANY murmur is identified.

Dislocations 52

Dislocations Documentation/Coding Ultrasounds Wellness 52