Dr. Smith's ECG Blog

SEPTEMBER 27, 2023

An ECG was recorded immediately and is shown below. How do you interpret the ECG? ECG#1 There is a regular tachycardia with a ventricular rate of about 180 bpm. After cardioversion, if successful, you can take a few moments to assess the 12-lead in more detail and assess the post conversion ECG. ECG#2 What do you think?

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EKG/ECG Resuscitation Academics EMS 136

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). In the initial ECG (ECG# 1) aVR had ST elevation.

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EKG/ECG Shock Emergency Department Ambulance Services 132

Dr. Smith's ECG Blog

MAY 26, 2023

A 20-something presented after a huge verapamil overdose in cardiogenic shock. mg/dL (sorry, Europeans, for the weird units) Here was the initial ED ECG: There is a junctional rhythm with retrograde P-waves (see the dip in the T-wave in lead II across the bottom; you can follow that up to all the other leads and see the retrograde P wave).

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Shock EKG/ECG Documentation/Coding Resuscitation 98

Dr. Smith's ECG Blog

JUNE 9, 2024

As the medics arrived, they handed me this ECG: What medication did I call for IMMEDIATELY when I saw this? Here is the transesophageal echo (TEE) at the same time as this 2nd ECG: Excellent LV Function. The ECG above is bizarrely wide. A fundamental and lifesaving ECG interpretation that everyone must recognize instantly.

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EKG/ECG Resuscitation Shock Wellness 104

RebelEM

SEPTEMBER 28, 2023

The STREAM-1 trial found that for [2] patients with STEMI presenting within 3 hours of symptom onset and unable to attain PCI within 1 hour of first medical contact, a pharmaco-invasive strategy resulted in similar rates of death, shock, heart failure, or reinfarction compared to primary PCI. Primary PCI: 95.7% Primary PCI: 95.7%

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EKG/ECG Allergic Reactions Shock Stroke 137

Taming the SRU

MARCH 10, 2024

Soon you’ll be able to view our whole pathway on the QI/KT page, but for now, we hope everyone remembers these points: 1) Get labs and an EKG on everyone presenting with hypoglycemia. ECG is a must for EVERY syncope patient. It is not specific enough in defining specific findings on the ECG that should be considered high risk.

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EKG/ECG Shock Wellness EMS 97

EMDocs

FEBRUARY 9, 2024

She is well appearing, and while being placed on the monitor becomes anxious stating the symptoms are recurring. An ECG is performed and is shown below: Figure 1. Adapted from Dr. Smith’s EKG Blog. Another ECG is obtained and shown below. If the response is appropriate, get another EKG and assess the QT interval.

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EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 87

Don't Forget the Bubbles

JULY 26, 2023

Add into this that the majority of children will be in normal sinus rhythm (NSR) by the time of assessment so to truly identify those who have something wrong we have to be confident in identifying arrhythmias where they are present and critical when analysing an ECG in NSR. All were examined and 98% had an ECG. Family history.

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EKG/ECG Hospitals Shock Documentation/Coding 98

Dr. Smith's ECG Blog

SEPTEMBER 23, 2024

Her ECG is shown below: What do you think? The conventional machine algorithm interpreted this ECG as STEMI. Alternatively, with STE in V1 and III, and STD in I and aVL, this ECG could represent proximal RCA OMI with right ventricular involvement. What do you do clinically when the ECG looks like this?

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EKG/ECG Ultrasounds Shock EMS 131

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!

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EKG/ECG Shock Hospitals Sepsis 134

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Here are his EMS ECGs along with the Queen of Hearts interpretations below each one: EMS1 0650 EMS2 0707 Click here to sign up for Queen of Hearts Access The ECGs show RBBB and LAFB, with small but important concordant STE in V2. In EMS2 ECG, the T waves in V5 is possibly hyperacute. So the cath lab was activated.

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EKG/ECG EMS Documentation/Coding Shock 124

Dr. Smith's ECG Blog

JANUARY 8, 2024

I was reviewing ECGs for a study, and came across this one, and was able to get all the clinical information: What do you think? Since that moment, she had had shortness of breath as well as pressure-like chest pain. Patient was given aspirin, sublingual nitro as well as heparin. She also has had some coughing at night.

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EKG/ECG Resuscitation Hospitals EMS 74

Dr. Smith's ECG Blog

OCTOBER 8, 2023

Triage is backed up, and 10 minutes into your shift one of the ED nurses brings your several ECG s that has not been overread by a physician. ECG#1 ECG#2 ECG#3 ECG#4 ECG#5 See outcomes of all 5 below, with the Queen of Hearts AI Bot interpretation. (THE True Positive ECG#2 : Also sinus rhythm.

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Hyperthermia / Hypothermia EKG/ECG Shock Wellness 126

Dr. Smith's ECG Blog

SEPTEMBER 17, 2023

The following ECG was recorded. The presenting ECG shows SR with narrow QRS complexes. There is some upwards concave ST segment elevation in the inferior leads with what seems to be well formed J-waves. First troponin I returned 3174 ng/l, at which point a repeat ECG was ordered. Not much difference from 1st ECG.

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EKG/ECG COPD Shock Wellness 120

EMDocs

JANUARY 23, 2024

Episode 93: BRASH syndrome Background: Brash syndrome has 5 components: bradycardia, renal failure, AV nodal blocker, shock, hyperkalemia. With BRASH, the major ECG change is mainly bradycardia and not all the typical hyperkalemia changes. ECG change is mainly bradycardia, not all of the typical hyperkalemia changes.

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Shock Dehydration Sepsis EKG/ECG 102

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 Wellness Point-of-Care Testing Shock 66

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. Are the lungs clear?

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EKG/ECG Dehydration Fluid Resuscitation Sepsis 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.

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EKG/ECG Outcomes Shock Sepsis 52

Dr. Smith's ECG Blog

MARCH 26, 2024

Here is his ECG: Original image, suboptimal quality Quality improved with PM Cardio digitization The ECG is highly suggestive of acute right heart strain, with sinus tachycardia, S1Q3T3, and T wave inversions in anterior and inferior with morphology consistent with acute right heart strain. Moreover, there is tachycardia.

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EKG/ECG Ultrasounds Shock Wellness 72

EMDocs

OCTOBER 8, 2024

Tachycardia may be present both from many medications or drugs, as well as withdrawal. Glucose POC ECG: Is this actually sinus tachycardia? Looking at the initial or even repeating the ECG will be helpful here. Additional resuscitation Have we addressed all potential sources of shock for the patient in front of us?

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Shock Emergency Department Pediatrics EKG/ECG 104

ACEP Now

JULY 7, 2023

1 Ventricular tachycardia (VT) and ventricular fibrillation (VF) represent the most common initial rhythms for patients presenting to the ED in out-of-hospital cardiac arrest, as well as for patients who develop cardiac arrest while in the ED. 6 What Can I Do Outside of Repeated Shocks and Standard ACLS? amiodarone or lidocaine).

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Resuscitation Shock Stroke Hospitals 98

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. Here was the ECG: There is sinus tachycardia. Well, don't we see diffuse ST Elevation in Myo-pericarditis (with STD in aVR)? This was sent by a reader. and K was normal. This is "Shark Fin" morphology. So this is STEMI, right?

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Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

Dr. Smith's ECG Blog

DECEMBER 15, 2015

No shock was ever delivered. He was in profound shock. There is no pericardial fluid to account for shock. Along with supportive cares, this first ED ECG was recorded: What do you think? Third: what does the ECG tell us about the left ventricle? So this ECG is typical of right ventricular (RV) STEMI.

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Shock Ultrasounds EKG/ECG Wellness 40

Pediatric EM Morsels

MARCH 17, 2023

J Emerg Trauma Shock. Ahmed 2008) Tetanus toxoid booster is usually recommended. Ahmed 2008, Meyers 2022) Of course, treat any other systemic symptoms (like respiratory failure, hypotension) as you typically would. But that puts them at risk for snake bites in some areas. Emergency treatment of a snake bite: Pearls from literature.

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CDC Poisoning Pediatrics Shock 130

Dr. Smith's ECG Blog

AUGUST 28, 2020

I was texted these ECGs. Now appears to be in cardiogenic shock." This insistence on calling it lateral is due to a paper by Bayes de Luna -- [link] ] Case Continued I could only see the ECGs, not the echo. By the ECG, it is not necessarily subacute, but could be. By the ECG, it is not necessarily subacute, but could be.

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Shock EKG/ECG Wellness Outcomes 40

EMDocs

DECEMBER 23, 2024

His initial EKG is the following: What do you think? Do we still shock? The most recent and well-known trial is the PROCAMIO trial (1). Well, the trial was a multicenter prospective open label trial. Well, lets look at some other trials. If the patient has a BP of 60/palp, its easy, right? Should you?

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EKG/ECG Shock Wellness EMS 73

Dr. Smith's ECG Blog

DECEMBER 14, 2016

Here was his ED ECG: I read this as normal --One might say there is ST depression in II, III, and aVF, but this is merely an atrial repolarization wave. --You We recorded a posterior ECG: V4-V6 are moved around to the back and are really V7-V9. Learning Point Acute coronary occlusion may occur with no ECG findings whatsoever.

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EKG/ECG Shock Hospitals Wellness 52

Dr. Smith's ECG Blog

AUGUST 13, 2020

Because of the tachcardia, I would expect her to be very poor left ventricular function and maybe Cardiogenic shock. 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. Looks like atrial fibrillation.

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EKG/ECG Shock Stroke Seizures 52

EM SIM Cases

SEPTEMBER 19, 2024

WHY IT MATTERS Patients in hemorrhagic shock require blood products expeditiously as well as identification and definitive management of the source of bleeding. This case provides an opportunity to practice identification and treatment of multiple sources of blood loss in hemorrhagic shock.

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Shock Emergency Nursing Operations Administration 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?

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EKG/ECG Shock Fluid Resuscitation Documentation/Coding 40

Dr. Smith's ECG Blog

OCTOBER 28, 2022

Cortland Ashbrook from Spokane County, Washington, sent this message: Hey doctor Smith, I wondered if you’d give me your opinion on these ECG tracings I took as a paramedic in the field? I believed this met modified Sgarbossa in II, III and aVF with excessive discordance as well as reciprocal in aVL.

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EKG/ECG EMS Shock Wellness 52

EM Curious

MAY 27, 2015

How well do you think the INR is as an indicator of coagulopathy in these patients? WHEN THE HEART FAILS CARDIOGENIC SHOCK: [BLOG]: We don't normally refer to the same blog twice in one week but these posts are just too good. Dr. Smith's ECG Blog See you next week Read on here at Boring EM. Check out these 7 pearls here.

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EMS Shock EKG/ECG Pediatrics 52

Dr. Smith's ECG Blog

MAY 8, 2023

Triage ECG: What do you think? Code STEMI was activated by the ED physician based on the diagnostic ECG for LAD OMI in ventricular paced rhythm. There is concordant ST elevation in I, aVL with reciprocal concordant STD in inferior leads, as well as excessively discordant TE in V2-V4. EKG and CT head were performed.

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EKG/ECG Documentation/Coding Outcomes Shock 52

AED Leader

JULY 10, 2024

It offers advanced features such as ECG monitoring and multiple rescue capabilities. Their Lifeline series includes the Lifeline DCF-100, Lifeline View, and Lifeline ECG. The Lifeline ECG is a professional-grade AED that offers the added benefit of ECG monitoring. Its AEDs are known for their quality and reliability.

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CPR EKG/ECG Shock Pediatrics 52

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.

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EKG/ECG Shock Sepsis Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 23, 2022

He had history of prior MIs and CABG, as well as diabetes, hypertension, and hyperlipidemia. Here is his triage ECG: PM Cardio version: With no other information at all, I sent this ECG to Dr. Smith, who replied: "I think it is real. He underwent CPR and then was shocked out of VF. STD in V4-5 too." Plate and Meyers.

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EKG/ECG Shock CPR Outcomes 52

Dr. Smith's ECG Blog

JULY 18, 2014

Here is his ECG: What is your interpretation? the presence of such well developed, wide, anterior Q-wave suggests completed transmural STEMI. Case Continued 2 days later the patient became increasingly tachycardic, hypotensive, ashen, clammy (in cardiogenic shock) and had a new murmur. This was the 12-lead ECG.

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EKG/ECG Ultrasounds Shock Wellness 52