Emergency Medicine Cases

SEPTEMBER 12, 2023

The post ECG Cases 45 ECG in Weakness and Neurological Symptoms appeared first on Emergency Medicine Cases.

EKG/ECG 118

EKG/ECG Seizures Stroke EMS 118

Dr. Smith's ECG Blog

NOVEMBER 14, 2023

In the last post, we saw how important old ECGs are in assessing the current ECG in a patient without atypical presentation (in this previous case, the patient had no chest pain, and the apparent inferior OMI did not have reciprocal ST depression in lead aVL). Here is that last post: A 90-something with acute stroke.

EKG/ECG 110

EKG/ECG EMS Stroke Outcomes 110

Sensible Medicine

FEBRUARY 12, 2024

Neurologist Hooman Kamel from the Weil Cornell Medical Center in NY had an idea about atrial fibrillation and stroke. Stroke came when these clots moved northward to the brain. One of the big issues with this theory was that studies had failed to show a strong relationship in time between the stroke and the irregular rhythm. (For

Wellness 122

Wellness Stroke EKG/ECG Academics 122

Dr. Smith's ECG Blog

OCTOBER 25, 2023

Here is his triage ECG: What do you think? What is the most likely cause of the patient’s ECG findings, and what would be your first step in management? What does the ECG show? What does the ECG show? Figure-1: The initial ECG in this case — and a rapid method for estimating the QTc ( See text ). Is it STEMI?

EKG/ECG 115

EKG/ECG Seizures Hospitals Stroke 115

RebelEM

SEPTEMBER 28, 2023

ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% ECG Results: Repeat ECG 90min after tenecteplase indicated 70.3% The upper range of this time was 120 minutes from diagnostic ECG in the majority of patients.

EKG/ECG 138

EKG/ECG Allergic Reactions Shock Stroke 138

EMDocs

MAY 4, 2024

. #1: Emergent Cath Lab Activations with “Normal” Computer ECG Interpretations Spoon Feed A significant minority of code STEMI patients have an initial normal computer ECG interpretation. Consequently, emergency physicians must remain vigilant to identify signs of OMI regardless of the initial computer ECG interpretation.

Documentation/Coding 78

Documentation/Coding Stroke Emergency Department Pediatrics 78

The Skeptics' Guide to EM

OCTOBER 5, 2019

Prehospital transdermal glyceryl trinitrate in patients with ultra-acute presumed stroke (RIGHT-2): an ambulance-based, randomized, sham-controlled, blinded, phase 3 trial. His 12-lead ECG shows a normal sinus rhythm without ST abnormality or ectopy. This episode will not debate the use of tPA for acute ischemic stroke.

Stroke 52

Stroke Hospitals EMS Administration 52

Taming the SRU

JANUARY 26, 2024

Morbidity & MOrtality - Mini Lit Blitz - Post-Rosc Care - Qi/KT Morbidity & Mortality WITH Dr. 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 (..)

Stroke 59

Stroke EKG/ECG Seizures Outcomes 59

Stop and Think

DECEMBER 29, 2023

For an older patient with stroke risk factors and 3 hours of AF on a cardiac device, pre-2023 thinking would have us leaning toward anticoagulation. Edoxaban reduced the primary endpoint of stroke, systemic embolism, and cardiovascular death by 19% (HR, 0.81; 95% CI, 0.60-1.08; The doctor would do an ECG and that would diagnose AF.

Stroke 90

Stroke EKG/ECG Research Wellness 90

Sensible Medicine

JUNE 28, 2024

She is admitted with suspected stroke. Case 1: Excess An elderly woman is admitted to a community hospital with a minor stroke. The plan was that she would get a two-week, continuous EKG monitor placed and have a sleep study at this hospital. Sensible Medicine is a reader-supported publication. I love my job.

Stroke 92

Stroke Academics Hospitals EKG/ECG 92

Dr. Smith's ECG Blog

SEPTEMBER 2, 2024

The ECG below was recorded by EMS. ECG #1 Interpretation: ECG #1 shows sinus rhythm at a heart rate of 77 bpm. At first glance, the ECG does not look too abnormal. In my experience, the pathologic finding in the above ECG is the easiest one to overlook — especially if you are in a rush and do not do a systematic review.

Seizures 106

Seizures EKG/ECG EMS Stroke 106

Dr. Smith's ECG Blog

JULY 5, 2024

Her heart rate was very fast, so we obtained an ECG immediately: ECG: What do you think? But the duration of symptoms was prolonged and so to avoid the risk of stroke, AV nodal blockade (rate control) was preferred. We want to avoid a stroke. WHY Did We Think Today's ECG was Supraventricular?

EKG/ECG 99

EKG/ECG Stroke Administration Wellness 99

Dr. Smith's ECG Blog

OCTOBER 28, 2023

Here is his ECG. See this articles: Heart Failure with Preserved Ejection Fraction (NEJM review) One etiology of LVH on the ECG is Hypertrophic Cardiolmyopathy (HOCM), and sometimes ECGs in patients with HOCM are specific for HOCM. But this ECG is NOT specific for HOCM. Figure-1: The ECG in today's case.

EKG/ECG 74

EKG/ECG Stroke Ultrasounds Wellness 74

Dr. Smith's ECG Blog

MAY 30, 2023

His prehospital ECG was diagnostic of inferior posterior OMI. Here is his ED ECG: There is bradycardia with a junctional escape. We recorded an ECG in which V1-V3 were put in the position of V4R-V6R, and V4-6 were placed in V7-9 to (academically) confirm posterior OMI. The patient was in clinical shock with a lactate of 8.

Shock 86

Shock EKG/ECG Academics Stroke 86

ALiEM

MARCH 22, 2024

Laboratory Data CBC , CMP , EKG , and Troponins were normal. The two main causes of internuclear ophthalmoplegia are demyelination of the medial longitudinal fasciculus (MLF) from multiple sclerosis (MS) and ischemic cranial nerve damage from stroke. There were no oligoclonal bands.

Stroke 67

Stroke Urgent Care Head Injuries Emergency Department 67

Sensible Medicine

FEBRUARY 13, 2024

In brief, the trial compared apixaban vs aspirin in patients who had had a stroke of unknown source and evidence of atrial cardiopathy. Recurrent stroke (the primary endpoint) occurred in 40 patients in each group. Apixaban did not reduce the rate of recurrent stroke over aspirin in these patients. The hazard ratio was 1.00.

Stroke 70

Stroke Outcomes Wellness EKG/ECG 70

Dr. Smith's ECG Blog

JANUARY 8, 2020

A former resident texted me this ECG, done for epigastric pain in an 18 year old. I put it on Facebook EKG club and this is the response: No one knew for certain what that was, but Ken Grauer suspected artifact (due to lead placement over an artery) or a Crochetage sign, which is strongly associated with atrial septal defect.

EKG/ECG 52

EKG/ECG Stroke Pediatrics 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2022

Written by Bobby Nicholson MD, with edits by Meyers A woman in her 50s with past medical history of heart failure, prior stroke, atrial fibrillation on Eliquis, lung cancer in remission, and CKD, presented to the emergency department for evaluation of cough and shortness of breath. EKG was obtained in triage and read as ventricular bigeminy.

EKG/ECG 52

EKG/ECG Stroke Emergency Department Wellness 52

Sensible Medicine

AUGUST 28, 2023

Some background: In patients with certain risk factors, AF increases the risk of having a stroke. The increase in risk parallels the presence of risk factors, such as age, high blood pressure, diabetes, coronary disease, and previous stroke. Net benefit means stroke reduction > bleeding increase. We call this clinical AF.

Stroke 93

Stroke Wellness EKG/ECG Outcomes 93

Dr. Smith's ECG Blog

APRIL 2, 2024

Here is the initial ED ECG. Other thought this was due to hyperkalemia, but the ECG does not have the appearance of hyperkalemia but does have the appearance of severe cardiomyopathy -- LBBB with very wide QRS) 3. Another ECG was recorded 12 minutes later: Paced rhythm, probable Pacemaker-Mediated Tachycardia ?

EKG/ECG 130

EKG/ECG Shock CPR Stroke 130

Taming the SRU

NOVEMBER 18, 2024

Other causes include gastritis, gastric malignancy, pancreatitis, hiatal hernia, SBO, large meal, spicy foods, and carbonated drinks Neurologic Stroke, space occupying lesion, epilepsy, CNS infection, demyelinating and neurodegenerative disorders such as multiple sclerosis and Parkinson’s disease are causes of intractable hiccups.

Stroke 76

Stroke Administration Dehydration COPD 76

Dr. Smith's ECG Blog

DECEMBER 5, 2023

Written by Kirsten Morrissey, MD with edits by Bracey, Grauer, Meyers, and Smith An older teen was transferred from an outside hospital with elevated serum troponin and and ECG demonstrating ST elevations. Acute coronary syndrome in a pediatric patient? He denied drug or alcohol use. He did have a family history notable for early CAD.

Pediatrics 115

Pediatrics EKG/ECG Hospitals Burns 115

Taming the SRU

AUGUST 7, 2023

The patient needs a transvaginal ultrasound w/ doppler with gynecology consult and possible laparotomy TVUS is not just for torsion, it can also be used for ectopic pregnancies or pregnancy of unknown location Acute Ischemic Stroke Updates WITH Drs. The expanded window of 3-4.5 hours increased the NNT for a good outcome to 20.

Stroke 93

Stroke Outcomes EKG/ECG Research 93

Dr. Smith's ECG Blog

DECEMBER 24, 2023

Here is her triage ECG: What do you think? And so was an appropriate anti-coagulant, since atrial flutter, like fibrillation, can result in thromboembolism and stroke. For clarity and ease of comparison, I've put together in Figure-1 — the 3 serial ECGs in today's case. Atrial flutter with 2:1 conduction.

EKG/ECG 125

EKG/ECG Stroke Administration Wellness 125

Dr. Smith's ECG Blog

FEBRUARY 18, 2024

ECG is shown below. Many ECG readers will not comment any further on rhythm once ventricular pacing has been identified, but it is still critical to determine the atrial rhythm. Cardiology felt that there was baseline artifact and recommended immediate repeat ECG which is shown below. What do you think?

EKG/ECG 93

EKG/ECG Stroke 93

Taming the SRU

JULY 31, 2024

Barometric pressure, humidity, and temperature changes may influence stroke and fall incidence (especially in elderly patients with cardiovascular risk factors). Nice people are not more likely to get cancer. Black clouds don’t exist (but I still sort of think they do).

EKG/ECG 52

EKG/ECG Sepsis Documentation/Coding Stroke 52

Dr. Smith's ECG Blog

DECEMBER 26, 2020

An ECG was recorded quickly on return to the ED: (sorry for poor quality, cannot get originals) What do you think? They called their transfer center cardiologist on call, who reviewed the case on the phone with them, as well as the ECG. In my opinion this makes the flutter waves slightly easier to recognize in this ECG.

EKG/ECG 52

EKG/ECG Stroke Administration Seizures 52

Dr. Smith's ECG Blog

JANUARY 9, 2024

The ECG below was recorded. The ECG was interpreted as showing atrial flutter with 2:1 conduction. Answer : The ECG above shows a regular wide complex tachycardia. Said differently, the ECG shows a rather slow ventricular tachycardia with a 2:1 VA conduction. How do you interpret the below ECG?

EKG/ECG 101

EKG/ECG Stroke Hospitals Documentation/Coding 101

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

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

EM SIM Cases

NOVEMBER 12, 2022

The exact moment these orders are completed, a stroke activation will be called for a patient eligible for tPA. Stroke protocol needs to be followed and tPA will need to be given. As soon as tPA is pushed, the resident will be handed an EKG with signs of hyperkalemia and told that a patient with depression has checked in.

Resuscitation 40

Resuscitation Stroke EKG/ECG Fractures 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. 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 ). This patient presented with status epilepticus. What do you think?

EKG/ECG 52

EKG/ECG Seizures Stroke Wellness 52

ACEP Now

JUNE 6, 2023

ECG, CXR, and troponin are negative. Notoriously elusive, with a high misdiagnosis rate, thoracic aortic dissection (AD) can mimic many conditions, including acute coronary syndrome (ACS, the most common), gastroesophageal reflux disease (GERD), stroke, and spinal-cord compression. ECG, CXR, and troponin are all normal.

EKG/ECG 85

EKG/ECG Stroke Documentation/Coding Operations 85

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. He had a h/o ischemic cardiomyopathy and right MCA stroke. The cath lab had been activated and then they sent me the ECG. Cath lab was cancelled.

EKG/ECG 52

EKG/ECG Shock Stroke Seizures 52

Taming the SRU

NOVEMBER 29, 2023

Workup with a negative troponin and EKG reliably rules out BCI. Posterior circulation stroke Patients with posterior strokes will likely have a low NIH. Involve the stroke team if posterior circulation stroke is suspected, as they may be a candidate for TNK, or more rarely, EVT.

Stroke 53

Stroke EKG/ECG Resuscitation Shock 53

ACEP Now

DECEMBER 11, 2023

The Case FIGURE 1: Initial EKG were notable for a leukocytosis of 23.19 A repeat ECG completed shortly after epigastric pain was controlled showed dynamic STE in aVL, V1 and aVR with diffuse ST depressions (see Figure 2). During the initial work-up, her ECG revealed STE measuring approximately 1 mm in V1, V2.

EKG/ECG 52

EKG/ECG Hospitals Stroke Emergency Department 52

RebelEM

MARCH 22, 2023

Differential to Consider (for Regular, Narrow Complex Tachydysrhythmias) Sinus Tachycardia AVNRT Orthodromic Atrioventricular Reentrant Tachycardia (AVRT) Atrial Flutter with 2:1 block Common EKG Findings Narrow-complex, regular rhythm with a rate that often exceeds the theoretical maximal heart rate (220 – age) for that patient.

EKG/ECG 52

EKG/ECG EMS Pediatrics Stroke 52