Dr. Smith's ECG Blog

NOVEMBER 16, 2016

A prehospital ECG was similar to the first ED ECG, which is shown below. Here is her initial ED 12-lead ECG: There is atrial fibrillation with a rate of approximately 114. It is most commonly due to demand ischemia, not due to ACS! If it were ACS, what reperfusion options were available? 911 was called. What happened?

ACS

EMDocs

JANUARY 6, 2025

ED Evaluation Transport to the ED from the refugee reception center takes 1 hour. Labs Laboratory workup in the ED is notable for a leukocytosis of 41,000/L, hemoglobin of 6.5 She is sent to the medical ward after three days in the ED with the diagnoses of resolving septic shock, severe malaria, and AKI.

ED

EMCrit Project

MAY 15, 2025

Blood sampled from existing peripheral IV cannulae yields results equivalent to venepuncture: a systematic review [ 10.1177/2054270419894817 ] Second Line 18 G Should we be placing in the AC? Questions Before Joining (FAQ) Join Now! Future Show: Upping your IV Game Fluids Get dinged for 4, rectal temps on elderly, etc.

ACS

Dr. Smith's ECG Blog

MAY 31, 2014

May mimic ACS Lesson : 1. By the time she was in the ED, it was no longer massive or submassive, as she had no symptoms, no tachycardia, and normal Echo. And such absence may or may not lead one to pursue other diagnoses. Remember that Pulmonary Embolus: 1. Causes anterior T-wave inversion plus T-wave inversion in III 2.

Coronary

EMDocs

AUGUST 11, 2025

ED Evaluation: Focus is assessing for other life-threatening treatable conditions: glucose, electrolytes, ECG. Imaging with CT in the ED; MRI while admitted. This is not possible in many EDs. Zehtabchi S, Abdel Baki SG, Malhotra S, Grant AC. If febrile: consider meningitis/encephalitis, perform LP for CSF. Neurocrit Care.

ICU

EMDocs

JULY 21, 2025

Causes: ACS, arrhythmia, valvular dysfunction, infection, nonadherence to meds, myocarditis, volume overload. ACEP level C recommendation that while there is no specific timing for diuretic therapy, physicians can consider earlier administration of diuretics in ED patients with HF (ACEP). What are the key tests?

E-9-1-1

EMDocs

NOVEMBER 25, 2024

25 AC = Anterior chamber, ELISA = enzyme-linked immunosorbent assay, NS = normal saline, PCR = polymerase chain reaction Management Oral Ivermectin 26 150 mcg/kg given once or twice yearly for 10 to 15 years to match the lifespan of the adult worm is the standard treatment. Ramos AN, ed. Bejon P, ed. PLoS Negl Trop Dis.

E-9-1-1

Broome Docs

DECEMBER 22, 2024

PECARN looks at probiotics for toddlers diarrhea… Schnadower D, Tarr PI, Casper TC, Gorelick MH, Dean JM, O’Connell KJ, Mahajan P, Levine AC, Bhatt SR, Roskind CG, Powell EC, Rogers AJ, Vance C, Sapien RE, Olsen CS, Metheney M, Dickey VP, Hall-Moore C, Freedman SB.

E-9-1-1

Dr. Smith's ECG Blog

JUNE 10, 2025

When seeing a South Asian patient with chest pain, concern for ACS must be heightened, given their disproportionately higher risk of CAD, despite often lacking traditional risk factors.) For clarity in Figure-1 — I've reproduced this 1st ECG in this case that I saw. The rhythm is sinus.

STEMI

Don't Forget the Bubbles

AUGUST 3, 2025

Arch Dis Child Fetal Neonatal Ed. Arch Dis Child Fetal Neonatal Ed. Katheria AC, et al. J Pediatr Gastroenterol Nutr. 2025 Jul 9. Diffuse white matter abnormality is independently predictive of neurodevelopmental outcomes in preterm infants. Derbie AY, et al. 2025 Jul 9:fetalneonatal-2025-328635. Beard LA, et al. Pediatrics.

E-9-1-1

EMDocs

JUNE 28, 2025

Jarcho JA, ed. 0318502 Lorenzi-Filho G, Genta PR, Figueiredo AC, Inoue D. Longo DL, ed. The patient’s caregivers noticed that the patient had become more short of breath over the last 12 hours and seemed confused. A chest radiograph is obtained, as seen above. Lay Responder Care for an Adult with Out-of-Hospital Cardiac Arrest.

EMS

EMDocs

MAY 17, 2025

Case: A 32-year-old female presents to the ED with chief complaint of abdominal pain. 10 g/dL in patients with acute coronary syndrome (ACS). Well keep it short, while you keep that EM brain sharp. Her pain started 8 hours ago and became severe within the last 30 minutes. C, and 20 respirations/min.

E-9-1-1

Dr. Smith's ECG Blog

OCTOBER 17, 2018

He was febrile in the ED. Here is the first ED ECG: Sinus tachycardia with deep T-wave inversions in both V1-V6 and in II, III, aVF. male with PMH significant for COPD presented with fever and dyspnea, no chest pain. The patient reported a several day history of difficulty breathing with an associated cough. How did I interpret it?

ACS

Dr. Smith's ECG Blog

APRIL 21, 2021

This is really good Prehospital, ED, and Cardiolog. Fever, tachycardia, hypotension, hypoxia and "SVT" A woman in her 40s with palpitations and chest pre. Flecainide toxicity 4/21/21 2597782 This case was flagged as a false positive cath lab. A man in his 60s with diaphoresis, vomiting, and i.

STEMI

EMDocs

MARCH 24, 2025

The syphilis and trichomonas tests come back negative in the ED, but his rapid HIV test is positive. How should clinicians approach the diagnosis and management of HIV in the ED? 11 These cardiovascular complications have further increased ED visits by HIV-positive patients by three times compared to individuals without HIV.

E-9-1-1

REBEL EM

JUNE 30, 2025

EDACS is broader—captures symptoms suspicious for ACS, not just chest pain, and performs well in low-risk patients. Between 6-9 million patients present to the ED for chest pain annually. Clinical Bottom Line Both HEART and EDACS are best utilized for identifying patients with suspected ACS who are at low risk for MACE.

ACS

REBEL EM

JULY 28, 2025

👉 Click here to access the PERC RULE on MDCalc 👉 Click here to access the Wells’ Criteria on MDCalc 🤕 Case A 35 year old woman with no past medical history presents to the ED with pleuritic chest pain and shortness of breath.    She is tachypenic but has a normal heart rate and oxygen saturation.

OR

American Burn Association

AUGUST 12, 2025

Ed Dellert, RN, MBA, CAE, FACEHP Chief Executive Officer American Burn Association Stay connected. ABA Strategic Collaborations : The ABA continues to strengthen its role as a convener and collaborator across the burn and broader trauma communities. As we shape the future together, your voice remains at the center. More to come in September.

ACS

Dr. Smith's ECG Blog

JANUARY 6, 2016

In the ED, after intubation due to AMS, he was found to be hypotensive and tachycardic to the 160s. He was started on ACS therapy and loaded with Plavix. This procedures were done due to prior similar presentations and concern of ACS. This is the most likely caused of his fixed ST elevation and no concern for ACS.

CAD

Dr. Smith's ECG Blog

OCTOBER 30, 2020

Share to X Share to Facebook Share to Pinterest Labels: draft No comments: Post a Comment DEAR READER: I have loved receiving your comments, but I am no longer able to moderate them. (4)

STEMI

Dr. Smith's ECG Blog

DECEMBER 6, 2017

Ed Burns (from Life in the Fast Lane) sent me this. See what happens when one fails to diagnose STEMI. Serial ECG recordings are essential: paramedic mak. Are These Wellens' Waves?? (4)

STEMI

EMCrit Project

JUNE 23, 2025

The 88 year old with dementia warehoused in the ED for days — 3 or 4 or 5 — while services battle over who might be bothered to look after them. Or, we can bring you back for an outpatient CT scan tomorrow and see you in the ED after for the results and reassessment. Questions Before Joining (FAQ) Join Now! Their cat.

Operating Room

Dr. Smith's ECG Blog

MAY 28, 2024

ED echo: The left ventricular ejection fraction appears: Severely reduced No pericardial effusion identified. Suspect type 2 NSTEMI, although difficult to rule out type 1 Given lack of ACS symptoms and multivessel coronary artery disease, her cause was paused for consideration of a heart team approach with consideration for CABG.

Coronary

Dr. Smith's ECG Blog

OCTOBER 1, 2022

Emergency (ED placement) Transvenous Pacer appears. Back to basics: what is this rhythm? What are your. 30 yo woman with trapezius pain. HEART Pathway =. Good case for showing a flutter and LBBB, Good cas. What is this rhythm? Back to basics. Is there Terminal QRS Distortion? What is so unusual about this inferior OMI (which.

STEMI

Dr. Smith's ECG Blog

JANUARY 16, 2020

A 20-something woman with Chest Pain Eric Abrams case A woman in her 50s with dyspnea and bradycardia Where is the focus of this tachycardia? Ventricular Fibrillation, ROSC after perfusion res. (4)

E-9-1-1

Dr. Smith's ECG Blog

APRIL 17, 2018

Dysnpea and Elevated troponin Takotsubo that looks like LVA Huge Precordial ST Elevation in an ED Patient Tachycardia, hyperthyroid, and ST elevation. Is this just right bundle branch block? Besides the Nonspecific T-wave Inversion in aVL, W.

STEMI

Dr. Smith's ECG Blog

MARCH 7, 2019

Chest pain resolved, and a "Normal" ED ECG 2 cases of false pos STE aVL What will you do for this patient transferred to y. 30-something male with confusion, weakness, headac. A Patient with Respiratory Failure and a Computer. Cardiac arrest with STEMI pattern: no acute corona. How accurate are the Monitor leads for ST Elevation?

STEMI

EMS 12-Lead

APRIL 9, 2024

At the time of ED arrival he was alert, oriented, and verbalizing only a headache with a normalized BP. The ED activated trauma services, and a 12 Lead ECG was captured. This was deemed “non-specific” by the ED physicians. Thus, the ED admission ECG changes cannot be blamed on LVH. The fall was not a mechanical etiology.

Coronary

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

male presents to the ED at 6:45 AM with left sided chest dull pressure that woke him up from sleep at 3am. He arrived to the ED at around 6:45am, and stated the pain has persisted. Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. The pain radiated to both shoulders.

Coronary

Pediatric EM Morsels

APRIL 19, 2024

Trauma season is at hand and like all other pediatric emergency departments in the country, we find our ED breaking ( pun intended ) at the seams with orthopedic injuries. We see all different flavors of upper extremity injuries. The minority of parents would have wanted clinic follow up (6%) and reimaging (14%). J Bone Joint Surg Br.

ALS

Emergency Medicine Cases

JULY 30, 2019

In the age of high sensitivity troponins and the HEART pathway, which patients are safe to discharge home from the ED? What are the most useful historical factors to increase and decrease your pretest probability for ACS? Which cardiac risk factors have predictive value for ACS?

ACS

The Skeptics' Guide to EM

JANUARY 18, 2020

You turn to the attending and ask, “do you really think this could be acute coronary syndrome (ACS)?” ACS is usually amongst this differential, as cardiovascular disease is a leading cause of morbidity and mortality in this population. The proportion of patients with ACS at the index visit or within 30 days. *

ACS

EMS 12-Lead

AUGUST 18, 2024

David Didlake EMT-P, RN, ACNP @DidlakeDW An adult male self-presented to the ED with palpitations and the following ECG. I interpreted the ECG as VT with two primary etiological possibilities: 1. Abrupt plaque ulceration of Type 1 ACS leading to VT. The patient was very uncomfortable, dyspneic, and displayed an SpO2 90% on RA.

CAD

ALiEM

AUGUST 30, 2024

A 5-year-old female presented to the emergency department (ED) with a one-year history of gradually increasing anterior neck swelling. She was discharged from the ED on levothyroxine 25 mcg daily with endocrinology outpatient follow-up. The patient had no significant past medical history. Pediatric neck masses. Pediatr Rev.

ACS

FOAMfrat

APRIL 25, 2024

They also discuss the challenges of pulse palpation and the need for more rigorous research in EMS and ED settings. References: Kimbrell J, Kreinbrook J, Poke D, Kalosza B, Geldner J, Shekhar AC, Miele A, Bouthillet T, Vega J. They emphasize the importance of confirming electrical capture before assuming mechanical capture.

ACS

EMS 12-Lead

JUNE 20, 2022

Although the attending crews did not consider the ECG pathognomonic for occlusive thrombosis, they nonetheless considered the patient high-risk for ACS and implored him to reconsider. Here is the final ECG just prior to ED transfer. It’s important to stress the presence of a normal QRS (i.e., The pathology is now painfully evident.

ACS

REBEL EM

SEPTEMBER 11, 2023

However, many institutions’ surgical teams still require or request a formal study over a bedside exam, likely due to a lack of confidence in the accuracy of POCUS, resulting in longer ED stays. ACS surgeons appeared to select surgery as their initial choice substantially more frequently than other subspecialties.

ED