Ken Grauer, MD

DECEMBER 15, 2023

For full discussion of this case — See ECG Blog #392 — == The ECG in Figure-1 was obtained from a man in his 60s — who described the sudden onset of "chest tightness" that began 20 minutes earlier, but who now ( at the time this ECG was recorded ) — was no longer having symptoms. Figure-1: The initial ECG in today's case. (

EKG/ECG 331

EKG/ECG EMS Hospitals 331

Ken Grauer, MD

FEBRUARY 15, 2024

The ECG in Figure-1 was obtained from a previously healthy middle-aged man — who presented to the ED ( E mergency D epartment ) for shortness of breath. QUESTIONS: How would YOU interpret the ECG shown in Figure-1 ? Figure-1: The initial ECG in today's case. Figure-1: The initial ECG in today's case.

EKG/ECG 312

EKG/ECG Wellness 312

Ken Grauer, MD

MARCH 11, 2024

By the P s, Q s & 3 R Approach ( which I review on ECG Blog #185 ): The R ate of the rhythm in Figure-1 is somewhat fast — averaging ~100/minute ( ie, with an R-R interval close to 3 large boxes in duration for most of the tracing ). PEARL # 2: We only see 2 of the 12 leads of an ECG in Figure-1.

EKG/ECG 370

EKG/ECG 370

Ken Grauer, MD

JANUARY 20, 2024

I was sent the tracing shown in Figure-1 — told only that this was a preoperative ECG obtained from an asymptomatic older woman scheduled for non-cardiac surgery. How would YOU interpret this ECG? Figure-1: Preoperative ECG from an asymptomatic older woman scheduled for non-cardiac surgery. The 12-lead ECG is very concerning.

EKG/ECG 231

EKG/ECG 231

Ken Grauer, MD

FEBRUARY 9, 2024

Imagine the only information provided for the ECG in Figure-1 — is that it was obtained from a 60-year old man with new CP ( C hest P ain ). QUESTIONS: In view of this brief history — How would YOU interpret this ECG in Figure-1 ? Is the cardiac rhythm related to the 12-lead ECG? Figure-1: The initial ECG in today’s case.

EKG/ECG 255

EKG/ECG Operations Wellness 255

Ken Grauer, MD

JUNE 26, 2023

The ECG in Figure-1 was obtained from a young man with a history of rheumatic heart disease — who presented with “palpitations”. How would YOU interpret the ECG in Figure-1 ? Figure-1: The initial ECG in today’s case. To improve visualization — I've digitized the original ECG using PMcardio ). What is the rhythm?

EKG/ECG 351

EKG/ECG Wellness 351

Ken Grauer, MD

JULY 29, 2023

The ECG in Figure-1 was obtained from an 18-year old woman — who moments before been resuscitated from out-of-hospital cardiac arrest. How would YOU interpret her post-resuscitation ECG? Does this ECG in Figure-1 provide clue(s) to the etiology of this patient's cardiac arrest? QUESTIONS: In light of the above clinical history.

EKG/ECG 369

EKG/ECG Resuscitation Documentation/Coding Hospitals 369

Ken Grauer, MD

OCTOBER 21, 2023

The ECG in Figure-1 is from an older man with known coronary disease — who presents to the ED ( E mergency D epartment ) with new CP ( C hest P ain ) over the past several days. QUESTIONS: In view of this history — How would you interpret the ECG in Figure-1 ? Figure-1: The initial ECG in today's case. Troponin is pending.

EKG/ECG 239

EKG/ECG Shock Wellness 239

Ken Grauer, MD

JUNE 6, 2023

== P lease N OTE : After today — No new ECG Blog posts for 2- to -3 weeks. — I will also not be prompt in replying to emails. == All material on this ECG Blog site remains open! So IF you are looking for ECG material — There is plenty on this web site! Figure-1: The initial ECG in today's case. I'll be back! —

EKG/ECG 195

EKG/ECG Hospitals Wellness Resuscitation 195

Dr. Smith's ECG Blog

MAY 3, 2024

There were 2 prehospital ECGs: What do you think? When I was shown this ECG, I said it looks like such widespread ischemia that is might be a left main occlusion, or LM ischemia plus circumflex occlusion (high lateral and posterior OMI). Total Left Main Occlusion presents with different ECG findings which are multi-faceted.

Shock 98

Shock EKG/ECG Hospitals EMS 98

Ken Grauer, MD

JULY 9, 2023

The ECG in Figure-1 was obtained from a 60-year old woman — who presented to the ED ( E mergency D epartment ) for “palpitations”. Her vital signs were normal at the time this triage ECG was recorded. How would YOU interpret the ECG in Figure-1 ? Do you see any indication on this ECG of WHY this patient was about to arrest?

EKG/ECG 195

EKG/ECG 195

Ken Grauer, MD

MARCH 18, 2023

The ECG in Figure-1 was obtained from a man in his mid-60s — who presented with new chest pain. Figure-1: T he initial ECG in today’s case. MY Thoughts on the Initial ECG: The rhythm in ECG #1 — is sinus at ~70/minute. Figure-2: I've labeled significant ST-T wave findings in the limb leads of ECG #1.

EKG/ECG 195

EKG/ECG Wellness 195

Ken Grauer, MD

MARCH 12, 2023

I start today’s case with the ECG shown in Figure-1 — obtained from a 30-something year old man, who presented with palpitations. How would YOU interpret the ECG in Figure-1 ? Figure-1: The initial ECG in today’s case. To improve visualization — I've digitized the original ECG using PMcardio ). What is the rhythm?

EKG/ECG 195

EKG/ECG Administration Wellness 195

Ken Grauer, MD

FEBRUARY 24, 2023

The ECG in Figure-1 was obtained from a previously healthy 30-ish year old man — who presented to medical attention for vasovagal syncope. Based on this initial ECG — the patient was transferred to a PCI-capable center: Do YOU agree with the need for transfer? Figure-1: The initial ECG in today's case.

EKG/ECG 195

EKG/ECG Hospitals Wellness 195

Ken Grauer, MD

APRIL 14, 2023

The ECG in Figure-1 was obtained from a 90-year old woman — who presented with a 2-to-3 day history of chest pain, that became worse on the day of admission. How would YOU interpret the ECG in Figure-1 ? Figure-1: The ECG in today’s case. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Wellness Hospitals 195

Ken Grauer, MD

MARCH 7, 2023

You are given this ECG to review. QUESTION: Is there a potential problem with this ECG? Figure-1: The initial ECG in today's case. == N OTE : Many of us are charged with reviewing ECGs that have been interpreted by other clinicians — often without the benefit of much ( or any ) history. The rhythm in ECG #1 is sinus.

EKG/ECG 195

EKG/ECG Wellness 195

Ken Grauer, MD

FEBRUARY 28, 2023

The ECG and long lead II rhythm strip in Figure-1 — was obtained from a COVID positive patient with persistent tachycardia not responding to Diltiazem. Figure-1: The initial ECG — obtained from a patient with persistent tachycardia. ( To improve visualization — I've digitized the original ECG using PMcardio ).

EKG/ECG 195

EKG/ECG Documentation/Coding Sepsis COPD 195

Ken Grauer, MD

MAY 12, 2023

As discussed in detail in ECG Blog #240 — the term, “SVT” — refers to any supraventricular rhythm (ie, with origin at or above the AV node ) that manifests a rate of ≥100/minute. R elated E CG B log P osts to Today’s Case : ECG Blog #205 — Reviews my S ystematic A pproach to 12-lead ECG Interpretation.

EKG/ECG 195

EKG/ECG Wellness 195

Ken Grauer, MD

OCTOBER 29, 2023

Based on ECG Blog #351 ( www.tinyurl.com/KG-Blog-351 ) LINK to this Page — www. tinyurl.com/KG-MedAll-351 — = = ECG Blog #205 = The Systematic Approach I favor. If the rhythm is sinus — ECG Blog #204 reviews how to determine if RBBB, LBBB or IVCD is present ). The talk will be recorded and posted on-line.

EKG/ECG 195

EKG/ECG 195

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

Written by Pendell Meyers First try to interpret this ECG with no clinical context: The ECG shows an irregularly irregular rhythm, therefore almost certainly atrial fibrillation. Here is the initial ECG: A temperature sensing Foley was inserted and reported a core temperature of 26.7 C), with Cardiac Echo -- A Pathognomonic ECG.

Hyperthermia / Hypothermia 118

Hyperthermia / Hypothermia EKG/ECG Wellness 118

Dr. Smith's ECG Blog

MAY 13, 2023

I was reading EKGs on the system and saw this one, with no other information. These ECGs are usually seen in young men, so I was surprised. This is a normal variant ECG. Read more about ECG findings in African Americans: Walsh B. Distinctive ECG Patterns in Healthy Black Adults. MacFarlane P.

EKG/ECG 52

EKG/ECG 52

Dr. Smith's ECG Blog

OCTOBER 18, 2023

All initial ECGs were labeled ‘normal’ or ‘otherwise normal’ by the computer interpretation, and below are the ECGs with the final cardiology interpretation. 1-3] But these studies were very short duration and used cardiology interpretation of ECGs or emergent angiography rather than patient outcomes.

EKG/ECG 108

EKG/ECG Documentation/Coding Emergency Department Outcomes 108

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 his first prehospital ECG: 1st Prehospital ECG What do you think?

EKG/ECG 93

EKG/ECG EMS Stroke Outcomes 93

ALiEM

FEBRUARY 20, 2024

What agent would most likely be responsible for these ECG findings? This EKG shows a wide complex (QRS 240 msec), irregular rhythm with left bundle branch block morphology at a rate slower than expected (90 bpm) for a ventricular arrhythmia such as ventricular tachycardia. 2019 Oct;37(10):1989.e1-1989.e3. Epub 2019 Jul 21.

Shock 73

Shock EKG/ECG Poisoning Burns 73

Dr. Smith's ECG Blog

APRIL 9, 2024

By Magnus Nossen This ECG is from a young man with no risk factors for CAD, he presented with chest pain. How would you assess this ECG? Note: lead format is Cabrera I was sent this ECG in real time. The above ECG was recorded. The Queen of Hearts AI model for ECG interpretation is still in its early days.

EKG/ECG 78

EKG/ECG Wellness 78

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.

EKG/ECG 62

EKG/ECG Wellness Point-of-Care Testing Shock 62

Dr. Smith's ECG Blog

MARCH 4, 2024

I have often written about how an ECG interpreted as "normal" by a conventional algorithm may well be manifesting OMI, or even long QT or hyperkalemia. Shifa Karim and Gabe Keller helped with a project to assess all these ECGs with the Queen of Hearts. The ECG told the story. I wanted to show some of the cases here.

EKG/ECG 96

EKG/ECG Documentation/Coding Wellness Resuscitation 96

Dr. Smith's ECG Blog

DECEMBER 15, 2023

The ECG below was recorded and electronically transferred to our PCI center for evaluation. ECG #1 I think many providers might be reassured viewing this ECG. There is slight baseline wander on this ECG which does make the interpretation more challenging. This ECG was recorded roughly 3 minutes after the first ECG.

EKG/ECG 59

EKG/ECG EMS Wellness 59

JournalFeed

NOVEMBER 14, 2020

We cover the importance of starting low tidal volume ventilation in the ED, fluid overload and ICU mortality, flying during COVID-19, the top critical care articles of 2019, and the accuracy (or lack thereof) of physician ECG interpretation.

EKG/ECG 52

EKG/ECG 52

Dr. Smith's ECG Blog

JUNE 4, 2019

Here is the ED ECG (no previous ECG was available for comparison). Computer interpretation: Normal ECG Cardiology overread: Normal ECG QTc-Bazett by computer = 479 ms Computer algorithm name unavailable What do you think? Full text: [link] Analysis: This ECG is not at all normal! No ECGs were recorded overnight 3.

EKG/ECG 52

EKG/ECG Documentation/Coding 52

Dr. Smith's ECG Blog

JANUARY 1, 2024

An initial electrocardiogram (ECG) is provided below. A subsequent ECG was taken: There is persistent ST elevation, especially being concordant in inferolateral leads. Notably , there are deflections which look like P-waves, easily seen in lead II (see Ken Grauer's annotated ECGs below). Why is ECG #1 So Challenging?

EKG/ECG 84

EKG/ECG Shock Administration Emergency Department 84

EMergucate

JULY 23, 2019

Following is an ECG of a 52 years of age man with a 3 day hx of intermittent chest discomfort. Describe the ECG abnormalities and what would you … He is currently asymptomatic with a BP 150/95 mmHg.

EKG/ECG 52

EKG/ECG EMS 52

EMergucate

DECEMBER 17, 2019

The ECG below is taken from a 36 year old patient found unconscious at home. Interpret the ECG. What is … Continue reading →

EKG/ECG 52

EKG/ECG 52

EMergucate

DECEMBER 3, 2019

You are shown and ECG on a 54 years of age male patient you have yet to review with decreased exercise tolerance with intermittent dizziness. Describe and discuss the abnormalities.

EKG/ECG 52

EKG/ECG EMS 52

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.

EKG/ECG 98

EKG/ECG Hospitals Shock Documentation/Coding 98

EMergucate

NOVEMBER 5, 2019

Following ECG was obtained from a 24 years of age man complaining of a week history of intermittent chest pain. He is clinically well and his haemodynamics are all within normal limits. Describe t…

EKG/ECG 52

EKG/ECG Wellness 52

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 97

EKG/ECG Seizures Hospitals Stroke 97