Emergency Care Today

Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia

Dr. Smith's ECG Blog

APRIL 2, 2024

Here is the initial ED ECG. Then I always look to see if the initial deflection of the QRS has a lot of voltage change per change in time (seen in tachycardias that are initiated from above the ventricle because the propagate through fast conducting purkinje fiber. Tachycardia exaggerates ST Elevation in LBBB and Paced rhythm 5.

EKG/ECG

EKG/ECG Shock CPR Stroke

A man in his 40s with acute chest pain. What do you think?

Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

Triage ECG: What do you think? It's a very "fun" ECG, with initial ectopic atrial tachycardia (negative P waves in inferior leads conducting 1:1 with the QRSs), followed by spontaneous resolution to sinus rhythm. Sudden CP and SOB with Inferior ST Elevation and in STE in V1. Is it inferior and RV OMI?

EKG/ECG

EKG/ECG Academics

An Intriguing Rhythm: Who Belongs to Whom?

Dr. Smith's ECG Blog

JUNE 26, 2023

Figure-1: The initial ECG in today's case. ( To improve visualization — I've digitized the original ECG using PMcardio ). Since the QRS complex for each of these non-sinus-conducted beats is narrow — beats #3,4; 9; 14 and 15 must be junctional beats. NOTE: It is unclear if beat #5 is junctional or sinus-conducted.

EKG/ECG

EKG/ECG Seizures Sepsis Operations

ECG Blog #391 — Asymptomatic but Irregular.

Ken Grauer, MD

AUGUST 18, 2023

He was not symptomatic with the ECG shown in Figure-1. How would YOU interpret this ECG? Extra Credit ( which is a HINT to the Answer! ): How many beats are recorded on 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 ).

EKG/ECG

EKG/ECG Dehydration Wellness

What is the rhythm?

Dr. Smith's ECG Blog

APRIL 30, 2024

Here is the only prehospital 12-lead: Sinus tachycardia, somewhat wide QRS, Ischemia Here is the first ED ECG: What is the rhythm here? This ECG is pathognomonic of hyperkalemia , with wide QRS, very SHARPLY peaked T-waves, flat ST segments, RBBB pattern and large R-wave in aVR. Is this an accelerated Junctional rhythm?

EKG/ECG

EKG/ECG CPR EMS Wellness

A young man with tachycardia. Should We Try Adenosine?

Dr. Smith's ECG Blog

JULY 17, 2023

An ECG was recorded: What do you think? There is a regular narrow complex tachycardia. Thus, it is supraventricular tachycardia. It is important to remember that SVT includes Sinus Tachycardia! Sometimes even Wide Complex Tachycardia is Sinus. A very fast narrow complex tachycardia in an Infant 3.

EKG/ECG

EKG/ECG Wellness

What do you suspect from this ECG in this 40-something with SOB and Chest pain?

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? Medics recorded the above ECG and called a STEMI alert. The 2 ECGs that were recorded in today's case are insightful. The Queen diagnosed "OMI with high confidence" due to the ST Elevation in V1-V3.

EKG/ECG

EKG/ECG Resuscitation Hospitals EMS

Wide complex tachycardia and hypotension in a 50-something with h/o cardiomyopathy -- what is it?

Dr. Smith's ECG Blog

JUNE 23, 2023

A 50-something male with unspecified history of cardiomyopathy presented in diabetic ketoacidosis (without significant hyperkalemia) with a wide complex tachycardia and hypotension. Here is the ED ECG: What do you think? Analysis: there is a wide complex tachycardia. Bedside echo showed "mildly reduced" LV EF. It is regular.

EKG/ECG

EKG/ECG Documentation/Coding Academics Wellness

What are these hyperacute T waves, with STE and T-wave inversion in aVL, and STD in inferior leads?

Dr. Smith's ECG Blog

FEBRUARY 27, 2023

See many examples of Pseudo STEMI due to hyperkalemia at these two posts: Acute respiratory distress: Correct interpretation of the initial and serial ECG findings, with aggressive management, might have saved his life. We've presented numerous examples of hyperkalemia on Dr. Smith's ECG Blog. Smith's ECG Blog.

EKG/ECG

EKG/ECG Documentation/Coding Administration

SGEM#213: Upside Down You Convert Me Out of SVT?

The Skeptics' Guide to EM

APRIL 1, 2018

Upside-down position for the out of hospital management of children with supraventricular tachycardia. Upside-down position for the out of hospital management of children with supraventricular tachycardia. Upside-down position for the out of hospital management of children with supraventricular tachycardia. February 2018.

Pediatrics

Pediatrics Emergency Department EKG/ECG Hospitals

Chest Pain and Inferior ST Elevation.

Dr. Smith's ECG Blog

JUNE 17, 2018

He had an ECG in clinic which worried the providers because of possible inferior MI, and they sent him to the ED. Here is that ECG: What do you think? There is sinus tachycardia. There is ST Elevation at the J-point, relative to the PQ junction (end of PR segment) in II, III, aVF.

EKG/ECG

EKG/ECG Documentation/Coding Shock Ultrasounds

Unconscious + STEMI criteria: activate the cath lab?

Dr. Smith's ECG Blog

JANUARY 21, 2023

ECG met STEMI criteria and was labeled STEMI by computer interpretation. What is your ECG interpretation, and would you activate the cath lab? This ECG shows a sinus bradycardia with a normal conduction pattern (normal PR, normal QRS, and normal QTc), normal axis, normal R-wave progression, normal voltages. What do you think?

Hyperthermia / Hypothermia

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures

New Onset Heart Failure and Frequent Prolonged SVT. What is it? Management?

Dr. Smith's ECG Blog

MARCH 6, 2020

Here was his ED ECG: There is sinus tachycardia (rate about 114) with nonspecific ST-T abnormalities. An ECG was recorded: This shows a regular narrow complex tachycardia at a rate of about 160. See my quick review of atrial tachycardia below) The tachycardia spontaneously resolved. C (99 °F), Resp (!)

EKG/ECG

EKG/ECG Ultrasounds Hospitals

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Dr. Smith's ECG Blog

NOVEMBER 26, 2018

Here is his initial ECG: What do you think? When the team saw this ECG, we obviously noticed the large STE in the inferior leads, with STD in V1-V5, I, and aVL, and STE in V6. Back to the interpretation of the ECG: Does the rhythm matter to you in this case? What will you do for this patient? How many problems does he have?

EKG/ECG

EKG/ECG Wellness Administration Academics

Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. At midnight.

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 You can see the PR segment sagging down, such that the PQ junction is also depressed. Thus, there is no elevation of the J-point relative to the PQ junction. --ST

EKG/ECG

EKG/ECG Shock Hospitals Wellness

POCUS findings of hemodynamically unstable PE with cardiac arrest

EMDocs

APRIL 22, 2024

A DVT was visible in the left femoral vein at the Saphenofemoral Junction (SFJ) and distal. DVT Left Saphenofemoral Junction. During a short period of ROSC an ECG was performed. The findings of RV strain on the ECG also supported the POCUS echo findings in this case. Under perfused femoral artery. EKG RV strain.

Ultrasounds

Ultrasounds Advances Cardiac Life Support (ACLS) EKG/ECG Shock

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

OCTOBER 7, 2019

When the paramedics arrived, they obtained a 12 lead ECG and confirmed the unstable vital signs. Although the shock is no doubt partly a result of poor pump function, with low stroke volume, especially of the RV, it should be compensated for by tachycardia. A right sided ECG was not recorded. Why is the patient in shock?

Seizures

Seizures EKG/ECG Shock EMS

ECG of the Week – 18th November 2020 – Interpretation

EMergucate

NOVEMBER 17, 2020

The ECG below is from a 46 year old lady who has presented to ED at 7pm after experiencing palpitations since 2am that day, but otherwise feels well.

EKG/ECG

EKG/ECG Wellness

Emergency Care Today

Ventricular Fibrillation, ICD, LBBB, QRS of 210 ms, Positive Smith Modified Sgarbossa Criteria, and Pacemaker-Mediated Tachycardia

A man in his 40s with acute chest pain. What do you think?

Trending Sources

An Intriguing Rhythm: Who Belongs to Whom?

ECG Blog #391 — Asymptomatic but Irregular.

What is the rhythm?

A young man with tachycardia. Should We Try Adenosine?

What do you suspect from this ECG in this 40-something with SOB and Chest pain?

Wide complex tachycardia and hypotension in a 50-something with h/o cardiomyopathy -- what is it?

What are these hyperacute T waves, with STE and T-wave inversion in aVL, and STD in inferior leads?

SGEM#213: Upside Down You Convert Me Out of SVT?

Chest Pain and Inferior ST Elevation.

Unconscious + STEMI criteria: activate the cath lab?

New Onset Heart Failure and Frequent Prolonged SVT. What is it? Management?

Arrhythmia? Ischemia? Both? Electricity, drugs, lytics, cath lab? You decide.

Persistent Chest Pain, an Elevated Troponin, and a Normal ECG. At midnight.

POCUS findings of hemodynamically unstable PE with cardiac arrest

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

ECG of the Week – 18th November 2020 – Interpretation

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