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ecg sgarbossas-criteria

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ECG Pointers: STEMI Equivalents from the American College of Cardiology

EMDocs

DECEMBER 11, 2023

The most common diagnostic test to identify patients who might require percutaneous intervention is the electrocardiogram (ECG). Emergency physicians have recognized for some time that there are many occlusions of the coronary arteries that do not present with classic STEMI criteria on the ECG.

EKG/ECG

EKG/ECG Emergency Department Academics Operations

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REBEL Core Cast 104.0 – Subtle ECGs in Acute Coronary Occlusion

RebelEM

JULY 5, 2023

If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately. POCUS has been a phenomenal tool in the management and early diagnosis of a lot of abnormal ECG and chest pain presentations. If it looks and feels like a STEMI clinically, get serial ECGs and consult Cardiology immediately.

EKG/ECG

EKG/ECG Sepsis EMS

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Handed this ECG from triage. What will you do?

Dr. Smith's ECG Blog

MAY 22, 2024

Written by Sean Trostel MD I returned to my desk after seeing a patient and saw this screening ECG sitting on my desk to be read. ECG #1 @ 15:30 What do you think? QRS is becoming still narrower Note with each ECG there is progressive narrowing of the QRS and dampening of the peaked T-waves.

EKG/ECG

EKG/ECG Shock Resuscitation

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A man in his 70s with acute chest pain and paced rhythm.

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. Queen of Hearts interpretation: The cardiologist initially was not convinced, stating the ECG was not diagnostic or could not be diagnostic because it was paced. Limkakeng AT.

EKG/ECG

EKG/ECG Documentation/Coding Outcomes Shock

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emDOCs Podcast – Episode 86 Tricky Cases Part 2

EMDocs

SEPTEMBER 19, 2023

Reference: emDOCs – NCSE Journal of Emergency Medicine – Review Case 4: 52-year-0ld male brought in by EMS with “code STEMI” ECG demonstrates ST depressions with rocket like T waves in V2-V4. NCSE accounts for almost 47% of all cases of status epilepticus.

Seizures Documentation/Coding EKG/ECG Emergency Department

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An 80 year old woman with Left Bundle Branch Block (LBBB) and pleuritic chest pain

Dr. Smith's ECG Blog

MARCH 19, 2024

This was the ECG obtained at triage. This ECG was recorded and was reviewed remotely by a cardiologist: What do you think? It only takes one such lead to fulfill the 2nd criterion of the Smith Modified Sgarbossa criteria. Smith : this ECG cannot represent a normal variant. There are hyperacute T-waves in V5 and V6.

EKG/ECG

EKG/ECG Hospitals Documentation/Coding Outcomes

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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. This meets the Smith Modified Sgarbossa criteria for acute OMI in LBBB and Paced Rhythm. 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. What do you think?

EKG/ECG

EKG/ECG Shock CPR Stroke

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ECG of the week 14th December 2022 – Interpretation

EMergucate

DECEMBER 20, 2022

ECG of the week 14th December 2022 – Interpretation This ECG was included as a reminder of the Sgarbossa criteria … Continue reading →

EKG/ECG

EKG/ECG

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LBBB: Using the (Smith) Modified Sgarbossa Criteria would have saved this man's life

Dr. Smith's ECG Blog

JUNE 11, 2021

The paramedics found the patient with ROSC and a GCS 7, and an ECG showing LBBB with possible lateral ST elevation. Below is the first ED ECG, labeled LBBB by the machine. There is sinus rhythm, LBBB and disproportionately discordant STE in V4 (ST/S = 2/6 = 0.33) that meets the Modified Sgarbossa Criteria.

EKG/ECG

EKG/ECG Documentation/Coding CPR Shock

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Chest pain with anterior ST depression: look what happens if you use posterior leads.

Dr. Smith's ECG Blog

FEBRUARY 9, 2024

Here's the prior ECG: This confirms thew anterior ST depression is new. The first ECG was labeled “anterior subendocardial ischemia”, but subendocardial ischemia does not localize. So a patient with high pretest probability (prior CABG with new chest pain), had new ECG changes showing posterior OMI. Do you need posterior leads?

EKG/ECG

EKG/ECG Outcomes

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ECG Cases 36 – PACER Mnemonic for Approach to Pacemaker Patients

Emergency Medicine Cases

OCTOBER 11, 2022

In this month's ECG Cases blog Dr. McLaren explains the PACER mnemonic approach to patients with pacemakers: Pacemaker spike: is it appropriately presence/absent, is there pacemaker-mediated tachycardia (apply magnet) or is there failure to pace (apply magnet to stop sensing, cardio consult)?

EKG/ECG

EKG/ECG Dehydration Sepsis EMS

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I'm so sorry when medics get abused for activating the cath lab

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. It was central and constant.

EKG/ECG

EKG/ECG EMS Shock Wellness

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An elderly patient with syncope, dyspnea, and weakness, but no Chest Pain, and mild hyperkalemia

Dr. Smith's ECG Blog

MAY 21, 2023

Here is the first ED ECG: COMPUTER INTERPRETATION: Electronic Atrial Pacemaker. The ECG: 1. Although the ECG meets the Smith Modified Sgarbossa criteria , with proportionally excessively discordant STE in V2 - V4 and concordant STE in aVL (it appears to be a proximal LAD OMI), I suspect that there is no OMI here , but only toxicity.

EKG/ECG

EKG/ECG

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ECG Cases 11: LBBB + Occlusion MI

Emergency Medicine Cases

JULY 13, 2020

In ECG Cases 11 - LBBB + Occlusion MI Jesse McLaren runs through 5 patients who present with potentially ischemic symptoms and LBBB and explains the evolution of decision making for cath lab activation criteria. The post ECG Cases 11: LBBB + Occlusion MI appeared first on Emergency Medicine Cases.

EKG/ECG

EKG/ECG EMS

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Acute dyspnea in an older woman, is it OMI?

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

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Wide complex and apparent hyperacute T-waves. Does absence of change from previous ECG mean that it is not New?

Dr. Smith's ECG Blog

NOVEMBER 5, 2023

Below is the presentation ECG At the time of recording the ECG the patient was complaining of chest discomfort 4/10. ECG#1 The ECG shows a wide complex QRS with LBBB type morphology. Below the ECG image quality is enhanced using the PM Cardio App. An ECG from three months prior was obtained. If yes, why?

EKG/ECG

EKG/ECG Wellness

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Episode 47 – Left Bundles and Implantable Cardiac Devices

FOAMCast Blog

APRIL 9, 2016

(ITUNES OR LISTEN HERE) The Free Open Access Medical Education (FOAM) We cover a post from Dr. Smith’s ECG blog investigating ways to read ischemia on a ventricular paced ECG.

EKG/ECG

EKG/ECG Wellness

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Anterior MI in paced rhythm, dismissed by cardiologist, patient died.

Dr. Smith's ECG Blog

OCTOBER 3, 2018

The medics recorded the following initial ECG at time 0: The computer read (see below) gives no further comment beyond ventricular pacemaker. He refused to listen to the medic and was convinced that the ECG was due to hyperkalemia and that acute MI cannot be diagnosed in the presence of paced rhythm. What do you think?

EKG/ECG

EKG/ECG Emergency Department Research Outcomes

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A woman in her 70s with bradycardia and hypotension

Dr. Smith's ECG Blog

JANUARY 19, 2020

Her family called EMS and EMS recorded hypotension and this ECG: What do you think? There is STE in III and aVF which does not meet STEMI criteria due to insufficient STE in lead aVF. Resuscitation was initiated and this ECG was obtained: Likely AFib (irregularly irregular) with bradycardia. There is reciprocal STD in I and aVL.

EKG/ECG

EKG/ECG EMS Resuscitation Wellness

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20-something with huge verapamil overdose and cardiogenic shock

Dr. Smith's ECG Blog

MAY 26, 2023

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). The ECG must always be interpreted in clinical context.

Shock

Shock EKG/ECG Documentation/Coding Resuscitation

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Is this Acute Ischemia? More on LVH.

Dr. Smith's ECG Blog

JANUARY 2, 2016

Here is his ECG ( Figure 1 ): What do you think? There may be ischemia present, but it is not evident on the ECG. Importantly, all ST-T abnormalities are discordant to (in the opposite direction of) the majority of the QRS) Indeed, this was the patient's baseline ECG. So the above ECG has slightly assymetrical inverted T-waves.

EKG/ECG

EKG/ECG Outcomes