EM SIM Cases

NOVEMBER 20, 2023

Co-morbid illnesses and medications can be risk factors and can also mask the usual responses to hyperthermia such as tachycardia. Classic Hyperthermia Download From Life in the Fast Lane, ECG Library [link]. The case will progress to the diagnosis and treatment of heatstroke/ heat related illness.

Stroke 52

Stroke Hyperthermia / Hypothermia EMS EKG/ECG 52

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 52

Hyperthermia / Hypothermia EKG/ECG Seizures Fractures 52

Taming the SRU

APRIL 13, 2023

stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e. stent, percutaneous nephrostomy) by urology or IR Hypokalemia evaluate for EKG changes assess for underlying cause and factors that may influence ability to replete (i.e.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Poisoning EKG/ECG Seizures 52

Dr. Smith's ECG Blog

MAY 6, 2019

This ECG was sent from South Asia. Here is the ECG: What do you think? Followup ECG: No Change Absence of evolution is the best evidence against ischemia as the etiology. Could this be a coincidence that the patient was experiencing chest pain and upon ECG capture the atypical brugada pattern was found? Did it subside?

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia 52

EMDocs

DECEMBER 16, 2023

A 12-lead EKG shows sinus tachycardia but is otherwise normal. Broad-spectrum antibiotics (A) for septic shock are not inappropriate given the hyperthermia, tachycardia, and hypotension. The patient is agitated, not oriented, and becoming combative with ED staff. 1 Fever is usually < 40C. 1 Fever is usually < 40C.

Hyperthermia / Hypothermia 67

Hyperthermia / Hypothermia EMS Stroke Seizures 67

Dr. Smith's ECG Blog

JANUARY 30, 2019

An initial EKG was obtained: Computer read: sinus tachycardia, early acute anterior infarct. Here is her prior EKG: When compared to the old EKG – Q waves present before, TWI in aVR present before, but all other changes are new. What is the differential for this EKG? T wave inversion III, aVR, TWF in aVF. Is this an OMI?

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia EKG/ECG Wellness Documentation/Coding 52

EMDocs

FEBRUARY 9, 2024

An ECG is performed and is shown below: Figure 1. Adapted from Dr. Smith’s EKG Blog. Another ECG is obtained and shown below. Source: [link] As you are calling the ICU and cardiology team, the patient has recurrence of her symptoms and repeat ECG shows return of the PVT. She denies chest pain. What do you do?

EKG/ECG 71

EKG/ECG Hyperthermia / Hypothermia EMS Documentation/Coding 71

Taming the SRU

AUGUST 25, 2023

patient on AC and remains pharmacologically active rivaroxaban/edoxaban: last dose within 18 hours (or 24 hours if CrCl <50ml/min) apixaban: last dose within 18 hours (or 24 hours if Scr >1.5mg/dL) lab assessment with PT> 16s, anti-Xa level greater of equal to 0.5 to 1 mcg/kg/hour procedural sedation loading dose: 0.5-1

Seizures 66

Seizures Fractures EKG/ECG Resuscitation 66

Taming the SRU

MAY 1, 2023

Patients must have EKG findings and meet one of a few other criteria (ie family history of sudden death, VF or VT episode, syncope, nocturnal agonal respirations) Most common in patients of Southeast Asian descent and the mean age of death from arrhythmia if untreated is in the 4th decade of life.

Poisoning 52

Poisoning Hyperthermia / Hypothermia Emergency Department Seizures 52

Dr. Smith's ECG Blog

FEBRUARY 16, 2020

Here was the ECG: There is sinus tachycardia. had at least 2 potential etiologies for developing acute myocarditis: i ) Profound hypothermia ( core temperature = 90°F = 32.2°C This was sent by a reader. A previously healthy 53 yo woman was transferred to a receiving hospital in cardiogenic shock. and K was normal. Our THANKS to Dr.

Shock 52

Shock Hyperthermia / Hypothermia EKG/ECG Hospitals 52

EMDocs

JANUARY 8, 2024

Editorial Comment : Yes to PCI after arrest with STEMI on ECG. Patients with spontaneous hypothermia after ROSC unresponsive to verbal commands should not routinely be actively or passively rewarmed faster than 0.5° COR 3, No benefit, LOE B-R. COR 2b, LOE C-LD. C per hour. COR 2b, LOE C-EO.

Seizures 81

Seizures Shock CPR Hyperthermia / Hypothermia 81

Mind The Bleep

JULY 8, 2023

Many questions were repeated, and on some, the resources were not included (“look at this ECG” but no ECG was visible). 150 ECG cases by Hampton, Adlam & Hampton- You are guaranteed to get at least a couple of ECG questions in the exam, and it’s difficult to get sufficient practice on ECGs.

EKG/ECG 52

EKG/ECG Wellness Hyperthermia / Hypothermia Poisoning 52

Mind The Bleep

DECEMBER 19, 2023

ECG: to monitor T wave changes due to hypokalaemia. ECG features of Hypokalaemia: Increased P wave amplitude (peaked P waves) Prolonged PR interval Widespread ST depression T wave flattening or inversion Prominent U waves (most noticeable in the precordial leads) Figure 2 : ECG of a patient with serum K+ of 1.9

Dehydration 98

Dehydration Fluid Resuscitation Shock Resuscitation 98

Dr. Smith's ECG Blog

OCTOBER 26, 2020

Here is his first ECG recorded after stable ROSC: Originally recorded in 50 mm/s (the standard in Norway), here converted to 25 mm/s. The patient received therapeutic hypothermia at 33 degrees C for 24 hours. While on telemetry the patient remained asymptomatic, however recurrent episodes of ECG abnormalities were recorded.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Wellness CPR 52

Dr. Smith's ECG Blog

JULY 22, 2023

An ECG was performed in the ED at 1554: Original image unavailable, this is the only recorded scanned ECG available. In a patient with syncope and fever, this ECG looks more like Brugada. Smith comment: the ECG in question could be due to Brugada, even though there is a change from baseline. PM Cardio digitized version.

EKG/ECG 65

EKG/ECG Hyperthermia / Hypothermia Documentation/Coding Wellness 65

Dr. Smith's ECG Blog

JULY 14, 2010

She arrived comatose and in cardiogenic shock and the following ECG was recorded. That this is an RVMI is confirmed with the following right sided ECG: Now it can be seen that most of the precordial ST elevation is in V4R, much more than is present on the left side of the heart (V1R, which is equivalent to V2 on the left sided ECG.

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia Seizures EKG/ECG EMS 52

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

A 12-lead ECG was recorded: There is sinus rhythm with RBBB and right axis deviation. Guide to this image: 30 minutes later, at 31 C, this ECG was recorded: The RBBB has resolved. Osborn waves persist The next day, this ECG was recorded at a normal temperature: Peak hs troponin I was 650 ng/L Day 1 echo ECMO flow 2.9

Hyperthermia / Hypothermia 52

Hyperthermia / Hypothermia CPR EKG/ECG Resuscitation 52

Dr. Smith's ECG Blog

MAY 5, 2022

Here is the initial ED ECG: What do you think? The ECG shows peaked T waves, QRS widening, a coved-type ST segment with inverted T waves most prominent in V1 and V2 consistent with Brugada pattern. They recommended repeating his ECG and awaiting troponin since the patient did not have any chest pain. Creatinine elevated at 3.09

EKG/ECG 52

EKG/ECG Fluid Resuscitation EMS Shock 52

EMergucate

MARCH 7, 2016

A 44 year old man was found unconscious at home. He was brought in to the ED by ambulance. On arrival GCS =3 with fixed and dilated pupils. Temperature 25.9, hypotensive.

EKG/ECG 40

EKG/ECG Hyperthermia / Hypothermia EMS 40

Dr. Smith's ECG Blog

DECEMBER 5, 2019

As part of the workup, she underwent an ECG. Drug toxicity , especially diphenhydramine , which has sodium channel blocking effects, and also anticholinergic effects which may result in sinus tachycardia, hyperthermia, delirium, and dry skin. We repeated the ECG: Brugada pattern is mostly resolved. Hyperkalemia 2.

EKG/ECG 52

EKG/ECG Hyperthermia / Hypothermia Seizures Documentation/Coding 52

EB Medicine

AUGUST 1, 2018

Nachi: Among metabolic abnormalities, patients can present with hyperthermia, hypoglycemia, hypokalemia, hyponatremia, and metabolic acidosis. Jeff: For any patient arriving with suspected cannabis or synthetic abuse, consider checking an EKG. Jeff: Orally and dentally, dry mouth is the most common finding in acute cannabis toxicity.

Seizures 40

Seizures Hyperthermia / Hypothermia Administration Dehydration 40

RebelEM

MARCH 30, 2023

However, there are no clear guidelines for management in post-cardiac arrest patients without ST-segment elevations on ECG. Clinical Question : In patients who suffer an OHCA without ST-segment elevation on the post-resuscitation ECG, will early coronary angiogram (CAG) vs. delayed CAG improve outcomes? Bougouin, W., Varenne, O.,

Hospitals 55

Hospitals Outcomes EKG/ECG Resuscitation 55

Dr. Smith's ECG Blog

NOVEMBER 25, 2022

As a routine part of his critical trauma evaluation, he had an ECG recorded: There is an rSR" in V1 and V2, with downsloping ST segment and inverted T-wave which is very similar to a Brugada Type 1 phenocopy. On the other hand, the RV lies directly under leads V1 and V2; this makes pneumothorax less likely as an etiology of the abnormal ECG.

EKG/ECG 52

EKG/ECG Fractures Hyperthermia / Hypothermia Wellness 52

Northwestern EM Blog

JANUARY 24, 2022

Hypocalcemia can be hinted at through history or by hints such as a prolonged QTc on an ECG. While the diagnosis of hypothyroidism can be delayed by lab results, clues to the diagnosis include thyroidectomy scar, non-pitting edema of the extremities, macroglossia, altered mental status, hypoglycemia and hypothermia.

Anaphylaxis 52

Anaphylaxis Shock Sepsis Resuscitation 52

Rural Doctors Net

AUGUST 30, 2013

Of course any fluids given should be warmed to help avoid the lethal triad – acidosis, coagulopathy and hypothermia. Monitors should be visible to the team leader and should include : SpO2 ETCO2 Anaesthetic gases NIBP Pulse, ECG Temperature I’d place an arterial line, NGT & IDC once in the ED or OT. Emlyns on the PROMMT data.

Burns 52

Burns Hospitals Wellness Ambulance Services 52

Taming the SRU

JUNE 6, 2023

then need further evaluation Usually with CTA imaging If normal physical exam & ABI>0.9,

Documentation/Coding 59

Documentation/Coding Seizures Wellness Psychiatric 59