Dr. Smith's ECG Blog

OCTOBER 26, 2023

Artificial Intelligence-Augmented ECG Interpretation Using Smartphone Technology @TheEKGGuy [link] == MY Comment , by K EN G RAUER, MD ( 10/26 /2023 ): == Our THANKS to Drs. @RobertHermanMD on Making Waves from Mayo clinic.

EKG/ECG 52

EKG/ECG Wellness 52

EMergucate

JULY 2, 2019

En route you the noted on his CXR showed cardiomegal… You are asked to review an ECG of a 24 years of age man complaining of a two day history of a mild intermittent non cardiac sounding chest pain.

EKG/ECG 52

EKG/ECG EMS 52

Taming the SRU

DECEMBER 8, 2023

EMS had reported she had coded en route. ED providers should be familiar with several extraction techniques for foreign bodies in the external auditory canal including the use of manual extractors, irrigation, and other methods such as adhesives and acetone. She regained pulses with warming on arrival.

Hyperthermia / Hypothermia 78

Hyperthermia / Hypothermia Resuscitation Head Injuries Documentation/Coding 78

Ziqitza HealthCare Ltd

FEBRUARY 26, 2024

These ambulances are equipped with advanced life-support systems, enabling paramedics to provide critical care en route to medical facilities. Ziqitza’s ambulances are designed to navigate through flooded streets and debris-laden roads, ensuring that medical assistance reaches those who need it the most.

Ambulance Services 52

Ambulance Services Disaster Management Fluid Resuscitation Resuscitation 52

Dr. Smith's ECG Blog

MAY 13, 2023

link] == MY Comment , by K EN G RAUER, MD ( 5/13 /2023 ): == NOTE: While true ( as per Dr. Smith ) that the chest leads show normal variant ST elevation and T wave inversion — there is LA-RA Lead Reversal in the limb leads! Read more about ECG findings in African Americans: Walsh B. MacFarlane P. J Electrocardiology 56:15-23; Sept-Oct 2019.

EKG/ECG 52

EKG/ECG 52

Ziqitza HealthCare Ltd

MARCH 6, 2024

Moreover, Ziqitza’s ambulances are equipped with advanced medical equipment and communication systems, enabling paramedics to provide life-saving interventions en route to the hospital, further enhancing patient outcomes. Such technological tools ensure that no time is wasted.

Ambulance Services 52

Ambulance Services Telemedicine Operations Wellness 52

Ziqitza HealthCare Ltd

JANUARY 23, 2024

The incorporation of telemedicine allows paramedics to consult with emergency room physicians, providing a higher level of care en route to the hospital. Advanced life support systems, telemedicine capabilities, and real-time communication tools are now integrated into Ziqitza fleet of ambulances.

EMS 52

EMS Ambulance Services Telemedicine Operations 52

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

Altered Mental Status, Bradycardia == MY Comment , by K EN G RAUER, MD ( 2/2 /2024 ): == Dr. Meyers began today’s case with the clinical challenge of asking you to identify the underlying cause of ECG #2. -- Read this ECG -- Osborn Waves and Hypothermia (this is the "Figure" above) What does LBBB look like in severe hypothermia?

Hyperthermia / Hypothermia 122

Hyperthermia / Hypothermia EKG/ECG Wellness 122

Dr. Smith's ECG Blog

AUGUST 3, 2023

⚕️ About the Author The OMI Pocket Guide ( [link] ) was designed and is curated by Mark Hellerman, MD - a cardiology fellow at Stony Brook University Hospital == MY Comment , by K EN G RAUER, MD ( 8/3 /2023 ): == I wanted to provide a “shout-out” to Dr. Mark Hellerman — for his excellent work in producing the OMI Pocket Guide , that is the subject (..)

EKG/ECG 65

EKG/ECG Wellness Research Hospitals 65

SheMD

SEPTEMBER 17, 2023

Bergsieker HB, Wilmot MO, Cyr EN, Grey CB. Stereotypes about surgeon warmth and competence: The role of surgeon gender. 2019 Feb 27;14(2):e0211890. doi: 10.1371/journal.pone.0211890. PMID: 30811457; PMCID: PMC6392236. A threat in the network: STEM women in less powerful network positions avoid integrating stereotypically feminine peers.

Research 59

Research Outcomes Wellness 59

RebelEM

FEBRUARY 12, 2024

Gottlieb RH, La TC, Erturk EN, et al. PMID: 25229916 DOI: 10.1056/NEJMoa1404446 Westphalen AC, Hsia RY, Maselli JH, Wang R, Gonzales R. Radiological Imaging of Patients With Suspected Urinary Tract Stones: National Trends, Diagnoses, and Predictors. 2011; 18(7):699-707. 2002; 225(2):441-449.

Radiology 57

Radiology Radiology Emergency Department Ultrasounds 57

EMDocs

JANUARY 11, 2024

Statements: Initiate EN as soon as possible after ICU admission (100%, 20/20). In patients with enteral intolerance or shock, start with trophic EN (rates of 10–20 mL/h) and adjust according to tolerance (91%, 19/21). In patients receiving EN, stress ulcer prophylaxis may not be necessary (90.5%, 19/21).

Seizures 73

Seizures Shock Infectious Diseases CPR 73

Ziqitza HealthCare Ltd

OCTOBER 16, 2023

This te­chnology enables paramedics to instantly conne­ct with specialized doctors, providing advanced me­dical care while en route­. Telemedicine Integration in Ambulance Services Ziqitza Healthcare ltd ­ has introduced a groundbreaking innovation in ambulance se­rvices with the integration of te­lemedicine.

Ambulance Services 52

Ambulance Services Telemedicine Hospitals Outcomes 52

Emergency Medicine Ireland

SEPTEMBER 6, 2021

The definition of when we have failed to establish EN is a little less well defined, but comes in somewhere around the 5-7 day mark. LITFL has a good summary but my TLDR is that there is insufficient evidence to say PN is better than EN for now we go enterally when we can and parenterally when we can’t. Firstly, indications.

Sepsis 40

Sepsis Wellness 40

Emergency Medicine Ireland

FEBRUARY 8, 2021

Management options at this stage include: * Acid suppression (eg PPI or H2RA) – gastric secretions are a major contributor to fluid losses here and typically there are more secretions than normal that cause fluid loss and also impair pancreatic enzyme function.

Operations 40

Operations Outcomes 40

Dr. Smith's ECG Blog

DECEMBER 22, 2023

If the ECG is nondiagnostic, one must use some combination of clinical suspicion, old ECGs, serial ECGs, echo, or simply angiography to be certain that an OMI is not being missed == MY Comment , by K EN G RAUER, MD ( 12/10 /2023 ): == Interesting "quick" case presented by Dr. Smith.

EKG/ECG 92

EKG/ECG Outcomes 92

Dr. Smith's ECG Blog

APRIL 30, 2024

See here another case of sinoventricular rhythm: And more cases discussing Sinoventricular Rhythm: [link] Ken Grauer ( below ) has a different opinion; I'm not sure I agree but it's good to have multiple viewpoints! == MY Comment , by K EN G RAUER, MD ( 4/30 /2024 ): == Today's case relates the unfortunate events of metamphetamine toxicity , resulting (..)

EKG/ECG 78

EKG/ECG CPR EMS Wellness 78

Don't Forget the Bubbles

JULY 24, 2023

Discitis en niños menores de 3 años. Yield of Image-Guided Needle Biopsy for Infectious Discitis: A Systematic Review and Meta-Analysis. American Journal of Neuroradiology. 2017 Oct;38. Miranda I, Salom M, Burguet S. Serie de casos y revisión de la literatura. Revista Española de Cirugía Ortopédica y Traumatología. 2014 Mar;58.

Radiology 98

Radiology Radiology Infectious Diseases Pediatrics 98

Dr. Smith's ECG Blog

OCTOBER 1, 2023

See the full post here == MY Comment , by K EN G RAUER, MD ( 10/1 /2023 ): == It is often insightful to "look back" — and see from where we have come, which Dr. Meyers skillfully does with today's repost from October 5, 2021.

EKG/ECG 117

EKG/ECG EMS Ultrasounds Wellness 117

Ziqitza HealthCare Ltd

JANUARY 25, 2024

This proactive monitoring enables early intervention and adjustments to the treatment plan, ensuring that patients receive the most appropriate care en route to medical facilities.

Ambulance Services 52

Ambulance Services Basic Life Support Airway Management Hospitals 52

Dr. Smith's ECG Blog

APRIL 9, 2024

link] == MY Comment , by K EN G RAUER, MD ( 4/9 /2024 ): == One can never get too much practice in recognizing acute tracings that must be distinguished from OMI mimics. It is not yet available, but this is your way to get on the list. I'll add the following thoughts to the interesting presentation by Dr.

EKG/ECG 82

EKG/ECG Wellness 82

Dr. Smith's ECG Blog

NOVEMBER 17, 2023

link] == MY Comment , by K EN G RAUER, MD ( 11/18 /2023 ): == Today's ECG provides unique insight into a less commonly seen manifestation of RBBB ( R ight B undle B ranch B lock ). It is not yet available, but this is your way to get on the list. It also highlights the importance of the History.

EKG/ECG 101

EKG/ECG Hospitals Ultrasounds Wellness 101

Dr. Smith's ECG Blog

OCTOBER 21, 2022

Searching for regular QRS complexes marching through potential artifact can help distinguish artifactual vs. actual ECG rhythms. == MY Comment, by K EN G RAUER, MD ( 10/19 /2022 ): == Today’s case by Dr. Meyers ( submitted by Dr. Arjun JV ) — is important for recognizing what it is not. This is not VFib or polymorphic VT!

EKG/ECG 52

EKG/ECG Wellness 52

Dr. Smith's ECG Blog

FEBRUARY 2, 2024

This is for the version housed on Telegram: [link] You can get the full PM Cardio app here: [link] == MY Comment , by K EN G RAUER, MD ( 2/2 /2024 ): == Our appreciation to Dr. Jean-Christophe Reiters from Belgium — for his contribution to Dr. Smith’s ECG Blog.

EKG/ECG 92

EKG/ECG Hospitals 92

Dr. Smith's ECG Blog

DECEMBER 13, 2023

link] == MY Comment , by K EN G RAUER, MD ( 12/11 /2023 ): == As per Dr. Smith — the KEY concept in today's case is proportionality. (THE PM CARDIO OMI AI APP) If you want this bot to help you make the early diagnosis of OMI and save your patient and his/her myocardium, you can sign up to get an early beta version of the bot here.

EKG/ECG 101

EKG/ECG COPD Wellness Outcomes 101

Dr. Smith's ECG Blog

SEPTEMBER 8, 2023

In the context of remote rural communities, this can help emergency physicians advocate for their patients, and reduce reperfusion delays by days for STEMI(-)OMI == MY Comment , by K EN G RAUER, MD ( 9/8 /2023 ): == Today’s case is distinguished by its occurrence in a remote rural community ( where the nearest cath lab is a plane ride away ).

EKG/ECG 118

EKG/ECG Emergency Department Wellness 118

Dr. Smith's ECG Blog

DECEMBER 5, 2023

PMID: 34013488; PMCID: PMC8134825. == MY Comment , by K EN G RAUER, MD ( 12/5 /2023 ): == Interesting case by Drs. Similarities and differences between multiple inflammatory syndrome in children associated with COVID-19 and Kawasaki disease: clinical presentations, diagnosis, and treatment. World J Pediatr. 2021 Aug;17(4):335-340.

Pediatrics 101

Pediatrics EKG/ECG Hospitals Burns 101

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

Regional wall motion abnormality--mid to apical anterior, mid anteroseptal, and apical septal akinesis. == MY Comment , by K EN G RAUER, MD ( 9/22 /2023 ): == Today's case is challenging — because our 1st look at the ECG in Figure-1 was without the benefit of any clinical information. --Estimated left ventricular ejection fraction 55-60%.

EKG/ECG 112

EKG/ECG Wellness Documentation/Coding 112

Dr. Smith's ECG Blog

DECEMBER 9, 2023

That will be improved in later versions!! == MY Comment , by K EN G RAUER, MD ( 12/9 /2023 ): == Today’s case brings with it an important lesson — namely that the “right answer” ( and the “right” clinical action ) — will not always be correct. A QR-wave is far more common, just like you would see in inferior ACUTE OMI.

EKG/ECG 97

EKG/ECG Seizures Wellness EMS 97

Dr. Smith's ECG Blog

MAY 21, 2023

and it results in a paced sine wave == MY Comment , by K EN G RAUER, MD ( 5/21 /2023 ): == Flecainide toxicity is a relatively uncommon — but extremely important condition to recognize. Note how the QRS gets wider when the HR gets higher: Hyperkalemia and Paced Rhythm Paced rhythm with wide QRS due to K 8.2 Is This a Simple Paced Rhythm?

EKG/ECG 69

EKG/ECG 69

Dr. Smith's ECG Blog

APRIL 22, 2024

Here are many examples of a very common mimic , which we call "Benign T-wave Inversion" and is a variant of Early Repol: Understanding this pathognomonic ECG would have greatly benefitted the patient. == MY Comment , by K EN G RAUER, MD ( 4/22 /2024 ): == When we talk about Wellens’ Syndrome — It is all about timing.

EKG/ECG 110

EKG/ECG Outcomes Ultrasounds Hospitals 110

Emergency Medicine Ireland

DECEMBER 3, 2020

As with all ICU nutrition EN is preferred over PN. . * Finally there is the late phase/chronic/rehab as the patient becomes more anabolic According to this concept don’t rush to feed new admissions with increasing pressors or acute bleeding or life threatening hypoxia/acidosis.

Burns 52

Burns Sepsis EMS Wellness 52

PEMBlog

SEPTEMBER 27, 2023

For more specific recommendations related to diagnosis and management of SARS-CoV-2, please see www.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/ ) · Hospitalized patients where tests impacts cohorting decisions, like in intensive care. antivirals for influenza) or public health recommendations (e.g.,

Pediatrics 52

Pediatrics Hospitals Emergency Department Infectious Diseases 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

That is what Emergency Medicine is all about. == MY Comment , by K EN G RAUER, MD ( 9/3 /2023 ): == I’ve seen a “common theme” with many of the ECGs that Drs. The past is past, and looking back will only help if we can find things that could have been done differently.

EKG/ECG 120

EKG/ECG Resuscitation CPR Emergency Department 120

Dr. Smith's ECG Blog

SEPTEMBER 26, 2023

Severity of chest pain on admission did not correlate to the likelihood of a true-positive STEMI diagnosis, although it was associated with improved patient prognosis, in the form of improved outcomes, and shorter times to reperfusion. == MY Comment , by K EN G RAUER, MD ( 9/26 /2023 ): == Today's post by Dr. Smith emphasizes the very important clinical (..)

EKG/ECG 97

EKG/ECG Hospitals Outcomes Wellness 97

Dr. Smith's ECG Blog

JANUARY 3, 2024

Get access to Queen of Hearts here: [link] == MY Comment , by K EN G RAUER, MD ( 1/3/ 2024 ): == Today's case provides another opportunity to study evolutionary changes of an acute OMI in progress — in which over the short timespan of ~30 minutes, a series of intriguing ECG changes are seen. No further ECGs were recorded.

EMS 79

EMS EKG/ECG Wellness Outcomes 79

EB Medicine

JULY 8, 2019

Another study found a 1-year post Roux-en-y ED visit rate of 31% and yet another found that 25% of these patients will require admission within 2 years of surgery. Not surprisingly, combined restrictive and malabsorptive procedures like the Roux-en-y gastric bypass tend to be the most effective. Next we have the Roux-en-Y bypass.

Emergency Department 40

Emergency Department Sepsis Operations Dehydration 40