Dr. Smith's ECG Blog

DECEMBER 27, 2023

Brief aside: "Early repolarization" is a frequently proclaimed and poorly understood electrocardiographic phenomenon which mostly serves to reassure clinicians that not all ST elevations are ischemic (something readers of this blog know well). It relies on an 1 mm cut point, which this blog does not favor as an approach to ECG.

E-9-1-1 131

E-9-1-1 OR Coronary ACS 131

Dr. Smith's ECG Blog

OCTOBER 21, 2023

For example — VT becomes much more likely if QRS morphology during WCT is not consistent with some known form of conduction defect ( See My Comment in the May 5, 2020 post in Dr. Smith's ECG Blog for more on "My Take" re criteria for distinguishing between SVT vs VT ). Figure-1: The initial ECG in today's case.

OR 139

OR 139

Dr. Smith's ECG Blog

JANUARY 2, 2025

T-waves are quite tall and possibly peaked (HyperK?), but potassium returned normal. I do not see OMI here and all trops were only minimally elevated, consistent with either chronic injury from cardiomyopathy or with acute injury from sepsis. What is the QT interval? In LBBB, the QT interval is partly prolonged by the wide QRS. Bogossian et al. (1)

Coronary 116

Coronary OR Defibrillator ALS 116

Emergency Medicine Cases

OCTOBER 17, 2023

In this ECG Cases blog Dr. Jesse McLaren guides us through 10 cases, driving home the points that sepsis is a common cause of rapid Afib and diffuse ST depression with reciprocal ST elevation in aVR, myo/pericarditis is a diagnosis of exclusion, endocarditis or lyme carditis can cause AV block, PE can cause low grade fever and ECG signs of acute RV (..)

OR 266

OR STEMI EMS 266

Dr. Smith's ECG Blog

MAY 13, 2024

Chest Pain – Benign Early Repol or OMI? Written by Destiny Folk, MD, Adam Engberg, MD, and Vitaliy Belyshev MD A man in his early 60s with a past medical history of hypertension, type 2 diabetes, obesity, and hyperlipidemia presented to the emergency department for evaluation of chest pain. But — Which ST-T wave is the "correct" one? (

OR 120

OR STEMI Heart Attack Coronary 120

REBEL EM

MAY 27, 2024

What they did: Prospective randomized controlled trial, unblinded, multicenter study Conducted from January 2017 to December 2022 Patients with confirmed PSVT were randomly assigned to receive MVM, IV Adenosine, or combined therapy. This absence of detail leaves the study open to bias. Evidence suggests that a weight-based dosing approach (0.1

OR 137

OR E-9-1-1 ED ALS 137

Dr. Smith's ECG Blog

OCTOBER 15, 2024

This is relevant — because among the causes of new low voltage is myocardial "stunning" from a large acute MI, such that this ECG finding may serve as a harbinger of a reduction in LV function that may soon be occuring ( See My Comment at the bottom of the page in the November 12, 2020 post of Dr. Smith's ECG Blog ).

OR 116

OR STEMI Coronary ED 116

Pulsara

NOVEMBER 7, 2024

Because the articles and advice found within contain such critical subject matter, we've elected to publish each segment one at a time here on our blog. Editor's Note: In August 2024, EMS1 and Fitch & Associates released their annual EMS trend survey, What Paramedics Want, proudly sponsored by Pulsara.

EMS 97

EMS Paramedic OR 97

Emergency Medicine Cases

AUGUST 8, 2023

In this ECG Cases blog with Dr. Jesse McLaren we interpret 10 ECG cases and explore cardiac, metabolic and GI causes: We consider anginal equivalents, and look for ECG signs of Occlusion MI, including subacute occlusion from delayed presentations.

STEMI 229

STEMI OR EMS 229

ALiEM

NOVEMBER 3, 2023

8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. More specifically, we identified 3 AIR and 5 Honorable Mentions. Please go to the above link.

Critical Care 211

Critical Care EMS Emergency Department ALS 211

ALiEM

FEBRUARY 5, 2024

8 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. More specifically, we identified 3 AIR and 5 Honorable Mentions. Please go to the above link.

Overdose 215

Overdose Critical Care EMS Emergency Department 215

EMOttawa

NOVEMBER 7, 2024

Here, we present a unified […] The post Inhalation Injuries: The Answers You’ve Been LUNGing For appeared first on EMOttawa Blog.

OR 86

OR 86

Dr. Smith's ECG Blog

MARCH 28, 2024

Per EMS report, patient believes he has been in atrial fibrillation for 5 days, since coming down with flu-like illness with rhinorrhea, productive cough, SOB. Patient is on rivaroxaben, carvedilol, and dofetilide (to suppress atrial fib -- rhythm control). He states that he maybe missed a dose or two during recent illness. SVT with aberrancy?

OR 129

OR Emergency Department Ambulance EMS 129

EMS 12-Lead

MAY 15, 2024

TCP in the ROSC Patient: False Electrical Capture at 75mA Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the second installment of a blog series showing how transcutaneous pacing (TCP) can be difficult and how you can improve your skills. Approach TCP with skepticism.

Epinephrine 331

Epinephrine Paramedic CPR EMT 331

The Skeptics' Guide to EM

SEPTEMBER 21, 2024

Background: We’ve discussed out-of-hospital cardiac arrest (OHCA) at least once or twice on the SGEM (see long list at end of blog). You and your partner initiate high-quality CPR, place a supraglottic airway, establish intra-osseous (IO) access and administer epinephrine. Your partner asks if you want to administer naloxone as well.

Naloxone 262

Naloxone NARCAN Overdose CPR 262

Dr. Smith's ECG Blog

SEPTEMBER 18, 2024

For more on MINOCA — See My Comment in the November 16, 2023 post in Dr. Smith's ECG Blog ). Review of the 2 ECGs in today's case is insightful ( Figure-1 ): The initial ECG shows sinus rhythm, LAHB and meets Peguero Criteria for LVH ( See My Comment in the August 15, 2022 post of Dr. Smith's ECG Blog for more on LVH criteria ).

Coronary 122

Coronary ACS OR EMR 122

REBEL EM

NOVEMBER 6, 2024

Elbow Dislocation Definition: Disarticulation of the proximal radius & ulna bones from the humerus Epidemiology: Incidence Second most common joint dislocation (after shoulder) in adults Most commonly dislocated joint in children Accounts for 10-25% of all injuries to the elbow ( Cohen 1998 ) Posterolateral is the most common type of dislocation (..)

E-9-1-1 116

E-9-1-1 ACS OR Emergency Department 116

ALiEM

APRIL 14, 2023

6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 2 AIR and 4 Honorable Mentions. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score.

EMS 246

EMS Emergency Department ED OR 246

The Skeptics' Guide to EM

JANUARY 13, 2024

Airway management in OHCA has also been covered in SGEM#247 and SGEM#396. We have looked at OHCA more than a dozen times on the SGEM.

CPR 274

CPR Defibrillator First Responder Epinephrine 274

The Skeptics' Guide to EM

NOVEMBER 11, 2023

DISCLAIMER: THE VIEWS AND OPINIONS OF THIS BLOG AND PODCAST DO NOT REPRESENT THE UNITED STATES GOVERNMENT OR THE US MILITARY. He will soon be transitioning out of the US military after a 20-year career in the Air Force and is soon to be Clinical Professor of Orthopaedics at UC San Diego.

ALS 329

ALS Emergency Department ED OR 329

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Smith : this ECG is definitely not OMI, but could be mistaken for Swirl pattern, which is a septal OMI with STE in V1 and STD in V6. See these cases: Precordial Swirl -- 20 cases of Swirl or Look-Alikes Subsequent serial high sensitivity troponin I measurements were all below the level of detection. AMI was ruled out altogether.

OR 125

OR STEMI EMS ED 125

ALiEM

OCTOBER 14, 2023

6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. Digital Impact Factor: A Quality Index for Educational Blogs and Podcasts in Emergency Medicine and Critical Care. More specifically, we identified 3 AIR and 3 Honorable Mentions. Please go to the above link.

Critical Care 169

Critical Care EMS Emergency Department ALS 169

Dr. Smith's ECG Blog

SEPTEMBER 22, 2023

This is diagnostic of full reperfusion.] An old ECG was found: As you can see, this patient has zero baseline STE, and normal T-waves. You never know if a patient's baseline has normal large STE or complete absence of STE, or somewhere in between. 90% of normals have some STE in V2 and V3. I focus my comment on this initial ECG in today's case.

OR 131

OR STEMI Coronary 131

Dr. Smith's ECG Blog

MAY 29, 2024

Written by Pendell Meyers Two patients with acute chest pain. Do either, neither, or both have OMI and need reperfusion? Patient 1: Patient 2: Patient 1: A man in his 40s with minimal medical history presented with acute chest pain radiating to his R shoulder.

CAD 116

CAD OR STEMI 116

EMOttawa

NOVEMBER 14, 2024

Yet, the reliance on these screens is fraught with inaccuracies, clinical irrelevance, and significant ethical concerns, particularly from […] The post Blurred Lines: The Ethical Pitfalls of Urine Drug Screens appeared first on EMOttawa Blog.

Emergency Department 78

Emergency Department ED OR 78

EMS 12-Lead

MARCH 30, 2024

Josh Kimbrell, NRP @joshkimbre Judah Kreinbrook, EMT-P @JMedic2JDoc This is the first installment of a blog series showing how transcutaneous pacing (TCP) can be difficult, and how you can improve your skills. TCP In Transit: A case reviewing transcutaneous pacing, false electrical capture, and re-arrest.

CPR 312

CPR Paramedic Ambulance Defibrillator 312

EMOttawa

JANUARY 25, 2024

With both ER and ICU experience, this post acts as a quick […] The post Mechanical Ventilation Basics appeared first on EMOttawa Blog. Mechanical ventilation has a lot of nuance associated with it, but a lot of reference guides focus on care in the ICU.

ICU 143

ICU ED OR Critical Care 143

ESO

DECEMBER 26, 2024

Check out the FAQs page for answers to your most pressing questions, our blog posts for the latest updates, and helpful videos for step-by-step guidance on how to adopt NERIS with confidence. To help your department prepare, check out our FAQs About NERIS and blog on the upcoming launch of NERIS Version 1.

First Responder 105

First Responder Emergency Medical Services EMS Critical Care 105

Dr. Smith's ECG Blog

OCTOBER 8, 2024

For more on Precordial Swirl — See the October 15, 2022 post in Dr. Smith's ECG Blog ). In support of my impression that the ST-T wave changes in the chest leads are acute until proven otherwise — is the ST segment flattening and depression in lead II — as well as the J-point ST depression in lead I ( BLUE arrows in these leads ).

OR 123

OR STEMI ICU Coronary 123

Dr. Smith's ECG Blog

MARCH 10, 2025

See > 50 cases on Dr. Smiths EGC Blog. Regular readers of Dr. Smiths ECG Blog are well familiar with the following facts: A normal ECG is not an ECG that is called normal by any computerized ECG interpretation program other than QOH ( Q ueen O f H earts ). Take home 1. Computer normal ECGs are not safe or accurate.

STEMI 89

STEMI OR Coronary Emergency Department 89

ALiEM

JULY 20, 2023

6 blog posts met our standard of online excellence and were approved for residency training by the AIR Series Board. More specifically, we identified 1 AIR and 5 Honorable Mentions. These posts have been flagged by and agreed upon by AIR Board members as worthwhile, accurate, unbiased, and appropriately referenced despite an average score.

Emergency Department 188

Emergency Department EMS OR 188

Dr. Smith's ECG Blog

OCTOBER 1, 2023

Elevated troponin" After hours of misdiagnosis and ongoing pain, the patient finally gets to go to the cath lab 6 hours after arrival ( could have been an immediate ECG diagnosis of LAD OMI using human expertise OR the Queen ), where they of course find a complete 100% thrombotic occlusion of the mid LAD, at the site of his prior LAD stent.

OR 127

OR STEMI Coronary CAD 127

REBEL EM

JUNE 29, 2023

Back on June 1 st , 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? REBEL EM Blog, June 1, 2023. Back on June 1st, 2023, Swami wrote a blog post on REBEL EM titled, The CT FIRST Trial, Should We Pan-CT After ROSC? Below you will find some of the points we discussed.

CPR 145

CPR ICU EMS ALS 145

REBEL EM

NOVEMBER 18, 2024

CEU Pre-Hospital *Military Discounts Available* View Course Dates The post Levitan/Rezaie Practical Airway Course appeared first on REBEL EM - Emergency Medicine Blog. Levitan and Dr. Rezaie on crisis performance, oxygenation, airway anatomy, laryngoscopy, endoscopy, pediatrics, rescue oxygenation techniques and critical care.

Critical Care 71

Critical Care EMS OR 71

Broome Docs

JANUARY 27, 2025

Full blog post here. Welcome to the first episode of the Broomedocs podcast for 2025. Justin and I are back for more nerdy goodness to make you smarter in the Resus room, or at a pub trivia night more likley… wether it is about salt correction, dissection or infection we can help you out! Listen in and learn! Emerg Med J.

ED 101

ED OR ACS Critical Care 101

ALiEM

AUGUST 19, 2024

Tips for the personal statement Mentioned Resources CORD website: New MyERAS® Application: Guidance for Emergency Medicine Read and Listen to the Other EM Match Advice Episodes Blog posts: [link] Author information Sara M. A new section allows you to explaining any unplanned training extensions and interruptions.

EMS 152

EMS OR 152

EMOttawa

JUNE 27, 2024

Originating in the 1960s, this practice was propelled by anecdotal evidence and early case reports suggesting that un-immobilized cervical spine injuries could worsen […] The post Spinal Immobilization: a Twisted Tale appeared first on EMOttawa Blog.

EMS 110

EMS OR Critical Care 110