Dr. Smith's ECG Blog

JULY 22, 2012

Course : A CT of the head, neck, chest, abdomen and pelvis showed no other unanticipated injuries and she was admitted to the ICU. More commonly, however, ECG and/or echo wall motion abnormalities are due to pre-existing disease, especially coronary disease complicating trauma.

Coronary 52

Coronary ICU OR ED 52

Dr. Smith's ECG Blog

OCTOBER 25, 2023

The patient was admitted to the ICU for close monitoring and electrolyte repletion and had an uneventful hospital course. The patient is a man in his 60s with established severe alcohol use disorder — and epidural abscess being treated with longterm Ciprofloxacin — who presented to the ED following a syncopal episode. As per Drs.

Overdose 124

Overdose ACS OR ICU 124

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). He was admitted to the ICU and was unstable, in shock, overnight.

Overdose 98

Overdose E-9-1-1 Coronary ICU 98

EMDocs

OCTOBER 21, 2023

A 68-year-old male with a past medical history of hypertension, diabetes mellitus, and coronary artery disease with a drug eluting stent placed 2 months ago presents with dizziness and vomiting that began 3 hours ago. Median time from ED arrival to diagnosis was 8 hours 24 min in one study, with only 19% being diagnosed within the 4.5-hour

EMS 98

EMS ALS OR ACS 98

Dr. Smith's ECG Blog

JANUARY 6, 2023

The patient vomited once and given the more intense pain decided to come to the ED. Immediate and early percutaneous coronary intervention in very high-risk and high-risk Non-STEMI patients. 2-hour hsTn: 615 ng/L; bedside ED echo (without contrast) did not show a clear wall motion abnormality (WMA). Lupu L, et al. mg/dL, K 3.5

ACS 52

ACS Coronary ICU STEMI 52

Dr. Smith's ECG Blog

APRIL 20, 2018

This is her pre-hospital ECG: This is her first ECG in the ED: What do you think? She also received an additional nitro in the ED after receiving aspirin and nitro via EMS. If she had no risk factors, it is doubtful that she would have developed such extensive coronary artery disease as we see on the angiogram.

Coronary 40

Coronary STEMI EMS ACS 40

Dr. Smith's ECG Blog

DECEMBER 13, 2019

in the ICU but survived with excellent function. IF , on the other hand — the patient with new chest pain is older and lacks predisposing viral symptoms — then acute pericarditis becomes a rare diagnosis in an ED setting. I completely agree with many of the KEY findings conveyed by Dr. Meyers.

E-9-1-1 52

E-9-1-1 ACS Coronary CAD 52

Dr. Smith's ECG Blog

JULY 24, 2018

Upon arrival in the ICU, before getting Continuous Veno-Venous Hemodialysis (CVVHD), his potassium had risen again to 7.8 Acute coronary syndrome is unlikely to be one of those entities. Bottom Line: Hyperkalemia is an increasingly common ED diagnosis that must not be missed. There is no ECG available from this time.

Epinephrine 52

Epinephrine ICU Coronary EMS 52

Dr. Smith's ECG Blog

MARCH 6, 2019

She was asymptomatic at the time of this ECG recorded on arrival to our ED: What do you think? If for some reason the angiogram is delayed, they should receive maximal medical therapy in an ICU setting with continuous 12-lead ST segment monitoring under the close attention of a practitioner with advanced ECG interpretation training.

STEMI 52

STEMI ALS ACS ICU 52

Dr. Smith's ECG Blog

SEPTEMBER 29, 2018

His ED cardiac ultrasound (which is not at all ideal for detecting wall motion abnormalities, and is also very operator dependent for this finding) was significant for depressed global EF. Fortunately, he was extubated several days later in the ICU with intact baseline mental status and was discharged shortly thereafter to subacute rehab.

CAD 52

CAD OR ED ALS 52

Dr. Smith's ECG Blog

JULY 12, 2020

We obtained access and monitoring, but she showed no signs of improvement, and we judged that an intervention must be done in the ED without delay. A CT was obtained later and showed appropriate positioning of the catheter: She was admitted to the ICU and the catheter was used several times to withdraw more fluid.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40

EMDocs

JANUARY 6, 2024

A 64-year-old male presents by EMS to the ED with shortness of breath. 1 There are over 50,000 visits related to heart transplant in the United States each year and over half of these patients are admitted to the hospital from the ED. We’ll keep it short, while you keep that EM brain sharp.

EMS 91

EMS E-9-1-1 ACS Coronary 91

ACEP Now

JUNE 14, 2024

Some of the critical differentials include pulmonary embolism, acute decompensated heart failure, pneumonia, pneumothorax, and acute coronary syndrome. Anginal chest pain, chest heaviness, or evidence of fluid overload suggest acute coronary syndrome or acute decompensated heart failure. Signs and symptoms of systemic infection (e.g.,

ALS 52

ALS Coronary OR ED 52

Dr. Smith's ECG Blog

MARCH 6, 2025

Fifth , potential management actions are in your hands; you do not need to request a coronary interventionalist or cath lab team. Making a specific ECG Diagnosis (less important in the ED) Without reading the below, I suspected posterior fascicular VT. Again the clinical history is helpful.

Coronary 96

Coronary ICU OR Defibrillator 96

EMDocs

OCTOBER 29, 2024

A 43-year-old male with a history of mitral valve regurgitation s/p valvular replacement, hypertension, hyperlipidemia was evaluated in the ED for septic shock secondary to a pyelonephritis with a renal abscess. Left ventricular outflow tract obstruction in ICU patients. He has clinically deteriorated and required intubation.

E-9-1-1 98

E-9-1-1 ICU Epinephrine EMS 98

Don't Forget the Bubbles

MARCH 24, 2025

This is likely because Dexmed helps dampen the sympathetic response to perioperative stress, improving coronary artery perfusion. How is Dexmedetomidine used in the ED? Future Roles of Dexmedetomidine in the Emergency Department Dexmedetomidine is increasingly being explored as a paediatric procedural sedation option in the ED.

E-9-1-1 59

E-9-1-1 Emergency Department ALS ICU 59