Dr. Smith's ECG Blog

JUNE 17, 2024

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. Stein et al.

E-9-1-1 134

E-9-1-1 ACS Emergency Department Coronary 134

Dr. Smith's ECG Blog

MARCH 9, 2023

Sent by anonymous, written by Pendell Meyers A man in his 50s with no prior known medical history presented to the Emergency Department with severe intermittent chest pain. Barely any STE, and thus not meeting STEMI criteria. Only now that the patient has STEMI criteria is he allowed to go to the cath lab, at around 0530.

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Dr. Smith's ECG Blog

JULY 18, 2014

Thus, this is BOTH an anterior and inferior STEMI in the setting of RBBB. How old is this antero-inferior STEMI? Although acute anterior STEMI frequently has narrow QR-waves within one hour of onset (1. the presence of such well developed, wide, anterior Q-wave suggests completed transmural STEMI. Lessons : 1.

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STEMI E-9-1-1 ALS Coronary 52

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

The patient’s ECG on arrival at the emergency department is shown below. For clarity — I’ve put these 2 tracings together in Figure-1. Figure-1: The initial ED ECG ( = E CG # 1) — with comparison to the patient’s baseline ECG done 4 years earlier ( = E CG # 3). No arrhythmias occurred en route.

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E-9-1-1 Coronary STEMI Emergency Department 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Here they are: Learning Points: 1. Clin Chem [Internet] 2020;Available from: [link] Smith mini-review: Troponin in Emergency Department COVID patients Cardiac Troponin (cTn) is a nonspecific marker of myocardial injury. 12 All STEMI patients had very high cTn typical of STEMI (cTnT > 1.0

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E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

JANUARY 10, 2020

Here is the parasternal short axis, performed by a real expert in emergency department point of care cardiac ultrasound: There does not appear to be an anterior wall motion abnormality. I was relieved to see this MRI result: MRI IMPRESSION 1) Mildly decreased LV function with no focal wall motion abnormalities. Pericarditis?

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E-9-1-1 OR STEMI Emergency Department 52

Dr. Smith's ECG Blog

DECEMBER 27, 2018

A Deep Neural Network learning algorithm outperforms a conventional algorithm for emergency department electrocardiogram interpretation. S-wave is in V2 = 17 mm S-wave V4 = 9 mm Total = 26 (not greater than 28), so not LVH by the new rule! For clarity — I’ve reproduced this ECG, to which I’ve made a few additions ( Figure-1 ).

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