Category: Dr. Smith’s ECG Blog

To activate or not to activate?

Written by Pendell Meyers, with edits by Steve Smith I was texted this ECG with no clinical information:(This will be called ECG-2) What do you think? I replied “Actually I think this might be a false positive.” The ECG shows sinus rhythm with relatively normal QRS complex followed by large STE in V1-V3, with ~4mm

Scary ST Elevation. What is it?

911 was called for an 18 year old who had altered mental status after using K2 (a recreational drug).  The medics put the patient on the monitor and saw ST elevation.  They then recorded a prehospital 12-lead (not shown, as it is identical to the ED ECG), which showed marked ST Elevation.  The computer diagnosed

ST-Elevation in aVR with diffuse ST-Depression: An ECG pattern that you must know and understand!

This case comes from Sam Ghali  (@EM_RESUS). A 60-year-old man calls 911 after experiencing sudden onset chest pain, palpitations, and shortness of breath. Here are his vital signs: HR: 130-160, BP: 140/75, RR:22, Temp: 98.5 F, SaO2: 98% This is his 12-Lead ECG: He is in atrial fibrillation with a rapid ventricular response at a rate of around 140

Altered Mental Status, Bradycardia

911 was called for an elderly woman who fell and was confused.  Medics found her unresponsive, with “convulsive” movements.  They could not find a pulse.  They performed CPR, gave epinephrine, and intubated the patient and regained a pulse, at which time she became responsive and had this prehospital ECG: On arrival, heart rate was 87

New paper by Smith: New Insights Into Use of the 12-Lead ECG for Diagnosing Acute MI in the Emergency Department

We just published this paper in the Canadian Journal of Cardiology.  The February 2018 issue is on “Advances and Controversies in Cardiac Emergency Care:” New Insights Into the Use of the 12-Lead Electrocardiogram for Diagnosing Acute Myocardial Infarction in the Emergency Department It is a very comprehensive update, concentrating on the ECG diagnosis of acute