Dr. Smith's ECG Blog

JULY 9, 2024

Written by Pendell Meyers A man in his 50s was found by his family in cardiac arrest of unknown duration. 15 minutes after EMS arrival, after at least 6 defibrillations, the patient achieved sustained ROSC. Meyers and Smith in the October 15, 2022 post of Dr. Smith's ECG Blog ).

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Defibrillator STEMI Cardiac Arrest Cardiogenic Shock 102

Dr. Smith's ECG Blog

JUNE 9, 2024

This is obviously severe hyperkalemia and the patient is near cardiac arrest. There was no IV access, so we obtained intraosseous (IO) access, but she arrested before we could give her all the calcium. Hyperkalemia and Cardiac Arrest Could you have prevented this young man's cardiac arrest?

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Cardiac Arrest Defibrillator Cardiac Function Tachycardia 131

Ken Grauer, MD

MARCH 23, 2023

She underwent cardiopulmonary resuscitation for VT/VFib — with ROSC ( R eturn O f S pontaneous C irculation ) following defibrillation and treatment with Epinephrine and Amiodarone. A series of cardiac arrhythmias were seen during the course of her resuscitation — including the interesting arrhythmia shown in the long lead II of Figure-1.

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Blog Tachycardia Arrhythmia Atrial Flutter 78

Dr. Smith's ECG Blog

APRIL 2, 2024

He was defibrillated, but they also noticed that he was being internally defibrillated and then found that he had an implantable ICD. He was unidentified and there were no records available After 7 shocks, he was successfully defibrillated and brought to the ED. There was no bystander CPR. The QRS is extremely wide.

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Tachycardia Pacemaker Cardiac Arrest Cardiomyopathy 128

Dr. Smith's ECG Blog

OCTOBER 10, 2022

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. He had multiple cardiac arrests with ROSC regained each time. This patient arrested shortly after hospital arrival. As a result — the history will often be limited to what was known prior to the arrest.

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Cardiac Arrest Chest Pain Embolism Pulmonary 52

Dr. Smith's ECG Blog

APRIL 6, 2018

Written by Pendell Meyers, with edits by Steve Smith Thanks to my attending Nic Thompson who superbly led this resuscitation We received a call that a middle aged male in cardiac arrest was 5 minutes out. There were two monitor spikes for every one electrical cycle on the cardiac monitor. Learning Points: 1.

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Cardiac Arrest Tachycardia Defibrillator ICU 52

Dr. Smith's ECG Blog

APRIL 29, 2020

A 60-something woman presented after a witnessed cardiac arrest. She was never defibrillated. This is commonly found after epinephrine for cardiac arrest, but could have been pre-existing and a possible contributing factor to cardiac arrest. Cardiac cath showed minimal disease. She recovered.

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Cardiac Arrest Defibrillator Ischemia Tachycardia 52

Dr. Smith's ECG Blog

JULY 14, 2023

He underwent further standard resuscitation EXCEPT that we applied the Inspiratory Threshold Device ( ResQPod ) AND applied Dual Sequential Defibrillation (this simply means we applied 2 sets of pads, had 2 defib machines, and defibrillated with both with only a fraction of one second separating each defibrillation.

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Cardiac Arrest Chest Pain Defibrillator Atrial Flutter 89

Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

Although one may have all kinds of ischemic findings as a result of cardiac arrest (rather than cause of cardiac arrest), this degree of ST elevation and HATW is all but diagnostic of acute proximal LAD occlusion. See Discussion in the June 29, 2024 post of Dr. Smith' ECG Blog ). This prompted cath lab activation.

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Cardiac Arrest STEMI Ischemia SCAD 80

Dr. Smith's ECG Blog

MAY 19, 2020

She was unable to be defibrillated but was cannulated and placed on ECMO in our Emergency Department (ECLS - extracorporeal life support). After good ECMO flow was established, she was successfully defibrillated. Here is a case of ECMO defibrillation with near shark fin that was due to proximal LAD occlusion. The K was normal.

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Defibrillator Circulation Plaque Cardiac Arrest 52

EMS 12-Lead

MARCH 30, 2024

TCP In Transit: A case reviewing transcutaneous pacing, false electrical capture, and re-arrest. 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. Current 85mA.

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Cardiac Arrest Pacemaker Pulmonary Bradycardia 124

Dr. Smith's ECG Blog

SEPTEMBER 12, 2023

Figure-2: A rapid method for estimating the QTc ( Figure from My Comment in the March 19, 2019 post in Dr. Smith's ECG Blog ). == Clinical Implications of a Short QTc: The differential diagnosis for today's tracing, with its short QTc ~360 msec. Treatment is by ICD ( implantable cardioverter defibrillator ).

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Cardiac Arrest Blog Atrial Fibrillation AFIB 69

Dr. Smith's ECG Blog

JULY 21, 2024

He required multiple defibrillations within a period of a few hours. This time, the arrhythmia did not spontaneously terminate — but rather degenerated to VFib, requiring defibrillation. Some episodes of PMVT would terminate spontaneously — but on many occasions, the PMVT degenerated to VFib, requiring defibrillation.

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Arrhythmia Cardiogenic Shock Bradycardia Defibrillator 113

Dr. Smith's ECG Blog

JUNE 21, 2023

Two hours later , the patient returned to this same urgent care facility with worsening chest pain, and this ECG was performed: While getting another ECG, the patient suffered cardiac arrest: After multiple defibrillations, ROSC was achieved with ongoing "STEMI".

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Chest Pain Cardiac Arrest STEMI Defibrillator 97

Dr. Smith's ECG Blog

OCTOBER 20, 2024

The arrhythmia spontaneously converted before defibrillation was achieved. This patient is actively dying from a left main coronary artery OMI and cardiac arrest from VT/VF or PEA is imminent! Complete LMCA occlusion is associated with clinical shock and/or cardiac arrest.

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Cardiogenic Shock Ischemia Chest Pain Cardiac Arrest 125

Dr. Smith's ECG Blog

OCTOBER 23, 2023

Edited by Bracey, Meyers, Grauer, and Smith A 50-something-year-old female with a history of an unknown personality disorder and alcohol use disorder arrived via EMS following cardiac arrest with return of spontaneous circulation. The described rhythm was an irregular, wide complex rhythm. What is ELECTRICAL ALTERNANS?

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Tachycardia Cardiac Arrest ICU Blog 120

Dr. Smith's ECG Blog

FEBRUARY 8, 2022

The patient was put on Extracorporeal Life Support in the ED 3 hours after initial resuscitation, the core temp was 30° C and the patient was defibrillated with a single attempt. Perhaps the bifascicular block ( RBBB/LPHB ) present on ECG #1 — but which resolved by ECG #2 — was also ischemic-related from the cardiac arrest.

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Cardiac Arrest Bradycardia Chest Pain Ischemia 52

Dr. Smith's ECG Blog

JULY 14, 2010

She was defibrillated successfully from ventricular fibrillation and developed a perfusing rhythm. A 56 yo f with h/o HTN and hypercholesterolemia called EMS from home after onset of L chest pain radiating to the left arm. Before EMS arrived, she had "seizure activity" and became unresponsive. She was intubated.

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Cardiac Arrest Cardiogenic Shock Chest Pain Defibrillator 52

Dr. Smith's ECG Blog

OCTOBER 4, 2010

He was resuscitated with chest compressions and defibrillation and 1 mg of epinephrine. This young male had ventricular fibrillation during a triathlon. On his bib it stated that he had a congenital heart disorder. He arrived in the emergency department hemodynamically stable. His initial ECG is shown here.

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Cardiac Arrest Ischemia Stenosis STEMI 52

Dr. Smith's ECG Blog

DECEMBER 23, 2014

The patient was diagnosed with esophageal reflux and was being discharged by the nurse when he had a cardiac arrest. He was defibrillated. The formula results in 23.43, just above the 23.4 Here is his post resuscitation ECG: Now the diagnosis is obvious. Anterolateral STEMI.

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Chest Pain Cardiac Arrest Ischemia STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

If cardiac arrest from hypokalemia is imminent (i.e., Here is another post on hypoK: Patient with severe DKA, look at the ECG In this post, I discussed another patient I took care of : Prehospital Cardiac Arrest due to Hypokalemia I recently had a case of prehospital cardiac arrest that turned out to be due to hypokalemia.

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Cardiac Arrest Tachycardia Nursing Ultrasound 52

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

I was texted these ECGs by a recent residency graduate after they had all been recorded, along with the following clinical information: A 50-something with no cardiac history, but with h/o Diabetes, was doing physical work when he collapsed. This blog is full of cases in which OMI that did not meet STEMI millimeter criteria were dismissed.

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STEMI Hospital Blog Defibrillator 52

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

The patient had 2 ventricular fibrillation arrests during transport, but was immediately defibrillated both times, and was awake in the ED, when the following ECG was recorded: The ST elevation has mostly resolved on this ECG, and were it not for the arrest and the prehospital ECG, this would not be a slam dunk diagnosis.

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Cardiac Arrest Chest Pain Defibrillator STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. It is apparently fortunate that she had a cardiac arrest; otherwise, her ECG would have been ignored. Then they did an MRI: Patient underwent cardiac MRI on 10/4 that showed mildly reduced BiV systolic function. I need to innoculate you against the subsequent opinions below.

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Plaque Chest Pain Thrombosis Stenosis 52

Dr. Smith's ECG Blog

OCTOBER 3, 2017

This is another case written by Pendell Meyers (who is helping to edit the blog and has many great recent posts) Case A 45 year old man was driving to work when he experienced acute onset sharp left sided chest pain with paresthesias of the left arm. He received aspirin en route via EMS, and no EMS ECGs are available.

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Chest Pain STEMI Defibrillator Stent 52

Dr. Smith's ECG Blog

OCTOBER 26, 2020

Case submitted by Magnus Nossen MD from Norway, written by Pendell Meyers A man in his 50s with no pertinent medical history suffered a witnessed cardiac arrest. 12 minutes later, the patient went back into VFib arrest and underwent another 15 minutes of resuscitation followed by successful defibrillation and sustained ROSC.

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Ischemia Arrhythmia Defibrillator Chest Pain 52

Dr. Smith's ECG Blog

MAY 6, 2019

This ECG pattern may be diagnostic of B rugada S yndrome IF seen in association with: i ) a history of cardiac arrest; polymorphic VT; or of non-vagal syncope; and / or ii ) a positive family history of sudden death at an early age; and / or iii ) a similar ECG in relatives. Cardioversion/defibrillation. Acute febrile illness.

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Chest Pain STEMI Ischemia Myocardial Infarction 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

In addition to a spontaneous or induced Brugada-1 ECG pattern, criteria for B rugada S yndrome require one or more of the following: History of cardiac arrest, of polymorphoic VT, or of non-vagal syncope — positive family history of sudden death at an early age — a similar ECG in close relatives.

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Heart Rhythm Sudden Cardiac Death Arrhythmia STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

Features of Short QT Syndrome: From My Comment at the bottom of the page in the September 2, 2019 post of Dr. Smith’s ECG Blog: SQTS is an inherited cardiac channelopathy determined by the presence of symptoms ( syncope, cardiac arrest ) — positive family history — and the ECG finding of an abnormally short QTc interval.

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Chest Pain Cardiac Arrest STEMI Arrhythmia 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Further history later: This patient personally has no further high risk features (syncope / presyncope), but her mother had sudden cardiac arrest in sleep. Implantable Cardioverter-Defibrillator ), with long-term potential for device-related complications from the ICD, including inappropriate shocks? 8, 2019 ) — ( Jan.

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Sudden Cardiac Death Heart Rhythm Article Tachycardia 52