Dr. Smith's ECG Blog

NOVEMBER 23, 2022

About an hour later, he was then found on the floor in cardiac arrest in the ED. Sooner identification likely leads to better outcomes, and in this case may have allowed prevention of cardiac arrest and better long-term outcome. His initial troponin T was 15 ng/L (only two hours since pain onset).

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Dr. Smith's ECG Blog

AUGUST 19, 2023

They had had twice the rate of cardiac arrest and twice the in-hospital mortality[1] In another study of patients diagnosed with STEMI, those on dialysis experienced delayed reperfusion and double the mortality.[2] They were less likely to have STEMI on ECG, and more likely to be initially diagnosed as non-ACS.

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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 underwent PCI and had a good outcome. Formula : There is not enough ST elevation in V2-V4 to be applying the LAD/early repol formula, but if it is applied, one gets 1.5 He was defibrillated.

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Chest Pain Cardiac Arrest Ischemia STEMI 52

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

But until that point, no one could have known his neurologic outcome, and the stated reason for not accepting was not worry for neurologic outcome but that the ECG did not meet STEMI criteria. The outcome measure was whether the patient ultimately had an OMI or not.

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Dr. Smith's ECG Blog

NOVEMBER 4, 2022

Thirty-six patients (36%) presented with cardiac arrest, and 78% (28/36) underwent emergent angiography. We’ve presented many variations on this theme on Dr. Smith’s Blog — with today’s case being distinguished by its discovery on abdominal exam ! Results Emergent angiography was performed in 80% (79/99) of patients.

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Dr. Smith's ECG Blog

NOVEMBER 30, 2022

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. She was defibrillated and resuscitated. Smith: this ECG and clinical presentation is diagnostic of LAD Occlusion.

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Dr. Smith's ECG Blog

SEPTEMBER 4, 2016

He had a previous MI with cardiac arrest 2 years prior. Jason asked me if I thought it is due to occlusion (without either of us knowing the outcome), and this was my answer: This is a posterolateral MI. He was clammy and looked unwell. Is this due to coronary occlusion? Some are STEMI-equivalents. This is because: 1.

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Dr. Smith's ECG Blog

NOVEMBER 18, 2019

Of course this is not a difficult case because one will always measure the K in such a case, but it does show that the K is markedly affecting cardiac electrical activity. Case outcome The Na was 109. This was the etiology of seizures. He was treated with hypertonic saline. Volume was down, and so repleted.

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Chest Pain Cardiac Arrest Bradycardia Ischemia 52

Dr. Smith's ECG Blog

JUNE 27, 2024

A patient had a cardiac arrest with ventricular fibrillation and was successfully defibrillated. A reliable study would keep track of all patients with shockable arrest and analyze the ones who were not enrolled to see their outcomes. This is FAR LESS than all other studies of shockable arrest.

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Dr. Smith's ECG Blog

NOVEMBER 12, 2020

However, in multiple studies, even in the absence of AMI, both acute and chronic myocardial injury (as diagnosed by any elevated cTn) are powerful markers of adverse outcomes in both the short and long term. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. 3–8 Shi et al.

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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. He was estimated to be in his 50s, with no known PMHx. He arrived with chest compressions ongoing, intubated, and being bagged.

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MIBHS

FEBRUARY 28, 2025

This blog explores how genetics influence heart health and whether mitigating these inherited risks is possible. Arrhythmias: Genetic mutations can also predispose individuals to irregular heart rhythms, such as atrial fibrillation or long QT syndrome, which may increase the risk of stroke or sudden cardiac arrest.

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Dr. Smith's ECG Blog

OCTOBER 20, 2013

What is the utility of a head CT in cardiac arrest? We found intracranial hemorrhage in 2% of non-traumatic cardiac arrest patients, and in 4 others the presence of cerebral edema changed management. in Vienna found that 27 of 765 (4%) of out of hospital cardiac arrests (OHCA) were due to SAH.

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Dr. Smith's ECG Blog

JUNE 23, 2024

The electrophysiologist is a reader of Dr. Smith's ECG Blog. Simply by correlating the history of cardiac arrest with serial ECGs recorded after the event — it became obvious that the 60% lesion on cardiac cath, despite its surprisingly good TIMI 3 flow — was indeed the "culprit" artery that had spontaneously reperfused after the event.

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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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Dr. Smith's ECG Blog

APRIL 8, 2016

The patient stabilized and had a good outcome. If cardiac arrest from hypokalemia is imminent (i.e., As I indicated above, in our cardiac arrest case, after pushing 40 mEq, the K only went up to 4.2 The mean serum potassium level was lower after resuscitation from cardiac arrest (3.6 mEq/L, from 1.9

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Dr. Smith's ECG Blog

NOVEMBER 19, 2014

It is highly associated with proximal LAD occlusion and bad outcomes. Here are three more dramatic cases that illustrate RBBB + LAFB Case 1 of cardiac arrest with unrecognized STEMI, died. So this is diagnostic of proximal LAD occlusion. New RBBB + LAFB is a very bad sign.

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Dr. Smith's ECG Blog

FEBRUARY 25, 2009

A stent was placed, and the patient had an excellent outcome with no wall motion abnormality. Were it not for this prehospital ECG and the cardiac arrest, the diagnosis may have been significantly delayed. Angiography revealed a very tight LAD stenosis with some flow (confirming the reperfusion that we see on the ECG).

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Dr. Smith's ECG Blog

MAY 13, 2017

Case 1: The outcome of this case is at the far bottom. On this blog, the warning is this : It is critical to use it only when the differential is subtle LAD occlusion vs. early repol. As he was alarmed by it, he went to the patient who now was having recurrent pain, then suddenly went into cardiac arrest (ventricular fibrillation).

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Dr. Smith's ECG Blog

OCTOBER 8, 2023

ECG#1 ECG#2 ECG#3 ECG#4 ECG#5 See outcomes of all 5 below, with the Queen of Hearts AI Bot interpretation. Smith: This bizarre ECG looks like a post cardiac arrest ECG with probable acidosis or hyperkalemia in addition to OMI. All of the patients presented with chest pain , and they are all in triage. What was the pH and K?

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Dr. Smith's ECG Blog

APRIL 18, 2025

If the ventricular escape rhythm also gives out, the patient has cardiac arrest. He suffered another cardiac arrest in the ICU with ROSC after another dose of epinephrine and one round of CPR. If that limb gives out due to ischemia or another cause, the heart becomes reliant on a ventricular escape rhythm.

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Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

It is highly associated with proximal LAD occlusion or severe left main ACS and with bad outcomes. Here are three more dramatic cases that illustrate RBBB + LAFB Case 1 of cardiac arrest with unrecognized STEMI, died. So this is diagnostic of proximal LAD occlusion. New RBBB + LAFB is a very bad sign.

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Dr. Smith's ECG Blog

OCTOBER 5, 2011

Sudden cardiac arrest associated with early repolarization. Long-term outcome associated with early repolarization on electrocardiography. No one is certain what to do with this information, and it certainly does not impact emergency medicine, in which the problem remains: is it STEMI or not? N Engl J Med 2008;358(19):2016-23.

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Dr. Smith's ECG Blog

NOVEMBER 24, 2017

I've been working on this a long time, thought about submitting it to a journal, but decided it gets more readers on this blog. However, none of the formulas have proven to be definitively better than another and none are well correlated with outcomes or events! This article discusses correction of the QT interval for rate.

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Dr. Smith's ECG Blog

OCTOBER 11, 2020

About two hours after admission, he suffered a cardiac arrest (whether it was VF/VT or PEA is not available) and expired. Like other cases on this blog who died before cath was done, I cannot prove that this patient had OMI. Could this outcome have been prevented with emergent cath? I do not accept the transfer." "It

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Dr. Smith's ECG Blog

OCTOBER 13, 2023

Depending on the age and sex of the patient — there may be borderline voltage for LVH ( See My Comment re LVH criteria — at the bottom of the page in the August 15, 2022 post in Dr. Smith's ECG Blog ).

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Dr. Smith's ECG Blog

FEBRUARY 2, 2025

Smith comment: The patient was lucky to have a cardiac arrest. By undergoing an arrest, providers became aware of his OMI which had not been noticed on his diagnostic ECG, and he thus has a chance at some myocardial salvage. Had he not had one, he would have sat in the waiting room until his entire myocardium at risk infarcted.

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Dr. Smith's ECG Blog

FEBRUARY 10, 2025

2] Curiously, ACLS does not include consideration of calcium in its bradycardia algorithm, which could have prevented the arrest and which along with the epi produced ROSC. HyperKalemia with Cardiac Arrest. Acute hyperkalemia in the emergency department: a summary from a Kidney Disease: Improving Global Outcomes conference.

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Dr. Smith's ECG Blog

FEBRUARY 18, 2025

The patient's long term outcome is unknown. In just 90 minutes from presentation, the patient progressed from that very subtle ECG to cardiac arrest. Dr. McLaren recently wrote an excellent blog post on a similar case. Discussion: This is a case of an initial ECG showing very subtle signs of hyperkalemia.

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Dr. Smith's ECG Blog

APRIL 9, 2025

But it does show a strong association of better outcome with lidocaine vs. amiodarone. A retrospective 'target trial emulation' comparing amiodarone and lidocaine for adult out-of-hospital cardiac arrest resuscitation. We used propensity score matching (PSM) to investigate the association between antiarrhythmic and outcomes.

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Dr. Smith's ECG Blog

MARCH 23, 2025

For the Queen, all 4 FPs had a culprit but the troponin was not high enough to qualify for this very strict OMI outcome definition requiring a peak hs troponin I of at least 5000 ng/L. We are lucky this patient did not have a cardiac arrest while in the Waiting Room.

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Dr. Smith's ECG Blog

APRIL 6, 2025

They felt that the asystolic arrest suggested a different etiology of cardiac arrest. With the severe acidosis and absence of ST elevation, they felt there was more likely to be a non-cardiac etiology of his presentation. In short with a very guarded likelihood for a positive outcome.

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Dr. Smith's ECG Blog

APRIL 16, 2025

Anyone who has been a reader of this blog understands the terrible significance of this ECG, which is diagnostic of acute proximal LAD occlusion. She survived the hospitalization, but long term outcome is not available. Plus recommendations from a 5-member panel on cardiac arrest. PMcardio digitized image.

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