Archive for February2009

EP Lab Digest

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The managing editor of the EP Lab Digest recently interviewed me about the Prehospital 12-Lead ECG Blog. You can see the interview here.

Obtain a 12-lead ECG with return of spontaneous circulation (ROSC)

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Here are some interesting ECGs from a cardiac arrest I worked recently. The arrest was witnessed but there was no CPR prior to EMS arrival. So, we performed 2-minutes of CPR prior to the first shock. Here’s the 12 lead ECG we captured after ROSC: As a side note, what is the cardiac rhythm? If you […]

False Positive Computerized Interpretive Statements

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Every time I’ve defended Southern California’s use of computerized interpretive algorithms in their STEMI system I’ve taken some flack for it. I agree that in a perfect world, paramedics would receive extensive 12 lead ECG training as part of their core education (including how to identify the STEMI mimics and how to identify STEMI in the […]

New exertional dyspnea and subtle ECG signs of LAD occlusion

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EMS responds to a 76 year old male with dispatch complaint of shortness of breath. At the time of EMS arrival, the patient appears acutely ill. He is slightly diaphoretic but not overly anxious. He admits to chest discomfort but denies nausea, vomiting, or palpitations. No jugular venous distension. Breath sounds are clear bilaterally. He […]

Right Ventricular Infarction – Part 3

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Let’s take a look at another case. This was one of the first ECGs ever transmitted to my local receiving hospital on the Lifenet Receiving Station. It was definitely the first STEMI. The data quality of the first 12 lead ECG wasn’t the greatest. This is the second ECG, with lead V4 in the position […]

Right Ventricular Infarction – Part 2

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Let’s look at a case study that demonstrates the potential danger associated with right ventricular infarction. EMS is called to the residence of a 68 year old female with chest pain. On arrival, the patient is anxious, cool, pale, and diaphoretic. Vital signs are assessed. HR: 68 RR: 20 NIBP: 105/55 SpO2 95% on RA A 12 […]

Who knew that StatCounter could be so entertaining?

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A visitor to the the blog from Birmingham, UK made me laugh today! Check out her search term.

ECG mimics of acute STEMI

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Peter Canning over at Street Watch: Notes of a Paramedic has a recent post entitled STEMI Interpretation that’s worth checking out. In it, he observes: When we take a class in STEMI recognition, the ECGs, once you know how to read them, are all pretty clear cut. You can flash the 12-leads on the screen […]

Right Ventricular Infarction – Part 1

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Right ventricular infarction. What is it and why should you care? Depending on what you read, right ventricular infarct may complicate up to 40 or 50% of all inferior MIs. Remember, when we say inferior MI or anterior MI we’re talking about the inferior wall of the left ventricle or the anterior wall of the […]

Differential diagnosis of tall R waves in lead V1

What is the differential diagnosis of tall R waves in lead V1? From Mattu, Brady, et al., Prominent R Wave in Lead V1: Electrocardiographic Differential Diagnosis. Am J Emerg Med 2001; 19:504-513. PMID: 11593472 Right bundle branch block Left ventricular ectopy Right ventricular hypertrophy Acute right ventricular dilation (acute right heart strain) Type A Wolff-Parkinson-White […]

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