Archive for July2009

Narrow complex tachycardias – Part II

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Here’s a call that was very well executed. The patient was a 35 year old Hispanic female; walk-in patient at a volunteer clinic. Through an interpreter it was learned that the patient was complaining of palpitations and slight chest discomfort. The onset was sudden. The medical history was significant for “arrhythmias”. No medications. Skin: warm […]

Narrow complex tachycardias – Part I

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I've come to dislike the term "SVT" (supraventricular tachycardia). In the first place, it's not an arrhythmia. It's an umbrella term that covers a group of arrhythmias which require the AV node for their maintenance. Most importantly, it includes sinus tachycardia! For some reason, this is a difficult concept for many clinicians to grasp, partly […]

Acute inferior STEMI – RCA or LCX?

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This discussion was moved here: http://www.ems12lead.com/2009/07/19/62-yom-cc-chest-discomfort/

62 year old male CC: chest discomfort (update)

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This discussion was moved here: http://www.ems12lead.com/2009/07/19/62-yom-cc-chest-discomfort/

Why capture a 12-lead ECG with the first set of vital signs?

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If for no other reason, because MONA can “clean up” a 12 lead ECG, making it non-diagnostic by arrival at the hospital! Before MONA After MONA If not for the prehospital 12 lead ECG, there’s no telling how long this patient would have lingered in the emergency department! *** Update *** Here’s another case (from […]

60s male with chest discomfort. Is this RCA or LCX occlusion?

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EMS is dispatched to a 62 year old male with a chief complaint of chest discomfort. On arrival, the patient is found sitting at the dinner table. He appears acutely ill. Onset: Fairly sudden after sitting down for dinner 20-30 minutes ago Provoke: Nothing makes the pain feel better or worse Quality: Dull pressure/ache Radiation: […]

35 year old male presents to the fire station with palpitations after heavy alcohol consumption

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35 year old male presents to the fire station complaining of an irregular heart beat. The patient states that he walked up to the top of the lighthouse earlier in the day and started to feel palpitations. He is on vacation and has been “drinking a lot” all week. He denies chest pain or shortness of […]

Right bundle branch block – Part 3

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Let’s take another look at the ECG from Part 2. Does anything stand out? How about lead V4? Here you can see the terminal deflection (blue arrow) is positive, and so is the T-wave (inappropriate T-wave concordance). There is also at least 1 mm of ST segment elevation. That’s definitely abnormal! Now let’s look in […]

Right bundle branch block – Part 2

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Generally speaking, right bundle branch block does not mimic or obscure the ECG diagnosis of acute STEMI the way left bundle branch block does. But how do we know what’s “normal” for right bundle branch block? One of the things we consider is the rule of appropriate T-wave discordance. This concept usually comes up in the […]

Happy 4th of July weekend

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Sorry I haven’t posted anything in a while, but I’ve been away at my parents beautiful log home on Lake Huron. It’s been nice to get away for a while and enjoy some crisp northern air! I’ve been power washing, painting, and digging all week (the artesian well sprang a leak — who knew trench […]