Archive for May2010

Quality Assurance of Prehospital 12-Lead ECG Programs

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I’m going to share with you my thoughts on quality assurance of prehospital 12-lead ECG programs. This is a excerpt from one of my posts in the current discussion called EMS Role in Reducing the Symptom to Reflow Interval for AMI at the National Association of EMS Physicians Dialog Group. I strongly believe that we need to […]

Are all STEMI patients the same?

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When it comes to regionalized STEMI care, we treat all STEMI patients the same. But are they the same? The answer is, "No!" Most EMS protocols include a maximum ground transport time of 30-60 when bypassing non-PCI hospitals (AHA Mission: Lifeline calls them "STEMI Referral Hospitals"). The idea is that when the "first medical contact-to-balloon" […]

66 year old male with chest pain and acute STEMI identified with serial ECGs

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Here’s a great case submitted by Nick Ciaravella of Grady EMS in Atlanta, GA. 66 year old male presents to EMS with chest pain. SAMPLE history S – Chest Pain A – None M – Atenolol, HCTZ P – Hypertension L – meal, 7 hours prior to event E – Mowing his lawn OPQRST O – Started […]

Is this hyperacute anterior STEMI or something else?

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A 41 year old male is pulled over during morning rush-hour by sheriff’s deputies. He states that he is on his way to the hospital because he is having chest pain. EMS is called to the scene. The patient is awake, alert, and oriented to person, place, time, and event. His skin is pink, warm, […]

PowerPoint Presentation on Strain Patterns!

This is an awesome PowerPoint presentation from one of my favorite ECG textbooks, 12-Lead ECG – The Art of Interpretation. You owe it to yourself to purchase this book (and no, they don’t pay me to say that). Make sure you use “full screen” so you can see all of the features of this important […]

Left ventricular hypertrophy – Part II

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I know I promised to go over the voltage criteria for left ventricular hypertrophy (LVH) but I lied! If you’re really interested you can check out the Wikipedia article HERE, the ECG Learning Center HERE, or Tom Evans’ crib sheet HERE. Personally? I think it’s a distraction. As far as STEMI recognition goes, it misses […]

Chest pain, left bundle branch block, and excessively discordant ST-segment elevation

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62 year old male presents to the emergency department complaining of chest discomfort. Past medical history is significant for dyslipidemia and ulcerative colitis. Also prior history of significant tobacco use. Maternal history of CAD. Maternal and paternal history of stroke. The patient’s only medication is Lipitor but he took an aspinin en route to the […]

Right ventricular hypertrophy vs. isolated posterior STEMI

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A reader of the Prehospital 12-Lead ECG blog asks, “How can you tell the difference (based on ECG criteria alone) between right ventricular hypertrophy and acute isolated posterior STEMI?” Well, the good news is you don’t have to tell “based on ECG criteria alone” and I’m sure all of my regular readers know that I […]

26 year old male with chest pain and acute isolated posterior STEMI

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Here’s an interesting case submitted by a faithful reader who wishes to remain anonymous. EMS is called to a 26 year old male complaining of chest pain. On arrival patient is found sitting on his living room couch. He appears anxious and acutely ill. The location of the chest discomfort is in the center of […]

Town of Hilton Head Island receives honorable mention for IAFC and Physio-Control's Heart Safe Community Award

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I’m pleased to announce that the Town of Hilton Head Island, SC has received honorable mention for the International Association of Fire Chiefs and Physio-Control’s Heart Safe Community Award! The ceremony took place this morning at The Orleans Hotel in Las Vegas, NV at Fire-Rescue Med 2010. The winners were announced immediately following the general session […]