Archive for September2014

Conclusion: Rate Related VS Primary ST-T Changes

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  This is the conclusion to our previous case, “RATE RELATED VS PRIMARY ST-T CHANGES“. Check it out before you read this final portion.   This was the initial 12 lead ECG obtained by EMS prior ED arrival: There is an irregularly irregular tachycardia with no signs of P waves, which the Lifepak 15 determined to […]

68 y.o. male with weakness: “Treat the monitor, not the patient?”

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A recent graduate of our hospital’s paramedic program brought this case to me. Leigh works for Stratford EMS, an excellent local service in Southwestern Connecticut. (A quick note on the specific details of the case: This patient did not necessarily come to my hospital. Additionally, several features of the case have been altered; some to […]

Rate Related VS. Primary ST-T Changes:

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A 56 year old black male presents to the Emergency Department via EMS, complaining of Chest Pressure, 10/10 pain scale. Pain started suddenly following sudden onset of palpitations, while mowing his lawn. All approximately 5 minutes prior calling EMS. Keep in mind, it was a hot and sunny day with temperature in the 90’s. He advised of prior episodes of chest pressure […]

The 360 Degree Heart – Part I

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The hexaxial reference system. If I asked you to imagine how the limb leads “look” at the heart you would probably picture something like the image below: Notice those gaps in the limb leads? They don’t really exist; they’re an illusion. This isn’t something that is commonly emphasized when the cardiac axis is being taught […]

Conclusion: “And then I gave her a NTG…”

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Recap: From  Part 1: A 64 y.o. woman with typical symptoms of ACS was given nitroglycerin by the paramedic. Her ECG: ECG Interpretation: As noted by many of our astute readers, there is obvious ST-segment elevation (STE) in leads III and aVF. Lead II doesn’t show much STE, but relative to the small R wave […]

64 y.o. Female with CP – “And then I gave her a NTG…”

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My apologies for the faded ECGs. Turns out the medic (a recent grad from our hospital’s program) had been carrying them in his work pants for over a week, waiting to catch me in the ED. The  patient had been brought to another hospital, but he wanted to review the ECGs with me. They had […]