Site Index

12-lead ECG interpretation

12-lead ECG – Lead placement diagrams

Contiguous and reciprocal lead charts

Muscle tremors, your patient's dignity, and staying organized

Artifact in the limb leads: which electrode is responsible?

The Six Step Method for 12-lead ECG interpretation

Large block method for heart rate calculation

Precordial leads – the transition, R-wave progression, R/S ratio in lead V1

Differential diagnosis of tall R-waves in lead V1

Maya glyphs and 12-lead ECGs

Treat the patient not the monitor?

Editors' Picks

Computerized interpretive statements

Computerized interpretive statements – false positives #1

Computerized interpretive statements and bundle branch blocks

Data quality and computerized interpretive statements

Comparing 12-Leads: Common problem or common disease?

Comparing 12-Leads: Discussion

Prehospital 12-leads

Prehospital 12-lead ECG programs (also posted at JEMS Connect)

Prehospital 12-lead ECG – what are the indications?

Top 10 myths about prehospital 12-lead ECGs

Why 12-leads?

McLearning and 12-lead ECG interpretation

Prehospital 12-lead ECG quiz for the kitchen table

2013 STEMI Guidelines: EMS is Accountable

Axis determination

Why learn axis?

Axis determination – Part I

Axis determination – Part II

Axis determination – Part III

Axis determination – Part IV

Axis determination – Part V

Axis determination – Part VI

Video: Axis Determination

Right bundle branch block

Right bundle branch block – Part I

Right bundle branch block – Part II

Right bundle branch block – Part III

"Funky trouble looking" RBBB with AMI

50 year old male CC: Respiratory distress, chest pain

88 year old male CC: Chest Pain

Conclusion to 88 year old male CC: Chest Pain

64 year old male CC: indigestion

64 year old male CC: indigestion-Discussion 

An unusual case of right bundle branch block

An unusual case of right bundle branch block-Discussion

What's wrong with Mr. Wilson?

RBBB abnormalities missed

Left anterior fascicular block

Left anterior fascicular block (LAFB)

Bifascicular block

66 year old male CC: Syncope

82 year old male CC: Chest pain

63 year old male CC: Sudden onset shortness of breath (computer says >>>>ACUTE MI<<<<)

88 year old male CC: Chest pain

Right ventricular infarction

Right ventricular infarction – Part I

Right ventricular infarction – Part II

Right ventricular infarction – Part III

Mimics of Acute STEMI

The problem of ST-segment elevation

ST-segment morphology

ECG Challenges from AACN Advanced Critical Care (links to article about STEMI mimics)

Mimics of acute STEMI (left ventricular aneurysm)

Left ventricular hypertrophy – Part I

Left ventricular hypertrophy – Part II

41 year old male CC: Chest pain

41 year old male CC: Chest pain – Answer

Wolff-Parkinson-White Syndrome (WPW) – STEMI Mimic

41 year old male CC: Chest pain (looks like BER, proves to be acute STEMI)

23 year old male CC: Chest pain (benign early repolarization)

76 year old female CC: Chest pain

76 year old female CC: Chest pain – The case for this being an acute anterior STEMI

76 year old female CC: Chest pain – Conclusion (Tako-Tsubo Cardiomyopathy)

90 year old male CC: "Possible Stroke" (LVH with Strain Pattern)

90 year old male CC: "Possible Stroke"-Conclusion

63 year old male CC: Shortness of breath (LVH with Strain Pattern)

63 year old male CC: Shortness of breath- Conclusion

57 year old female CC: Shortness of breath and chest pressure (LVH with Strain Pattern)

57 year old female CC: Shortness of breath and chest pressure-Discussion

39 year old male CC: "sick" (pericarditis)

39 year old male CC: "sick"- Discussion

68 year old female unresponsive on the kitchen floor

Osborn waves (j-waves) of hypothermia 

Left ventricular aneurysm vs. acute anterior STEMI

The early repolarization experiment

Acute inferior STEMI

49 year old male CC: Weakness, nausea

66 year old male CC: Chest pain (ST-elevation disappears by arrival to the hospital)

58 year old male CC: Chest pain

62 year old male CC: Chest discomfort

62 year old male CC Chest discomfort – Update (Angiograms)

Acute inferior STEMI – RCA or LCX?

65 year old female CC: Chest pain

39 year old male CC: Syncope while playing tennis

81 year old male CC: "Cold and shaky"

81 year old male CC: "Cold and shaky" – Conclusion (angiograms)

The missed STEMI (case study with angiograms)

58 year old male CC: Chest discomfort

53 year old female CC: Chest discomfort and shortness of breath

46 year old female: Injuries from a fall

46 year old female: Injuries from a fall-Discussion

49 year old male CC: Chest pain

49 year old male CC: Chest pain-Conclusion

54 year old female CC: BLS intercept

54 year old female CC: BLS intercept-Conclusion

79 year old female CC: Chest pain

79 year old female CC: Chest pain- Conclusion

The Bait and Switch (switched leads)

The Bait and Switch- Conclusion

47 year old male: Holiday Indigestion

47 year old male: Holiday Indigestion- Conclusion (Inferoposterior)

59 year old male- "Lifting Boxes"

59 year old male- "Lifting Boxes", Part II- With a Twist! (Infero-postero-lateral)

"What Happened?"

"What Happened?"- Discussion (Atypical Wenckebach)

Acute posterior STEMI

48 year old male CC: Chest discomfort, shortness of breath

Anterior ischemia or posterior STEMI? (at Paramedicine 101)

50 year old male CC: Respiratory distress, chest pain

74 year old male CC: Chest pain

74 year old male CC: Chest pain – Update

74 year old male CC: Chest pain – Final update (angiograms)

26 year old male CC: Chest pain

Right ventricular hypertrophy vs. isolated posterior STEMI

66 year old male CC: Chest pain (postero-lateral)

66 year old female CC: Chest pressure

66 year old female CC: Chest pressure- Conclusion

63 year old male CC: Substernal chest pain (Guest Brooks Walsh)

63 year old male CC: Substernal chest pain- Discussion (Guest Brooks Walsh)

Acute anterior STEMI

82 year old male CC: Chest pain (bifascicular block RBBB/LAFB)

76 year old male CC: Shortness of breath while walking (early acute anterior STEMI)

What's the heart rhythm?

Found on the Lifenet Receiving Station

52 year old male CC: Syncope, chest pain

52 year old male CC: Syncope, chest pain – Update (angiograms)

82 year old female CC: "Flu-like" symptoms

54 year old male CC: Chest pain (unusual looking STEMI)

66 year old male CC: Chest pain (ST-elevation starts to resolve to arrival to the hospital)

66 year old male CC: Chest pain – Update (angiograms)

57 year old male CC: Chest pain

69 year old male CC: "Indigestion" (codes en route to the hospital)

54 year old male CC: Chest pain

54 year old male CC: Chest pain – Discussion

Elderly female: Chest Pain

Elderly female: Chest Pain-Discussion

41 year old female: Chest pain

Conclusion to 41 year old female: Chest pain

63 year old male: Chest Pain

Discussion to 63 year old male: Chest Pain–Wellens' Syndrome? Or something else…

58 year old female CC: Chest pain

58 year old female CC: Chest pain-Conclusion

77 year old female CC: Chest pain

77 year old female CC: Chest pain-Conclusion

71 year old male CC: Chest pain (antero-lateral)

71 year old male CC: Chest pain- Conclusion

81 year old male CC: Palpitations

Conclusion to 81 year old male CC: Palpitations (LVA vs STEMI)

51 year old female CC: Near syncopal episode

51 year old female CC: Near syncopal episode- Conclusion

62 year old male: Chest Discomfort

62 year old male: Chest Discomfort- Part II

62 year old male: Chest Discomfort- Conclusion

51 year old male: Chest Pain

Discussion for 51 year old male: Chest Pain

Semi-STEMI (borderline cases)

59 year old male CC: Chest discomfort (very subtle)

45 year old male CC: Chest pain (very subtle – patient left hospital AMA)

43 year old female CC: "Indigestion-like" chest discomfort

37 year old male CC: "Light-headedness"

37 year old male CC: "Light-headedness" – Discussion

53 year old male with a suspicious ECG

53 year old male with a suspicious ECG-Conclusion

55 year old male CC: Chest pain?

55 year old male CC: Chest pain?- Conclusion

53 year old male: Severe leg pain

53 year old male: Severe leg pain- Conclusion (Aortic dissection)

Snapshot: 64 year old male- Chest Pain

Snapshot Discussion: 64 year old male- Chest Pain

Identifying acute STEMI in the presence of LBBB or paced rhythm

80 year old male CC: Chest pain (*a Tom Bouthillet favorite)

Excessive discordance as a marker of acute STEMI in LBBB

80 year old male CC: Chest pain – Conclusion

58 year old female CC: Chest pain

58 year old female CC: Chest pain – Conclusion (meets all 3 of Sgarbossa's criteria)

62 year old male CC: Chest pain (LBBB with ST-elevation > 0.2 the QRS complex)

Identifying AMI in the presence of LBBB – Sgarbossa's Criteria Part I

Identifying AMI in the presence of LBBB – Sgarbossa's Criteria Part II

"New" LBBB – What's the big deal?

Discordant ST-segment elevation in LBBB or paced rhythm

Sgarbossa's Criteria – New Graphic

Found on the Lifenet Receiving Station (LBBB with concordant ST-depression in leads V3 and V4)

88 year old female CC: Chest pain

88 year old female CC: Chest pain-Conclusion

50 year old male CC: Chest Pain

50 year old male CC: Chest Pain-Discussion (unusual LBBB or IVCD)

An unusual case of left bundle branch block (60 year old male CC: shortness of breath)

An unusual case of left bundle branch block-Discussion

88 Year old male CC: Chest Pain

88 Year old male CC: Chest Pain-Conclusion(paced STEMI)

Left main coronary artery lesion/ subendocardial ischemia

63 year old male CC: Chest pain

63 year old male: "Dental Pain"

63 year old male: "Dental Pain"-Discussion

Wellens and Reperfusion T Waves

Name that ECG: 66 year old female

Name that ECG: 66 year old female- Findings

62 year old male: Chest discomfort- Conclusion

Pulmonary Embolus

56 year old female CC: Short of breath

56 year old female CC: Short of breath- Conclusion

Hyperkalemia and other Sodium Channel Blockades

29 year old female: Unresponsive

29 year old female: Unresponsive- Conclusion

Life-threatening hyperkalemia: do you recognize the ECG signs?

76 year old female CC: Diminished LOC

76 year old female CC: Diminished LOC- Discussion

HyperK and Shades of Grey: Myths and facts about Hyperkalemia Part I (Guest Brooks Walsh)

HyperK and Shades of Grey: Myths and facts about Hyperkalemia Part II (Guest Brooks Walsh)

49 year old male: Chest Pain

HyperK and Shades of Grey

Atrial fibrillation

35 year old male CC: Palpitations (Holiday Heart)

Brugada's

79 year old female CC: Unresponsive (final diagnosis was not verified)

Importance of serial 12-lead ECGs

The Only Constant is Change (review of Tim Phalen's article)

82 year old male CC: Chest pain

41 year old male CC: Chest pain

Found on the Lifenet Receiving Station

43 year old female CC: "Indigestion-like" chest discomfort

54 year old male CC: Chest pain (unusual looking STEMI)

57 year old male CC: Chest pain

54 year old male CC: Chest pain

54 year old male CC: Chest pain – Discussion

58 year old male CC: Chest discomfort

Elderly female: Chest Pain

Elderly female: Chest Pain-Discussion

41 year old female: Chest Pain

Conclusion to 41 year old female: Chest Pain

Implantable Medical Devices

Inappropriate or ineffective ICD shocks – Part I

Inappropriate or ineffective ICD shocks – Part II

Inappropriate or ineffective ICD shocks – Part III

81 year old female CC: ICD shocks x6

71 year old male CC: Seizures

Incredible video of soccer player saved by ICD (links to YouTube video)

Scientist shocked by ICD at Copenhagen summit (links to YouTube video)

Evaluating the pacemaker patient – Part I

94 year old male CC: Chest pain (perfectly normal looking paced rhythm)

A Change of Pace: What Happened?

Discussion for "A Change of Pace: What Happened?"

Transcutaneous pacing (TCP)

Transcutaneous pacing (TCP) – The problem of false capture

Transcutaneous pacing (TCP) with a Lifepak 12

Wide complex tachycardias

Differential diagnosis of wide complex tachycardias – Part I

Differential diagnosis of wide complex tachycardias – Part II

Differential diagnosis of wide complex tachycardias – Part III

Differential diagnosis of wide complex tachycardias – Part IV

Differential diagnosis of wide complex tachycardias – Part V

Differential diagnosis of wide complex tachycardias – Part VI

More on wide complex tachycardias

Should you ever give a calcium channel blocker to a wide complex tachycardia?

The Prehospital 12-Lead ECG blog receives its first hate mail

44 year old male CC: Palpitations

Stump the Experts – Case of the Tachy Trucker

78 year old male CC: "Chest heaviness"

78 year old male CC: "Chest heaviness" – Update

77 year old male CC: Palpitations

64 year old male CC: Chest pain

68 year old male CC: Chest pain

12 year old male CC: Palpitations

46 year old male CC: Chest pain (heart rate > 250)

90 year old female CC: Abdominal pain

79 year old male CC: Shortness of breath

90 year old male CC: Chest Discomfort

90 year old male CC: Chest Discomfort–Discussion

90 year old female CC: Seizure

90 year old female CC: Seizure- Conclusion

47 year old male CC: Crushing chest pain (V-Fib)

47 year old male CC: Crushing chest pain-Conclusion

60 year old male CC: "I don't feel well"

Discussion to 60 year old male CC: "I don't feel well"

74 year old female CC: Chest pain

74 year old female CC: Chest pain-Conclusion

85 year old female CC: Respiratory Distress

85 year old female CC: Respiratory Distress-Discussion

78 year old male CC: Dizziness

78 year old male CC: Dizziness-Conclusion

Snapshot: 32 year old male-Chest Discomfort

Snapshot Discussion: 32 year old male-Chest Discomfort

Name that ECG: 51 year old male

Name that ECG: 51 year old male- Findings

65 year old male CC: Fall with injury

65 year old male CC: Fall with injury- Conclusion

Narrow complex tachycardias

Narrow complex tachycardias – Part I

Narrow complex tachycardias – Part II

Narrow complex tachycardias – Part III

83 year old male CC: "Cardiac patient in distress"

83 year old male CC: "Cardiac patient in distress"-Conclusion

68 year old male CC: Chest Pain

68 year old male CC: Chest Pain-Conclusion

Atrial Flutter can cause false-positive ***acute MI suspected*** interpretive statements

The Trouble with Sinus Tachycardia

24 year old male: "Anxiety attack"

24 year old male: "Anxiety attack"- Conclusion

57 year old male: Chest Discomfort

57 year old male: Chest Discomfort- Conclusion (Flutter)

88 year old female: Weakness

88 year old female: Weakness- Discussion (Lewis Lead)

77 year old female: Unresponsive

77 year old female: Unresponsive- Discussion (Artifact)

52 year old male CC: Seizure

52 year old male CC: Seizure- Discussion

Bradycardias

81 year old female CC: Chest Pain

81 year old female CC: Chest Pain-Conclusion

89 year old female CC: Sick (3rd degree AV block, huge inverted T waves)

89 year old female CC: Sick-Discussion

82 year old male CC: Shortness of breath

82 year old male CC: Shortness of breath- Conclusion

Name that ECG: 88 year old male

Name that ECG: 88 year old male- Findings

Stump the Chumps: Atropine and Complete Heart Block

Stump the Chumps: Atropine and Compete Heart Block- Discussion

Pediatrics

17 year old male CC: Syncope

17 year old male CC: Syncope-Discussion

15 year old male CC: fall from vehicle

Part 1 of the Conclusion to 15 year old male CC: fall from vehicle

Part 2 of the Conclusion to 15 year old male CC: fall from vehicle

13 year old female CC: Syncope

13 year old female CC: Syncope- Discussion

Rhythm challenge

What's the heart rhythm?

Rhythm challenge #1

Rhythm challenge #2 (life-threatening hyperkalemia)

Rhythm challenge #3

Rhythm challenge #4

Rhythm challenge #4 – Discussion

ECG Challenge- Is it a STEMI?

Found on the LifeNet 5/2011

Second Degree or Third Degree Atrioventricular Block?

Found on the LifeNet 3/2011

Tweet about ECG leads to mystery- Is this a mimic or the real thing?

Is this a mimic or the real thing?- Discussion

Found on the LifeNet-January, 2011

Airway management

Prehospital advanced airway – should paramedics be intubating?

Patient Safety

Peter Pronovost – The Science of Safety

Man dies at home after paramedics diagnose acid reflux

Code STEMI Web TV Series

Code STEMI Web TV Series in South Dakota-That's a Wrap!

Code STEMI Web Series- EMS 12-Lead Podcast episode #6

Episode 2 of the Code STEMI Web Series-Race Program in North Carolina

Episode 3 of the Code STEMI Web Series- Dearborn, Michigan

Jamie Davis interviews Ted Setla about the Code STEMI Web Series at the EMS 10 Awards

Code STEMI Web Series- London to premier at EMSToday in Washington DC

Code STEMI- London Ambulance Service

Regional PCI for STEMI, and STEMI systems of care

If "Time is Muscle" What's Taking So Long? (review of David Jaslow, MD's article)

Prehospital 12-Lead ECG (review of supplement in JEMS magazine – July 2006)

Prehospital ECG Activation of the Cardiac Cath Lab (links to D2B Alliance webinar)

False positive cardiac cath lab activations (review of  “False-Positive” Cardiac Catheterization Laboratory Activation Among Patients With Suspected ST-Segment Elevation Myocardial Infarction, JAMA 2007;298(23):2754-2760)

Are you up for the E2B Challenge? (review of Ivan Rokos's article)

AHA Scientific Statement on Prehospital 12 Lead ECGs (review of Implementation and Integration of Prehospital ECGs Into Systems of Care for Acute Coronary Syndrome – published online ahead of print on August 13, 2008)

Drs. Jacobs and Gibson discuss AHA Mission: Lifeline (links to MD TV and TCT 2008)

ACC/AHA 2008 Statement on Performance Measurement and Reperfusion Therapy (review of same in J Am Coll Cardiol, 2008; 52:2100-2112)

Who receives the most benefit from reperfusion therapy? (based on data from thrombolytic trials)

Physio-Control – Voice of Life Saving (Tom discusses 12-leads and STEMI care with Physio-Control)

SC Chapter of AHA Mission: Lifeline (Tom praises the highly trained professionals involved with AHA Mission: Lifeline)

Angioplasty with Bezold-Jarisch reflex (links to BBC news story)

AHA Mission: Lifeline survey reveals problems

AHA Mission: Lifeline video

Dr. Rokos and Dr. Gibson discuss prehospital STEMI activation pathways (links to MD TV and video from LUMEN 2009)

Any delay in D2B time associated with increased mortality (review of Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: a national cohort study. BMJ 2009; 339:b1807)

Prehospital ECGs have big impact on door-to-balloon times

Chicago ambulances lack EKG machines

Congratulations to Dr. Michel LeMay (discusses Ottawa, Canada's regional STEMI program)

ACC/AHA focused update for STEMI and PCI

How to establish a multi-hospital STEMI transfer system (links to D2B Alliance webinar)

Review of Factors Associated With False-Positive Emergency Medical Services Triage for Percutaneous Coronary Intervention

AHA changes acceptable time to primary  PCI from 90 to 120 minutes for acute STEMI

10 Questions with Jodi Doering RN- South Dakota AHA Mission: Lifeline Director

Fun and games with response time reporting

Survivor gives us a lens into regional systems of care for acute ischemic stroke in North Dakota

The Importance of Data Collection

The importance of data collection and sharing

Cardiac arrest

The case for continuous chest compressions (review of Surviving Cardiac Arrest – Location, Location, Location – JAMA 2008; Vol 300, No. 12)

Time lapse video of heart in VF (video no longer active on YouTube due to a "terms of use" violation but this was the video they show in the LUCAS compression device presentation). The concept is discussed.

Agonal breathing predicts survival from cardiac arrest (review of Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation. Published online before print November 24, 2008)

Politics vs. Patient Care (links to Jeffrey Guy's ICU Rounds podcast about therapeutic hypothermia)

ECG Grand Rounds (contains an interesting ROSC case)

65 year old male CC: Cardiac arrest

No advantage seen with drugs in out-of-hospital cardiac arrest

Why you need to strengthen your community's chain-of-survival

Be the beat!

Cardiac arrest – are you ready to save one of our own?

57 year old male CC: Cardiac arrest

69 year old male CC: "Indigestion" (codes en route to the hospital)

60 year old male CC: Sudden cardiac arrest

Conclusion to 60 year old male CC: Sudden cardiac arrest

Sudden Cardiac Arrest podcasts from EMS Today 2011

Wake County EMS cardiac arrest survival rate among the highest in the country

High Performance CPR- Seattle Style!

91 year old female CC: Seizure (a strange situation)- Discussion

56 year old female with a "cardiac disorder"

Transcutaneous pacing (TCP) for asystole

the "pit crew" concept in cardiac arrest

63 year old male CC: Chest Pain

63 year old male CC: Chest Pain- Conclusion

Must-watch video of cardiac arrest save!

The "Save a Life" Simulator by the Heartrescue Project

Firefighter health and safety

Firefighter job stress and heart attacks

Cardiac arrest – are you ready to save one of our own?

The politics of transporting a patient in a fire engine

18 year old male: Structure Fire Rehab

18 year old male: Structure Fire Rehab-Conclusion

Cardiac-related medical devices

Philips introduces the HeartStart FR3 Defibrillator

EMS World Magazine names ReadyLink 12-Lead ECG by Physio-Control as one of the top innovations of the year

RescueNet 12-Lead by Zoll Medical Corporation at EMS World Expo 2011

ReadyLink 12-Lead ECG by Physio-Control (Update)

12-Lead ECG Challenge App now available for Android and Apple IOS

Physio-Control to launch ReadyLink 12-Lead ECG- New device will tie rural areas into reagional systems of care

New device allows you to assess BP with iPhone

AliveCor's iCard ECG for iPhone 3G, iPad, and Android

LifePak 12 Li-ion battery and Redi-Charge battery charger now available

Physio-Control and BeneChill enter strategic partnership to launch RhinoChill intranasal cooling system in Europe

Dick Cheney on his LVAD

iPhonECG turns the iPhone 4 into a cardiac event monitor

Physio-Control demos how to incorporate the LUCAS into a "pit crew" approach to resuscitation

Just for fun

Mad scientist teaching arrhythmias (YouTube video)

Fishin' with Fuzzy! (Tom takes the crew of Engine 6 out fishing with a legend)

What ever happened to good ol' Bretylium?

Watch your own heart attack (British PSA for heart attacks)

 

Infographics

New infographic: Left Anterior Fasicular Block (LAFB)

 

Everything else

Honoring our veterans

Merry Christmas!

FEMA Structural Collapse Technician Course

Horse and buggy to space shuttle! (Tom gets an iPhone)

Who knew that statcounter could be so entertaining?

Water spouts

Happy 4th of July weekend (my parents house on Lake Huron)

Social media and health care

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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