Search Results for: anterior MI

Left ventricular aneurysm vs. acute anterior STEMI

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Some of you expressed concerns about the possibility of the ECG abnormality we sometimes refer to as left ventricular aneurysm (persistent ST-elevation after previous MI).

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

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As many of you pointed out, the history and clinical presentation isn’t exactly screaming “Acute Coronary Syndrome!”

Anterior T wave inversions and PE.

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Last week, I described the case of a middle-aged male with a vague history of heart failure who had been having progressive shortness of breath for 4-5 days. On the day he called 911, he had been walking a short distance when he syncoped. EMS obtained an ECG: Compared with the prior ECG, the anterior […]

Conclusion: 53 YOF with AMS: STEMI or Secondary ST-T changes?

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This is the conclusion to the previous case: 53 YOF with AMS: STEMI or Secondary ST-T changes? This female presented to the ED with Altered Mental Status (AMS), via ambulance, as STEMI ALERT, after completing approximately 3 hours of her usual dialysis. This was the 12 lead ECG provided by EMS…   We have a […]

QRS AXIS DETERMINATION

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During ECG interpretation, cardiac¬†Axis, or direction of electrical impulses, may be normal (physiologic) or abnormal (pathologic), suggesting abnormal cardiac conductivity. Although every deflection obtained on the ECG will have an axis, we will focus on the ventricular axis. When we think of our cardiac monitoring lead placement, we have to understand cardiac¬†Vectors, which is the […]

RBBB Abnormalities Missed

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The original presentation of this case appeared as  "What's Wrong with Mr. Wilson?"… You can read the original post here. Much has been written lately about RBBB abnormalities that were missed.  Dr. Smith has recently posted two cases here, and here discussing this. First, let's review the 12 lead of a typical RBBB. When learning […]

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

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Thanks to Ivan Rokos, M.D. for pointing out an important change in the 2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention. Photo credit: Code STEMI Web Series at First Responders Network For years now many have complained about the AHA's official recommendation that primary PCI for acute STEMI be accomplished within 90 minutes of first medical […]

Excessive discordance as a marker of acute STEMI in LBBB

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Positively deflected QRS complexes can be expected to show ST-depression and inverted T-waves.

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" […]

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 […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Matt King
Snapshot Case: What Happened?
Also I would be moving the combo pads around after the first unsuccessful shock to try and find the ectopic foci.
2015-05-29 10:57:55
Matt King
Snapshot Case: What Happened?
Nice case and strong work, but this is why I shock everything in an adult at 200J with a bi-phasic monitor. I would not do this if this was a pediatric PT. If the first shock at say 50-70j is not enough then that means you're just going to have to shock again and submit…
2015-05-29 10:56:24
Steve Pike
Snapshot Case: What Happened?
Thus is the story with elective electrocution. If it works, it's medicine, if it doesn't, it's murder. Every shock shown was indicated, if you don't count the first one.
2015-05-28 22:49:42
Glenda
Snapshot Case: What Happened?
torsades des pointes! Electrolytes??
2015-05-28 16:56:49
Olivier
Snapshot Case: What Happened?
To support Donovan's analysis, QRS are remarkably thin and eventually consistent with paediatric findings. However, as noted, atrial fibrillation in very young patients are quite rare.
2015-05-28 07:36:54

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