Tag Archives: appropriate T-wave discordance

Revisiting Transcutaneous Cardiac Pacing

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“Transcutaneous cardiac pacing is an effective procedure for patients experiencing unstable bradycardia.” Or is it? If you’ve read Tom’s introduction to the subject of false capture you’re already ahead of the game. We’ve shown case after case of unstable bradycardia patients receiving ineffective transcutaneous pacing due to a lack of capture. In each case, phantom pacing impulses […]

Discussion for 70 Year Old Male: Short of Breath

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This is the discussion for “70 Year Old Male: Short of Breath“. Tough case. Lots of excellent comments and observations from our readers. Right off the bat, the patient’s presentation offered a major distraction: the recent eye surgery resulting in the old “eye patch presentation”. Confounding the situation further was the lack of any cardiac […]

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 […]

63 Year Old Male: "Dental Pain" — Discussion

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This is the discussion to "63 year old male: "Dental Pain". You may wish to review the case. For starters, i think we all agree that the patient, with his signs and symptoms, needs to be transported. We have all had patients like this who don't want to go, even though we know they should. […]

64 year old female CC: Trouble Breathing – Conclusion

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Lots of great comments and it was good to see the depth of discussion on the appropriate treatment and transport for this patient! This is the conclusion to 64 year old female CC: Trouble Breathing. When we left off our crew was attending to an elderly female patient in respiratory extremis. Pulmonary edema was present […]

80 year old male CC: Chest pain – Conclusion

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This is Part II of the conclusion to 80 year old male CC: Chest pain. For Part I see Excessive discordance as a marker of acute STEMI in LBBB. First, let's take another look at the initial 12-lead ECG. The first thing that catches my eye in this ECG is the strange morphology of the ST-segments […]

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.

80 year old male CC: Chest pain

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Here’s a case submitted by a faithful reader who wishes to remain anonymous. It’s a great case and destined to be one of my favorites! EMS is called to evaluate a 80 year old male patient with a chief complaint of chest pain. On arrival the patient is found sitting on his living room couch. […]

58 year old female CC: Chest pain – Conclusion

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Here’s the conclusion to the 58 year old female with chest pain and left bundle branch block. To refresh your memory here is the 12-lead ECG. And for those of you who requested lead V4R. This ECG meets all 3 of Sgarbossa’s criteria to identify acute STEMI in the presence of left bundle branch block. Keep […]

58 year old female CC: Chest pain

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Here’s another case study from an international reader who wishes to remain anonymous. Presenting Complaint – Chest Pain History of Present Complaint – 58 year old female, nil cardiac history, mild smoker, social drinker and overweight. Complaining of acute central chest pain @ rest. Awoken by pain. On Arrival – Sat upright on settee (Editor’s […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
darren
53 year old male with a suspicious ECG
1st degree AV block. Left Anterior Hemiblock (rS waves in II, III and aVF, Left Axis Deviation -45 degrees QRS < 0.12). ST-changes I and aVL (concave rather than convex but suggestive of possible high lateral injury). Requires cardiologist referral.
2015-03-05 12:52:44
William Dillon
60 year old male CC: Sudden cardiac arrest
Great case but it stopped short. It should continue. The patient was transferred to an experienced PCI center. Focused medical evaluation was performed in the ED and emergent cardiology consultation was obtained. Although there is not clear ST elevation on the 12 lead the interventional cardiologist knows the data that over 70% of VF cardiac…
2015-03-03 12:53:20
Sharon Sinclair
The 12 Leads of Christmas: V3
As a technician, I absolutely love how comprehensive these posts are. Although I do not have the advanced knowledge or understanding of a licensed provider, I try to absorb as much as I can from posts like these. Maybe one day I will muster the courage to transition to a more advanced position in cardiac…
2015-02-28 20:40:17
A visit to Johns Hopkins #EMSToday2015 | EMS 12 Lead
Episode #11 – Are we harming patients with oxygen?
[…] might remember Mike from one of our most popular EMS 12-Lead podcasts Episode #11: Are we harming patients with oxygen? We finished up the night with food and adult beverages in the […]
2015-02-25 14:33:03
Rollo
The Trouble with Sinus Tachycardia
Had a pt today with a rate @ and around 160, it was indeed sinus tachycardia. The tachycardia was secondary to a stimulant which caused over stimulation of sympathetic nervous system ie sympathomimetic O.D. The treatment was fluid and a benzo. Problem solved.
2015-02-25 00:14:18

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