Tag Archives: benign early repolarization

The early repolarization experiment

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Any paramedic who has studied the STEMI mimics has heard of the classic benign early repolarization pattern of a "fish-hooked" J-point with upwardly concave (smiley-faced) ST-segment, often best appreciated in lead V4. But, as the excellent work of Stephen Smith, M.D. demonstrates, not all cases of early repolarization present this way, and it can often […]

50 year old male CC: Chest Pressure – Discussion

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This is the discussion for 50 year old male CC: Chest Pressure. We could not have been happier at the number of insightful comments we received on this case! Many of you caught on to our purpose for this case as we could not have picked a better borderline example! When we last left our […]

53 year old male with a suspicious ECG – Conclusion

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This one was really challenging because we all know that reciprocal changes are strongly supportive of acute STEMI.

Is this a mimic or the real thing? – Discussion

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This is the follow-up discussion to: Tweet about ECG leads to mystery – is this a mimic or the real thing? Let’s take another look at the 12-lead ECG. This is a very suspicious ECG and must be considered acute inferior STEMI until proven otherwise. This was my initial gut feeling about this ECG and […]

Early Bird Gets the Worm – Conclusion

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The conclusion to the November 2010 EMS 12-Lead column Early Bird Gets the Worm is now posted at EMS1.com. Early Bird Gets the Worm: Patient Follow-Up You can become a fan of EMS1.com on Facebook by clicking HERE.

63 year old male CC: Syncope – Conclusion

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Here is the conlcusion to 63 year old male CC: Syncope. First, let’s take another look at the 12-lead ECG. This 12-lead ECG shows poor data quality. This is a problem because the ECG is abnormal and suspicious for acute anterior STEMI. We need to consider whether or not this could be benign early repolarization […]

47 year old female CC: Chest pain – Discussion

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Thanks for all the comments! I’m not allowed to blog while I’m on duty (the policy has nothing to do with me personally) so if it seems like I’m not responding, I’m probably just at work. The paramedic who submitted this case has requested the follow-up information from his supervisor, but unfortunately she’s out-of-town for […]

23 year old male CC: Chest Pain

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Here’s a fascinating case submitted by Geoff Dayne. EMS is called to a VA clinic for a 23 year old male who came in to get checked into the system. Somewhere in the exchange, he mentioned that he had been experiencing chest pain off & on for just over a month. Onset: Today’s pain came […]

41 year old male CC: Chest pain

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41 year old male complaining of chest discomfort. The patient has had similar episodes before (after exertion), but in the past it always cleared up after use of an asthma inhaler. EMS finds the patient sitting in a chair. He had just taken a shower, with no relief of the chest discomfort. He describes the […]

The problem of ST segment elevation

The criterion seems quite simple. In the absence of contraindications, reperfusion therapy should be administered to patients with symptom onset within the prior 12 hours and ST elevation greater than 0.1 mV (1 mm) in at least 2 contiguous precordial leads or at least 2 adjacent limb leads, or new or presumably new LBBB on […]

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
know it all parapup
83 Year Old Male: Shortness of Breath
@ Kyle I would question your authority to call out people for not having a license or being a know it all parapup when your tx basically entails "call medical control." I think we can both agree that his cardiac output is not great at all. I assume your reluctance to give him any other…
2014-10-30 20:26:11
Kyle
83 Year Old Male: Shortness of Breath
Well st elevation in avr and v1 associated with anterior and lateral depression would call for possible posterior wall MI. 15 lead would be in order. Also check all the leads for appropriate placing. If v7, v8, and v9 show the elevation i would treat as a STEMI per my protocol. Asprin only until medical…
2014-10-30 18:14:05
Tim
The most awesome STEMI test on the internet!
Thanks for the app. It made me think about all that one may see in the field. The only problem was I never got a score or saw the results of how I did other than saying I had completed the test. Anyway a great way to get the old brain working.
2014-10-30 13:14:27
Brian
83 Year Old Male: Shortness of Breath
I mostly agree with dustin. I believe this is may be an isolated posterior MI. The R wave in V2 points to it being a posterior MI. otherwise it is a 1st degree av block with a LAHB. I am somewhat concerned with the concordant t segment depression noted and in fact if you were…
2014-10-30 04:22:44
Karl Brennan
Understanding Amiodarone
Great article , however in VF caused by hyperkalemia it should be avoided along with lidocaine , Since it shuts down the K channels, the eiteiology of the arrest hyper K, K channels are needed to exchange K in the cell. Calcium , Bicarbonate, dextrose and insulin should be used to decrease K levels along…
2014-10-30 03:04:45

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