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
Comments
Jewel
53 Year Old Male: Severe Leg Pain
Hmm it appears like your site ate my first comment (it was extremely long) so I guess I'll just sum it up what I wrote and say, I'm thoroughly enjoying your blog. I as well am an aspiring blog writer but I'm still new to the whole thing. Do you have any helpful hints for…
2014-08-31 17:51:28
David Baumrind
All that wiggles isn’t Wellens’
@Gary, by all means, nitpick all you like. I agree with your assessment, and the post has been modified. Thank you for the feedback!
2014-08-30 17:28:16
Gary Huntress
All that wiggles isn’t Wellens’
Not to nitpick but is this really a "slightly leftward axis"? I and AVF are both positive. I put it at about +20 degrees, not leftward.
2014-08-30 11:49:35
Handsome Robb
87 YOM COMPLAINING OF CHEST DISCOMFORT AND DYSPNEA
CHF. 12-lead shows a sinus Tachycardia in the 120s with PACs, besides the anterior leads there's diffuse ST depression, the STE in the anterior leads can be explained by the LBBB, axis is good as well. I wish they posted the EtCO2 waveform so we could see but I'm assuming it's non-obstructive. The elevated EtCO2…
2014-08-30 08:08:22
Christopher Watford
“Bad heartburn” – 82 y.o. female without chest pain.
Brooks, Firstly, thank you for the warm welcome to the club. Secondly, the Glasgow algorithm's only published sens/spec for AMI is 51.6%/97.6% respectively (Tuscon STEMI Database). I've not been able to find any other publications. The GE Marquette 12SL algorithm has been widely studied, but is much older, and ranges in sensitivity from 48% to…
2014-08-29 16:50:14

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