Tag Archives: bundle branch block

58 year old male CC: Chest pain

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Here’s an interesting case sent in by a faithful reader who wishes to remain anonymous. EMS is called to the residence of a 58 year old male complaining of chest discomfort. On arrival the patient is found sitting on the edge of the bed. He is anxious but alert and oriented to person, place, time, […]

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

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There has been a lot of discussion lately about identifying AMI in the presence of LBBB (see Dr. Bearemy’s “My Emergency Medicine Blog” here and a recent thread on the EKG Club). I’ve also been receiving a lot of emails offlist, so I think a full discussion is in order. In my recent post Who […]

Computerized interpretive statements and bundle branch blocks

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Here’s an ECG that I’ve used in my 12 lead class for many years. It’s usually good for a laugh! I show this ECG right after I teach students to identify LBBB on the 12 lead ECG. I explain that it was captured on an emergency call for a 80 year old male who was […]

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
James
59 Year Old Male: Unwell
This is a ugly EKG. Wide complex irregular tachycardia around 150's. A-fib and a-flutter are possibilities. He's severely symptomatic. At this point, all treatment is same, electricity. If A fib, it may not want to "shock out" easily. This may be a case where initial cardioversion at max joules would be prudent. Pulmonary edema likely…
2015-07-01 22:00:13
Bryan
59 Year Old Male: Unwell
Calcium has little to no side effects, given the first EKG I think it is reasonable to consider it for first line treatment. Repeat EKG after 5 mins and reassess.
2015-07-01 21:14:40
Mike MacKenzie
The Trouble with Sinus Tachycardia
An absolute must read for all Medics. Great article. I am always trying to tell students to consider referring to these fast rhythms as a narrow complex tachycardia, then start looking for the cause, be it physiologic response or an electrical conduction issue. And as many have stated, I often hear that it must be…
2015-07-01 20:11:34
Josh
59 Year Old Male: Unwell
Looks like anterior lateral STEMI with BBB. Possibly LAD infarct. Positive Avr indicative of a Proximal LAD. Clear elevation to high and low lateral leads. I, AVL, V3,4,5,6. Reciprocal inferior ST Depression in II, III and AvF. Tachycardia could be secondary to hypotension, anxiety, pain or tachyarrythmia caused by hypoxic excitation. Descernable P waves, ST…
2015-07-01 16:19:15
Todd Ellingson
59 Year Old Male: Unwell
Being irregular argues against VT, though first glance it does look like that. This is likely afib with aberrancy. One could consider WPW with afib with antidromic conduction down accessory pathway, however WPW is usually dx'd when someone is younger - unlikely to be 59 and not know this. Electrolytes, especially high K, is a…
2015-07-01 16:02:58

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