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
Comments
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
CB
57 Year Old Male–Chest Discomfort
Given what he was doing (paint fumes on ladder painting) I would first question if the pain is reproducable. Yes his ekg isn't normal but looks like old inferior MI. And he is hypertensive. 02 a must. Def. would give ASA. First would give morphine and see how his cp and bp are. If still…
2014-08-29 11:37:25

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