Tag Archives: concave up

Conclusion to Snapshot Case: 44 Year Old Male – Chest Tightness

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This is the conclusion to the Snapshot Case located here. You may want to review the initial description again. As many readers correctly pointed out, this patient is experiencing a STEMI. Let's start with the basics and work our way up to some pretty advanced topics. First, there is anterior ST-elevation with upwardly-concave T-waves, as […]

Snapshot Case: 44 Year Old Male – Chest Tightness

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Here's a new "Snapshot" case courtesy of Dr. Bojana Uzelac from Serbia… A 44 year old male presents with a chief complaint of tightness in his chest x 1 hour. He was on his way to a conference when it started and states: "It feels kind of like asthma. I've never been diagnosed but I […]

ST segment morphology

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In a previous post, we discussed the problem of ST segment elevation. Because acute myocardial infarction (STEMI) is not the most common cause of ST segment elevation in chest pain patients, we need to consider other factors like reciprocal changes to shore up the diagnosis. It’s also a good idea to be well versed in […]

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Anthony Garlick
68 y.o. male with weakness: “Treat the monitor, not the patient?”
So my working clinical impression would be hypoglycaemia with possibly dehydration and an electrolyte imbalance. Reasoning for this is that the patient frusemide and metolazone are both diuretics are known to cause these problems. ECG does have a wide and bazar QRS complex with ? ? AV disassociation plus what looks to be peaked T…
2014-09-30 22:22:35
jason
68 y.o. male with weakness: “Treat the monitor, not the patient?”
I'm with Dave Eastman on this. I think it's hyper K+ and will treat as such. But I'll do that will I head to the PCI capable facility. Do I think there is an underlying STEMI? Nope, I sure don't. Do I know the computer has a hard time with false positives? yup. Am I…
2014-09-28 22:15:54
Rodrigo Furtado
68 y.o. male with weakness: “Treat the monitor, not the patient?”
I did forget, is it possible pacer is placed??? sorry that went right over my head.
2014-09-28 20:38:19
Rodrigo Furtado
68 y.o. male with weakness: “Treat the monitor, not the patient?”
1) Change to every lead? STEMI is questionable on my Dx # 6 on a list of 5. IF my recall on this, IF a Global presentation of ST change with QRS Change: a) STEMI is extremely unlikely or NOT STEMI b) start looking for mechanical problems ( tamponade) or chemical/ electrical (electrolyte imbalance or…
2014-09-28 20:34:36
Dave Eastman
68 y.o. male with weakness: “Treat the monitor, not the patient?”
My first thought was hyperkalemia. If the pt is stable, begin with Ca++ & bicarb. Consider albuterol. Serial 12-leads. Start toward PCI capable facility. If it is hyperkalemia, initial treatment should begin to improve pt's condition and there is no harm caused from the increased transport time. If there is an underlying MI as well,…
2014-09-28 18:05:12

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