Tag Archives: concordant ST-elevation

64 year old female CC: Trouble Breathing – Conclusion

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Lots of great comments and it was good to see the depth of discussion on the appropriate treatment and transport for this patient! This is the conclusion to 64 year old female CC: Trouble Breathing. When we left off our crew was attending to an elderly female patient in respiratory extremis. Pulmonary edema was present […]

88 year old female CC: Chest pain – Conclusion

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This is the conclusion to 88 year old male CC: Chest pain. Let's take another look at the 12-lead ECG. This ECG shows acute STEMI in the presence of left bundle branch block. It's also an excellent example of the value of using "excessive discordance" to identify acute STEMI in the presence of left bundle […]

58 year old female CC: Chest pain – Conclusion

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Here’s the conclusion to the 58 year old female with chest pain and left bundle branch block. To refresh your memory here is the 12-lead ECG. And for those of you who requested lead V4R. This ECG meets all 3 of Sgarbossa’s criteria to identify acute STEMI in the presence of left bundle branch block. Keep […]

58 year old female CC: Chest pain

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Here’s another case study from an international reader who wishes to remain anonymous. Presenting Complaint – Chest Pain History of Present Complaint – 58 year old female, nil cardiac history, mild smoker, social drinker and overweight. Complaining of acute central chest pain @ rest. Awoken by pain. On Arrival – Sat upright on settee (Editor’s […]

Sgarbossa's Criteria – New Graphic

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Here is a graphic I created to help explain Sgarbossa’s criteria for identifying acute myocardial infarction (AMI) in the presence of left bundle branch block (LBBB) or paced rhythm. In a previous article I showed this graphic which was created using PowerPoint. Here is a similar graphic I created this morning by cropping actual ECGs […]

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

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In Part I, we discussed Sgarbossa’s Criteria for identifying AMI in the presence of LBBB. We also talked about the “rule of appropriate T wave discordance” for bundle branch blocks and other forms of abnormal depolarization (like ventricular rhythms or paced rhythms). You will recall that I drew a distinction between a QRS complex’s main […]

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 […]

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Vince DiGiulio
Transcutaneous Pacing Success!!! Part 2
Thanks! I've yet to have a chance to check heart tones during TCP but I'll try to make it a priority next time to see how well it works for me.
2015-03-30 04:37:42
Snapshot Case: 85yo M – Chest Pain | EMS 12 Lead
Conclusion to Snapshot Case: 85yo M – Chest Pain
[…] UPDATE: Conclusion to this case. […]
2015-03-29 19:54:59
Jake
47 year old male CC: Crushing chest pain
I know this is old, but it just popped up on facebook so I'll go ahead and put in my $0.02 worth. With that hx and that 12-lead, there's no question this is an acute STEMI. I'm comfortable calling that third strip Torsades (assuming I've verified it's not an equipment issue). The defib pads are…
2015-03-24 14:14:19
Ngan Thanh
17 year old male CC: Syncope
I thinks about WPWs on ECG!
2015-03-21 23:27:41
bob
Adenosine for sinus tachycardia: Try to avoid this!
I have a better answer for Shay's patient (and Mel) and it's called lone a-flutter because I just had it diagnosed in me. I'm looking at my ekg showing a rate of 230 which fooled the doc who thought it was svt's until I told him I had no history of anything and talked him…
2015-03-21 21:57:17

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