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. […]

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
Danny - EMT - Aide
68 y.o. male with weakness: “Treat the monitor, not the patient?”
JMJ Treat for hypokalemia: Advocate for ER to further evaluate Myotonic dystrophy(MD2) as symptoms closely match chief complaint. IV D5W KVO - slowly rehydrate to avoid aggravating preexisting CHF Closest facility Chief complaint weakness, and legs giving out. PT history. The list of medicines raised a red flag. HCTZ and furosemide used together can deplete…
2014-10-01 21:23:53
Bever
68 y.o. male with weakness: “Treat the monitor, not the patient?”
cardiomyopathy
2014-10-01 21:10:44
Harrison
68 y.o. male with weakness: “Treat the monitor, not the patient?”
Only mild weakness to bilateral legs points this case away from a neruo issue.
2014-10-01 20:52:06
Harrison
68 y.o. male with weakness: “Treat the monitor, not the patient?”
Potassium, not calcium That's my vote. I can't wait until 10 years from now when we will get something like POC blood testing in the rigs. Makes life much easier!
2014-10-01 20:51:27
UK Student Para
68 y.o. male with weakness: “Treat the monitor, not the patient?”
Am I really the only one considering CVA in my diffential diagnosis? Hx of AF puts the Pt at increased risk of a clot and Warfarin puts him at increased risk of a bleed. Where I come from we do not have a computerized rhythm interpretation on our ECG which I really like because it…
2014-10-01 07:36:14

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