Tag Archives: discordant 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 […]

85 year old female CC: Respiratory distress – Discussion

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This is the follow-up and discussion for 85 year old female CC: Respiratory distress. As usual, thank you for all the insightful comments! The case demonstrates some very important points not the least of which is that the differential diagnosis of shortness of breath can be difficult, even for emergency physicians who have access to […]

80 year old male CC: Chest pain – Conclusion

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This is Part II of the conclusion to 80 year old male CC: Chest pain. For Part I see Excessive discordance as a marker of acute STEMI in LBBB. First, let's take another look at the initial 12-lead ECG. The first thing that catches my eye in this ECG is the strange morphology of the ST-segments […]

Excessive discordance as a marker of acute STEMI in LBBB

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Positively deflected QRS complexes can be expected to show ST-depression and inverted T-waves.

80 year old male CC: Chest pain

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Here’s a case submitted by a faithful reader who wishes to remain anonymous. It’s a great case and destined to be one of my favorites! EMS is called to evaluate a 80 year old male patient with a chief complaint of chest pain. On arrival the patient is found sitting on his living room couch. […]

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 […]

62 year old male CC: Chest pain

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62 year old male presents to the emergency department complaining of chest discomfort. Past medical history is significant for dyslipidemia and ulcerative colitis. Also prior history of significant tobacco use. Maternal history of CAD. Maternal and paternal history of stroke. The patient’s only medication is Lipitor but he took an aspinin en route to the […]

Discordant ST-Segment Elevation in LBBB or Paced Rhythm

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If you’ve been following the Prehospital 12-Lead ECG blog for a while, you know that I’m advocate of using Sgarbossa’s criteria to help identify acute STEMI in the presence of left bundle branch block (LBBB) or paced rhythm. According the Sgarbossa’s original criteria, 5 mm of discordant ST-segment elevation is required to identify AMI in […]

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 […]

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Proficiency vs Deficiency… The Art Of Electrocardiography | EMS 12 Lead
Understanding Amiodarone
[…] on the highlighted title for an Amiodarone breakdown, UNDERSTANDING AMIODARONE   One tool I use in these cases of bradycardia, is SPo2 monitoring. Remember, with every systole […]
2015-05-22 16:59:43
Wayne
12 Lead ECG – Lead Placement Diagrams
I have been doing EKG's for the past thirty years. It use to be that you always lay the patient in the supine position but here lately I have been told that with the patient sitting up right will not change the EKG, is this so ?
2015-05-21 17:37:37
Ivan Rios
Understanding Atropine
Hi Tony, thank you for writing. It's always a bit of a gamble to give opinion in such topics without being there, however, addressing ventilation is a must. The rate could be secondary to vagal stimulation and/or respiratory depression, but it sounds like the patient is compensating pretty well when it comes to the hemodynamic…
2015-05-21 12:55:43
Tony Correia
Understanding Atropine
Looking for an opinion. Had a pt. who was unconscious from unknown etiology, Agonal respiration = 6, SPO2 = 59, heart rate =37 sinus bradycardia, B/P = 137/80 . We ventilate the pt. approx for 2 minutes without change in status. Would you have administered atropine or continue with BVM to attempt to correct hypoxia,…
2015-05-21 12:16:26
dan
57 year old male: Chest Discomfort
I'm sorry but I don't see any flutter here. With a rate of 150 we are at the very upper limit of sinus tach. No O2 is indicated with a pulse ox of 94%, especially if you are thinking cardiac. Place in position of comfort, large bore IV, fluid bolus, ASA, nitro, capnography, complete assessment…
2015-05-14 03:50:36

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