Tag Archives: Dr. Smith’s ECG Blog

The early repolarization experiment

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Any paramedic who has studied the STEMI mimics has heard of the classic benign early repolarization pattern of a "fish-hooked" J-point with upwardly concave (smiley-faced) ST-segment, often best appreciated in lead V4. But, as the excellent work of Stephen Smith, M.D. demonstrates, not all cases of early repolarization present this way, and it can often […]

Left ventricular aneurysm vs. acute anterior STEMI

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Some of you expressed concerns about the possibility of the ECG abnormality we sometimes refer to as left ventricular aneurysm (persistent ST-elevation after previous MI).

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.

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 […]

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
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
Jessica
68 y.o. male with weakness: “Treat the monitor, not the patient?”
the bizzare complexes coupled with the fact that the patient takes a potassium sparing diuretic make me think hyperkalemia
2015-04-29 12:31:37

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