Tag Archives: ECG

Found on the LIFENET 05/2011

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Found on the LIFENET. What is your impression of this ECG?   *** UPDATE *** Consider this recent case from Dr. Smith's ECG Blog. ST-elevation in aVR, with widespread ST-depression "ST elevation in aVR is often thought to represent left main occlusion. However, it really just signifies widespread and diffuse subendocardial ischemia which could be […]

82 year old male CC: Shortness of breath – Conclusion

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This is the conclusion to 82 year old male CC: Shortness of breath. Let's take another look at the 12-lead ECG. This ECG shows a severe bradycardia. We need to ask a couple of very important questions. Is the patient stable or unstable? The patient is unstable. In fact, the patient is periarrest. We cannot […]

82 year old male CC: Shortness of breath

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Here's an interesting and somewhat unusual case submitted by a faithful reader who wishes to remain anonymous. EMS is called to the residence of a 82 year old male complaining of shortness of breath and weakness. On arrival the patient is found slumped sideways in a chair. He is weak and in significant distress, repeating, […]

88 year old female CC: Chest pain

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Here’s a really interesting ECG submitted by my good friend David Hildebrandt. EMS is called to an assisted living facility for an 88 year old female who is weak and complaining of chest pain. The patient is found lying on her side in bed. She appears acutely ill and states she is nauseated. She is […]

49 year old male CC: Chest pain

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From the archives. EMS is called to the vacation residence of a 49 year old male complaining of chest pain. On arrival the patient is found sitting at the kitchen table. He appears anxious and acutely ill. Past medical history: Healthy Meds: None Allergies: NKDA Skin is cool, pale and diaphoretic. He confirms that he […]

74 year old female CC: Chest pain

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Is there anything else you’d like to know about this patient?

50 year old male CC: Chest pain

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Here’s a really interesting case submitted by “Anonymous from Ann Arbor, Michigan.” Wolverines! Sorry, Buckeyes. EMS is called to the residence of a 59 year old male with a chief complaint of chest pain. Past medical history: Dyslipidemia Meds: Zocor The patient was given 600 mg ASA by the spouse prior to EMS arrival. Onset: […]

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 […]

85 year old female CC: Respiratory distress

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EMS is called to a local nursing home for a 85 year old female with a chief complaint of respiratory distress. On arrival the patient is found lying in bed in obvious distress. Respirations are 40 and shallow with a prolonged expiratory phase and accessory muscle usage. Auscultation of the chest reveals a poor tidal […]

78 year old male CC: Dizziness – Conclusion

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There were so many great comments on this case, including some great discussion on classifying wide complex tachycardias!

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation
Comments
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
The option was indeed turned on! As for non-CP presentations of ACS, I absolutely believe that these warrant the same level of urgency as the "typical" presentations. Both men and women, young and old, all commonly present without classic chest pain. Besides, how much difference is there between "burning in the epigastrium," and "pain in…
2014-08-21 17:10:37
Austin
“Bad heartburn” – 82 y.o. female without chest pain.
You took the words right off of my keyboard, Jason! A little bit of critical thinking works wonders when faced with "protocol versus best interests of the patient" type decisions. Not to encourage deviation from protocols and such, but it is a much less severe trespass if you bend the rules a bit as long…
2014-08-21 16:33:27
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
My uninformed opinion? I pretty much agree with AHA - if they aren't hypoxic, no need. I'm not sure how terrible superoxia really is, short-term, but why bother if it doesn't help?
2014-08-21 16:31:05
jason
“Bad heartburn” – 82 y.o. female without chest pain.
Chris Watford- as you probably know the "acute MI suspected" detection function in the LP12/15 is a programable option. I suspect the software didn't miss this but rather it wasn't turned on. As for treatment everyone has pretty much got it down. Finally as for activation. Absolutely! Don't real care if the protocol allows for…
2014-08-21 16:30:34
Austin
“Bad heartburn” – 82 y.o. female without chest pain.
There's not much I think I can add at this point, but I will comment on a couple of things. The reciprocal changes indicate to me that there is likely RCA involvement. Also, I've recently been hearing quite a bit about withholding O2 in ACS patients like this. Dr. Walsh, do you have any opinions…
2014-08-21 16:23:21

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