Tag Archives: inappropriate concordance

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 […]

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 […]

Found on the Lifenet Receiving Station

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Is there anything about this ECG (other than the poor data quality) that interests you? The patient was a 90 year old male, fall with injury. Also complaining of pain between the shoulder blades. *** UPDATE *** This ECG caught my eye because it satisfies one of Sgarbossa’s criteria for the identification of AMI in […]

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 […]

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Comments
jason
68 y.o. male with weakness: “Treat the monitor, not the patient?”
I'm with Dave Eastman on this. I think it's hyper K+ and will treat as such. But I'll do that will I head to the PCI capable facility. Do I think there is an underlying STEMI? Nope, I sure don't. Do I know the computer has a hard time with false positives? yup. Am I…
2014-09-28 22:15:54
Rodrigo Furtado
68 y.o. male with weakness: “Treat the monitor, not the patient?”
I did forget, is it possible pacer is placed??? sorry that went right over my head.
2014-09-28 20:38:19
Rodrigo Furtado
68 y.o. male with weakness: “Treat the monitor, not the patient?”
1) Change to every lead? STEMI is questionable on my Dx # 6 on a list of 5. IF my recall on this, IF a Global presentation of ST change with QRS Change: a) STEMI is extremely unlikely or NOT STEMI b) start looking for mechanical problems ( tamponade) or chemical/ electrical (electrolyte imbalance or…
2014-09-28 20:34:36
Dave Eastman
68 y.o. male with weakness: “Treat the monitor, not the patient?”
My first thought was hyperkalemia. If the pt is stable, begin with Ca++ & bicarb. Consider albuterol. Serial 12-leads. Start toward PCI capable facility. If it is hyperkalemia, initial treatment should begin to improve pt's condition and there is no harm caused from the increased transport time. If there is an underlying MI as well,…
2014-09-28 18:05:12
Lisa
68 y.o. male with weakness: “Treat the monitor, not the patient?”
Cath lab
2014-09-28 17:29:51

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