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
Matt King
Snapshot Case: What Happened?
Also I would be moving the combo pads around after the first unsuccessful shock to try and find the ectopic foci.
2015-05-29 10:57:55
Matt King
Snapshot Case: What Happened?
Nice case and strong work, but this is why I shock everything in an adult at 200J with a bi-phasic monitor. I would not do this if this was a pediatric PT. If the first shock at say 50-70j is not enough then that means you're just going to have to shock again and submit…
2015-05-29 10:56:24
Steve Pike
Snapshot Case: What Happened?
Thus is the story with elective electrocution. If it works, it's medicine, if it doesn't, it's murder. Every shock shown was indicated, if you don't count the first one.
2015-05-28 22:49:42
Glenda
Snapshot Case: What Happened?
torsades des pointes! Electrolytes??
2015-05-28 16:56:49
Olivier
Snapshot Case: What Happened?
To support Donovan's analysis, QRS are remarkably thin and eventually consistent with paediatric findings. However, as noted, atrial fibrillation in very young patients are quite rare.
2015-05-28 07:36:54

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