Tag Archives: lead placement

Comparing 12-Leads: Discussion

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This is the discussion for Comparing 12-Leads: Common Error or Common Disease? All of our readers were on the right track, and many were spot on! Sometimes, troubleshooting an ECG is more than just lead placement. In this case report, we had three 12-Lead ECG's, all featuring a similar pattern: inappropriate R-wave progression. Initially, when […]

23 year old male CC: Chest Pain

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Here’s a fascinating case submitted by Geoff Dayne. EMS is called to a VA clinic for a 23 year old male who came in to get checked into the system. Somewhere in the exchange, he mentioned that he had been experiencing chest pain off & on for just over a month. Onset: Today’s pain came […]

72 year old male CC: "Unknown problem" – Conclusion

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Here is the conclusion to 72 year old male CC: Unknown problem (man down) Here was the initial 12-lead ECG.   Based on this ECG the lead paramedic called a "STEMI Alert" and transmitted the ECG to the receiving hospital. The on-duty ED physician received the ECG and the paramedic's radio report. The ED physician […]

72 year old male CC: "Unknown problem"

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EMS is dispatched to a 72 year old male patient. Third party call. History of Parkinson's Disease. Patient is conscious. No further information. On arrival, EMS finds a 72 year old Spanish-speaking male. Through an interpreter the lead paramedic determines that the patient became dizzy, fell down, and hit his head. A small hematoma is […]

Data quality, lead placement, your patient's dignity, and undressing female patients

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I thought long and hard about allowing anonymous comments on the PH12ECG blog. In my experience, anonymous posters don’t exercise the same level of responsibility as posters who use their real names or blogger identities. Anonymous posters are often bomb throwers. Or, they engage in proselytizing, propagandizing, sensationalizing, or advertising. For them, there are no […]

Contiguous and reciprocal lead charts

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Here are some charts to help you identify and localize acute STEMI on the 12 lead ECG. Contiguous leads What do we mean when we say leads are “contiguous”? Contiguous leads are “next” to one another anatomically speaking. They view the same general area of the heart (specifically the left ventricle). For example, these states […]

12 Lead ECG – Lead Placement Diagrams

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On October 15, 2008, Lynne left me this comment: I’m an EMT-B that just found your blog. My agency allows EMT-Bs to perform 12-leads prehospital, so that doctors and paramedics at the hospital have a printout to look at. Also, if our monitor sees an Acute MI or something critical going on with the heart, […]

Muscle Tremors, Your Patient's Dignity, and Staying Organized

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The importance of good data quality to a successful prehospital 12 lead ECG program cannot be overemphasized. After all, life and death decisions are made based on the 12 lead ECG. If an EMS system routinely transmits garbage to the emergency department, it should come as no surprise to anyone that the cath lab isn’t […]

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Anthony Garlick
68 y.o. male with weakness: “Treat the monitor, not the patient?”
So my working clinical impression would be hypoglycaemia with possibly dehydration and an electrolyte imbalance. Reasoning for this is that the patient frusemide and metolazone are both diuretics are known to cause these problems. ECG does have a wide and bazar QRS complex with ? ? AV disassociation plus what looks to be peaked T…
2014-09-30 22:22:35
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

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