Tag Archives: modified chest leads

Modified Chest Leads (was: Modified Leads "On the Ice")

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Occasionally I receive emails from readers who ask various questions or submit interesting ECGs which I sometimes use as case studies on the Prehospital 12-Lead ECG blog. Back in November I received an email from a reader who wrote: Hello! I’m currently in Antarctica on a medical support contract. I was issued a 3-lead Lifepak […]

50 year old male CC: Respiratory distress, chest pain

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EMS is dispatched to a 50 year old male in respiratory distress. En route, dispatch advises that the chief complaint is actually chest pain. On arrival, the patient is found lying supine on the floor just inside the front door to his house. He is cold to the touch and pale but his skin is […]

62 year old male CC: chest discomfort

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EMS is dispatched to a 62 year old male with a chief complaint of chest discomfort. On arrival, the patient is found sitting at the dinner table. He appears acutely ill. Onset: Fairly sudden after sitting down for dinner 20-30 minutes ago Provoke: Nothing makes the pain feel better or worse Quality: Dull pressure/ache Radiation: […]

Right ventricular infarction – Part III

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Let’s take a look at another case. This was one of the first ECGs ever transmitted to my local receiving hospital on the Lifenet Receiving Station. It was definitely the first STEMI. The data quality of the first 12 lead ECG wasn’t the greatest. This is the second ECG, with lead V4 in the position […]

Right ventricular infarction – Part II

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Let’s look at a case study that demonstrates the potential danger associated with right ventricular infarction. EMS is called to the residence of a 68 year old female with chest pain. On arrival, the patient is anxious, cool, pale, and diaphoretic. Vital signs are assessed. Resp: 20 Pulse: 68 BP: 105/55 SpO2 95 on RA […]

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, […]

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Brian Brubaker
59 Year Old Male: Unwell
At a quick glance it looks like tombstones (R on T). At closer look without calipers, it appears to be accelerated ideoventricular rhythm due to complete heart block. Not enough information to go off of, so cardioverting or pacing might just kill the patient quicker than anything. Transport immediately since his sick heart could stop…
2015-07-02 05:49:02
Holden
59 Year Old Male: Unwell
I've only studied cardiology for a few months and have read Dubin's book 1.5 times so I'm not an expert by any means. However, can a possible interpretation be a junctional tachycardia with aberrant ventricular conduction and a STEMI? No P waves and aberrancy causing a slightly wide QRS (but not wide enough for V-Tach).
2015-07-02 00:50:22
James
59 Year Old Male: Unwell
This is a ugly EKG. Wide complex irregular tachycardia around 150's. A-fib and a-flutter are possibilities. He's severely symptomatic. At this point, all treatment is same, electricity. If A fib, it may not want to "shock out" easily. This may be a case where initial cardioversion at max joules would be prudent. Pulmonary edema likely…
2015-07-01 22:00:13
Bryan
59 Year Old Male: Unwell
Calcium has little to no side effects, given the first EKG I think it is reasonable to consider it for first line treatment. Repeat EKG after 5 mins and reassess.
2015-07-01 21:14:40
Mike MacKenzie
The Trouble with Sinus Tachycardia
An absolute must read for all Medics. Great article. I am always trying to tell students to consider referring to these fast rhythms as a narrow complex tachycardia, then start looking for the cause, be it physiologic response or an electrical conduction issue. And as many have stated, I often hear that it must be…
2015-07-01 20:11:34

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