Tag Archives: posterior STEMI

2013 STEMI Guidelines: EMS is Accountable

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On Monday, the American College of Cardiology Foundation and the American Heart Association released the 2013 Guidelines for the Management of ST-Elevation Myocardial Infarction. Their last updates to these guidelines were in 2004 and 2006, so this is an important milestone. If you have been following our blog and podcast, most of the changes will […]

63 year old male CC: Substernal Chest Pain – Discussion

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This is the discussion for 63 year old male CC: Substernal Chest Pain, brought to you by Dr. Brooks Walsh of Mill Hill Avenue Command and Doc Cottle's Desk. Be sure to review the first part! When we last left off, our patient was a 63 year old male complaining of substernal chest pain which awoke […]

Discussion for 58 year old male CC: Epigastric pain

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This is the discussion for our "Snapshot" case, 58 year old male CC: Epigastric pain. You may wish to review the case before continuing. Thanks to all of you, we had a lot of great comments! Many of you had wished we had a rhythm strip to analyze… keep in mind, this 12 lead is a […]

66 year old female CC: Chest pressure – Conclusion

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This is the conclusion to 66 year old female CC: Chest pressure. Let’s take another look at the 12-lead ECG. Let’s break this down 3 leads at a time starting with leads I, II and III. When you have artifact in a particular cardiac cycle you need to make a conscious effort not to let […]

66 year old male with chest pain and acute STEMI identified with serial ECGs

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Here’s a great case submitted by Nick Ciaravella of Grady EMS in Atlanta, GA. 66 year old male presents to EMS with chest pain. SAMPLE history S – Chest Pain A – None M – Atenolol, HCTZ P – Hypertension L – meal, 7 hours prior to event E – Mowing his lawn OPQRST O – Started […]

Right ventricular hypertrophy vs. isolated posterior STEMI

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A reader of the Prehospital 12-Lead ECG blog asks, “How can you tell the difference (based on ECG criteria alone) between right ventricular hypertrophy and acute isolated posterior STEMI?” Well, the good news is you don’t have to tell “based on ECG criteria alone” and I’m sure all of my regular readers know that I […]

26 year old male with chest pain and acute isolated posterior STEMI

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Here’s an interesting case submitted by a faithful reader who wishes to remain anonymous. EMS is called to a 26 year old male complaining of chest pain. On arrival patient is found sitting on his living room couch. He appears anxious and acutely ill. The location of the chest discomfort is in the center of […]

Respiratory distress, chest pain, right bundle branch block, and posterior STEMI

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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 […]

The Transition, R-Wave Progression, R/S Ratio in Leads V1-V2

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We covered the first 6 leads of the 12 lead ECG in the 6-part tutorial on axis determination, so it’s time to discuss the precordial leads (V1-V6). These are the unipolar leads that are placed directly on the patient’s chest. The heart is a 3-dimensional object, and calculating the heart’s electrical axis in the frontal […]

Chest discomfort, shortness of breath, and acute inferior-posterior STEMI

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Here’s an interesting 12 lead ECG that I found on the Lifenet Receiving Station at my receiving hospital. It immediately caught my eye for a couple of different reasons. In the first place, it’s an incomplete 12 lead ECG. Lead V1 is missing. This is probably the reason the GE/Marquette 12SL interpretive algorithm is giving […]