Tag Archives: right bundle branch block

59 year old male: chest pressure – Conclusion

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This is the conclusion to 59 year old male: chest pressure, be sure to read the case study first! When we left off, we’d loaded our 59 year old male patient with 10 of 10 chest pressure into the back of our unit with the help of a local volunteer EMT. The patient appeared acutely unwell […]

RBBB Abnormalities Missed

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The original presentation of this case appeared as  "What's Wrong with Mr. Wilson?"… You can read the original post here. Much has been written lately about RBBB abnormalities that were missed.  Dr. Smith has recently posted two cases here, and here discussing this. First, let's review the 12 lead of a typical RBBB. When learning […]

77 year old female: Unresponsive – Discussion

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This is the discussion for 77 year old female: Unresponsive, if you have not read the case report we recommend you start there! First, a hat tip to our readers who were unafraid to tackle this challenging scenario. Second, we were very impressed to see a number of readers correctly identify this challenging rhythm! When we […]

63 Year Old Male: "Dental Pain" — Discussion

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This is the discussion to "63 year old male: "Dental Pain". You may wish to review the case. For starters, i think we all agree that the patient, with his signs and symptoms, needs to be transported. We have all had patients like this who don't want to go, even though we know they should. […]

81 year old female CC: Chest Pain – Conclusion

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This is the conclusion to 81 year old female CC: Chest Pain. Due to a significant language barrier, we were unable to obtain a useful medical history. Yet this case highlights the importance of a good scene assessment to gain additional information of clinical importance. First, let's examine the patient's 12-Lead ECG. We have a bradycardic, […]

68 year old male CC: Chest Pain – Conclusion

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This is the conclusion to 68 year old male CC: Chest Pain. When we last left off, our patient was sitting outside a convenience store with a sensation of, "somebody punching me in the chest". Our patient had a fast, irregular pulse, and we had acquired a rhythm strip and a 12-Lead ECG. The rhythm strip shows […]

64 year old male CC: Indigestion – Discussion

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This is the discussion to 64 year old male CC: Indigestion. If you recall, we had a stubborn gentleman complaining of indigestion with a significant cardiac history. Considering the symptoms kept our patient awake, are highly suggestive of a coronary event, and we have uncompensated hypotension, we should have a keen interest on any ECG […]

78 year old male CC: Dizziness – Conclusion

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There were so many great comments on this case, including some great discussion on classifying wide complex tachycardias!

An unusual case of right bundle branch block – Discussion

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Here is the conclusion to an unusual case of right bundle branch block. Let's take another look at the 12-lead ECG. This 12-lead ECG shows acute anterior STEMI in the presence of right bundle branch block, but you really need a trained eye to see it. We talk a lot about the "rule of appropriate […]

An unusual case of right bundle branch block

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We Yankees can learn a lot from the way they do things across the pond.

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Brian
83 Year Old Male: Shortness of Breath
I mostly agree with dustin. I believe this is may be an isolated posterior MI. The R wave in V2 points to it being a posterior MI. otherwise it is a 1st degree av block with a LAHB. I am somewhat concerned with the concordant t segment depression noted and in fact if you were…
2014-10-30 04:22:44
Karl Brennan
Understanding Amiodarone
Great article , however in VF caused by hyperkalemia it should be avoided along with lidocaine , Since it shuts down the K channels, the eiteiology of the arrest hyper K, K channels are needed to exchange K in the cell. Calcium , Bicarbonate, dextrose and insulin should be used to decrease K levels along…
2014-10-30 03:04:45
Dustin
83 Year Old Male: Shortness of Breath
I see a very sick and complicated patient. 12 Lead: ST elevation in AVR and V1 along with depression in I, II, V4-V6 leading me to an LMCA occlusion. The tall R wave in V2 also points me to Posterior involvement. Posterior MIs and LMCA occlusions can and do cause pulmonary edema, which this patient…
2014-10-30 02:38:21
Adrian
83 Year Old Male: Shortness of Breath
Firstly, the patient is septic, he needs high flow O2 (which he's already receiving), IV fluids, blood cultures and antibiotics (most likely IV) and needs to be in resus sharpish. Secondly, the ECG needs doing again, V2 is wrong and I'm not sure where it's been placed to get that reading. Assuming the rest of…
2014-10-30 01:00:42
Ken Grauer, MD
83 Year Old Male: Shortness of Breath
I see a regular rhythm at ~ 95/minute with LOTS of baseline artifact. I am not certain if there are P waves or not ..... It does look in leads V3,V4 like there are P waves with a long PR interval - but I cannot be certain in lead II that there is an upright…
2014-10-30 00:59:40

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