Archive for October2008

Weakness, nausea, and inferior-posterior-lateral STEMI

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You are dispatched to a report of a disoriented man on the beach. On arrival bystanders direct you to a 49 year old male who is sitting on a bench. An elderly couple states they were taking a walk and saw the man sitting on the bench and became worried about him due to his […]

False Positive Cardiac Cath Lab Activations

Here are some highlights from Larson, Menssen, Sharkey et al False-Positive” Cardiac Catheterization Laboratory Activation Among Patients With Suspected ST-Segment Elevation Myocardial Infarction. JAMA 2007;298(23):2754-2760. The false positive rates (suspected STEMI patients with ST-segment elevation but no clear culprit coronary artery, no significant coronary artery disease, and negative cardiac biomarker results) were analyzed at the Minneapolis […]

Are You Up for the E2B Challenge?

In the October 2008 issue of Emergency Medical Services, our very good friend Ivan Rokos, MD made some comments that are worth repeating. “[P]aramedics are now in a novel role, where they are able to diagnose STEMI faster and earlier than ever before using a prehospital EKG machine. This is important for two reasons: One […]

The Only Constant Is Change

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In this excellent article from the March 2007 Journal of the Emergency Medical Services, Tim Phalen discusses the importance of performing serial 12 lead ECGs. Here are some of the highlights. “Acute myocardial infarctions (AMIs) aren’t like broken bones and, therefore, ECGs aren’t static like X-rays. If an EMS crew were treating a hip fracture […]

The problem of ST segment elevation

This post has been updated and moved here:  

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 […]

If time is muscle, what's taking so long?

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That’s that tag line of a tremendous article that appeared in the March 2007 issue of Emergency Medical Services entitled Out-of-Hospital STEMI Alert by David Jaslow, MD, MPH, EMT-P, FAAEM. I think the tag line sums up the frustration many of us “STEMI activists” feel when our prehospital 12 lead ECG programs flounder. Here are […]

Artifact in the limb leads: which electrode is responsible?

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This is the latest in a series of posts I am dedicating to achieving excellent data quality for prehospital 12 lead ECGs, particularly when they are being transmitted to the emergency department for physician interpretation (and early activation of the cardiac cath lab). Lately I have noticed that when an ECG shows artifact in the […]

Time lapse video of a heart in VF

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This video was shown during a LUCAS device demonstration at our receiving hospital in 2008. It’s a time lapse of a heart in VF (swine model). The handout from Physio-Control had a diagram explaining that forward blood flow continues for several minutes after the onset of VF while arterial pressure (AP) and central venous pressure […]

Mad Scientist Teaching Arrhythmias

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For all you visual learners out there. This one is a classic!

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