Editor-in-Chief
Tom Bouthillet is a Fire Captain / Paramedic with Hilton Head Island Fire & Rescue, developer of the 12-Lead ECG Challenge smartphone app, host of the Code STEMI web series on the First Responders Network, a member of the Editoral Advisory Board of EMS World Magazine, a columnist for EMS1.com, and has taught nationally in the Critical Care Transport (CCEMT-P) program out of UMBC.
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Associate Editor
David Baumrind is an ALS-Critical Care provider in Eastern Long Island, New York where he is the STEMI/Cardiac Arrest coordinator for his department. David has spent the last couple of years studying 12 Lead ECG’s and found the EMS 12 Lead blog early in his studies. David has been an active reader and frequent contributor, and joins the team as an Associate Editor.
Associate Editor
Christopher Watford is a Paramedic with Leland Volunteer Fire/Rescue Department (Leland, NC) and New Hanover Regional EMS (Wilmington, NC). At his day job, Christopher is a Lead Software Engineer with GE Hitachi Nuclear Energy and a Captain on their industrial fire brigade (Wilmington, NC). Christopher found the EMS 12 Lead blog during paramedic school, has been an active reader and contributor, and joins the team as an Associate Editor.
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Tom,
I have come across your web site many times and find it to be an awesome resource. Thank you and keep it up! Since HIPAA, I have found it difficult to follow up on patient outcomes-hence my learning was limited in that respect.
Thank you again.
You’re welcome, L!
Just an off the wall question kinda related to this topic. I recently had an anterior MI new and evolving en route to the ED. Anyways everything went great cath lab and all the bells and whistles but my question was the Doc called the shape of this guys st segment a “sign” of some sort like a name of some famous doctor or something… I just cant remember what he said but I know it has to do with the type and shape being concave or convex or a specific type of st segment maybe only or usually found in anterior wall MI’s. I cant remember what he called it and I have heard it before. Anyone can help me out?
Perhaps Wellen’s T-waves?
Yes Wellen’s is correct. That what he said. You know a good site I can learn more about this or do you know a little bout it
Dr. Smith’s ECG Blog has at least one case featuring the evolution of Wellen’s T-waves. They are typically deeply inverted, symmetrical T-waves or biphasic T-waves in V2-V3, without the loss of R waves in those same leads. Often a sign of proximal LAD stenosis. Along with de Winter and Brugada, it is a shape of ST/T waves that you should become familiar with in the long term.
I was looking at your diagram for 12 leads placement..I counted only 10 sites..where are the other 2 electrodes or is it only 10 sites?
Thanks
I had a question. I am doing a reasearch on time to prehospital 12 lead and I was wondering if you have studies that you are aware of that may be helpful. I have looked at the usual places, pubmed, etc but have not found much. Anything you can share would be appreciated.
Thanks
John
Leevy,
10 sites are normal. These 'sites' to name them properly are called electrodes. An ECG Lead is made up by combining two of these electrodes.
Basically the three electrodes placed on the right arm (RA), left arm (LA) and left leg (LL) are combined to make 3 lead views of the heart (leads I, II and III). The ECG machine then augments them to generate an additional 3 views (aVR, aVF and aVL), thus these three electrodes generate a total of 6 lead views of the heat. The chest leads V1 – V6 make up the other 6 views giving us a total of 12 leads from 9 electrode placements.
The electrode on the RL is used only as an earth reference point.
If you are interested to learn more you should do some reading on Einthoven's Triangle and Wilsons Central Terminal.
I need a a diagram showing where to put the leads where can i find a picture?
Hi,
I am a student paramedic, and I was curious if I am came across a patient with an aortic aneurysm or a ruptured aortic aneurysm (providing they stil have an output) would the ECG have an abnormalities in a pre-rupturing aaneurysm?
Thank you for your time