Editor-in-Chief
Tom Bouthillet is a Fire Captain / Paramedic, developer of the 12-Lead ECG Challenge smartphone app, host of the Code STEMI web series on First Responders Network, a member of the Editoral Advisory Board of EMS World Magazine, a member of the EMS Advisory Panel of the American Heart Association, a columnist for EMS1.com, and an EMS 10 Award recipient. He has taught nationally in the Critical Care Transport (CCEMT-P) program out of UMBC and his writings have been referenced in the American Heart Journal, the Journal of the American College of Cardiology: Cardiovascular Interventions and the EP Lab Digest. All opinions expressed by Tom are his own and not the opinion of his employer.
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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 and Board Member at Leland Volunteer Fire/Rescue Department (Leland, 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.
Contact: Email, StackOverflow, Facebook
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?
I sincerely appreciate all of the knowldege I've been able to gleen from your website. So that I might further develop my knowledge of interpreting 12 leads, is there a single-book resource you might recommend – something I can have as a "Universal Reference" for those hard to discern 12-leads?
Thanks a million~~
Mike
Mike,
Tomas Garcia and Neil Holtz's: 12-Lead ECG: The Art of Interpretation.
Thank You Tom for your incredible lecture at the EMS Expo in New Orleans this past Thursday. I was in the front row with about 5 other co-workers some of who have 15+ years as ALS providers in EMS. I can honestly say that this was, hands down, the best/most concise 12-Lead lesson I have ever been exposed to. And this feeling was shared by all of my co-workers as we walked away from your lecture. Keep up the good work you all do in demystifying this topic and helping to change the way we look at this vital tool in our everyday assessments. J. Pace NREMT-P