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What are the indications for a prehospital 12-lead ECG?

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The primary purpose of the prehospital 12 lead ECG is to detect acute coronary ischemia or injury in the prehospital setting. That’s not to say it’s the only purpose for a prehospital 12 lead ECG, but it’s the main reason we carry 12 lead monitors on the ambulance! Ideally, the early identification of STEMI patients […]

Differential Diagnosis of Wide Complex Tachycardias – Part 6

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Let’s take a look at a couple of rhythms you never want to see on the monitor. First, from ABC of clinical electrocardiography – Broad complex tachycardia Part II, BMJ 2002; 324:776-779 This is an irregular and polymorphic wide complex tachycardia that appears to show a streamer effect, or “turning of the points.” Is it […]

Differential Diagnosis of Wide Complex Tachycardias – Part 5

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Let’s switch gears a little bit and discuss irregular or polymorphic wide complex tachycardias. First I need to tell you a story. A few years ago I was teaching ACLS to a group of mostly nurses at the local community hospital. I volunteered to teach Bradycardias, Tachycardias, and the Hypotension/Shock/Acute Pulmonary Edema algorithm. At first […]

Differential Diagnosis of Wide Complex Tachycardias – Part 4

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Let’s look at a more typical case of wide complex tachycardia. This case comes from Lt. Jason Kinley of Xenia Fire Division. Here’s the story. EMS is called for a 89 year old male with chest pain. Onset 30 minutes ago. Non-radiating. Patient is A+OX4. Skin is moist. Skin color is good. No increase in […]

Differential Diagnosis of Wide Complex Tachycardias – Part 3

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Let’s look at another unusual case. This was the ECG of a chest pain patient in the emergency department. Let us assume for a moment that the patient is hemodynamically stable but diaphoretic and complaining of severe substernal chest pressure. What does this 12 lead ECG show? It’s a regular rhythm. The rate is 120. […]

Differential Diagnosis of Wide Complex Tachycardias – Part 2

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By definition, a wide complex tachycardia is a heart rhythm with a QRS duration ≥ 120 ms (0.12 s) and a ventricular rate ≥ 100. When this criteria is met, and the the rhythm is regular (no variability in the R-R interval) then it’s a regular wide complex tachycardia. This is a very broad and inclusive definition […]

Differential Diagnosis of Wide Complex Tachycardias – Part 1

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There seems to be a lot of confusion with regard to wide complex tachycardias. For some reason, health care providers of all ranks and stripes forget the most basic rule. If it’s a wide complex rhythm (fast or slow) it’s ventricular until proven otherwise! Reasonable people can disagree as to what constitutes “proof” but you […]

Contiguous and Reciprocal Lead Charts

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Here are some charts to help you identify and localize acute STEMI on the 12 lead ECG. Contiguous leads What do we mean when we say leads are contiguous? Contiguous leads are next to one another anatomically speaking. They view the same general area of the heart (specifically the left ventricle). For example, these states […]

Identifying STEMI in the presence of LBBB – Sgarbossa’s Criteria Part 2

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This series has been updated and moved. Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 1 Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 2 Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 3

Identifying STEMI in the presence of LBBB – Sgarbossa’s Criteria Part 1

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This series has been updated and moved. Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 1 Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 2 Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 3

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