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AHA Scientific Statement on Prehospital 12 Lead ECGs

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The AHA Scientific Statement Implementation and Integration of Prehospital ECGs Into Systems of Care for Acute Coronary Syndrome was published online ahead of print on August 13, 2008. The ACC’s Cardiosource posted a good summary of the document on August 21, 2008 that included these 10 talking points: Prehospital electrocardiograms (ECGs) in patients with ST-elevation myocardial […]

12 Lead ECG – Lead Placement Diagrams

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On October 15, 2008, Lynne left me this comment: I’m an EMT-B that just found your blog. My agency allows EMT-Bs to perform 12-leads prehospital, so that doctors and paramedics at the hospital have a printout to look at. Also, if our monitor sees an Acute MI or something critical going on with the heart, […]

Prehospital 12 Lead ECG Supplement in JEMS Magazine – July 2006

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It’s a little bit dated now, but the July 2006 Prehospital 12 Lead ECG Supplement in JEMS magazine makes some interesting points. 10 Reasons to Perform a Prehospital ECG Does not significantly delay transport. Takes only one or two minutes to perform. Quality is increasingly high. Allows early diagnosis of AMI. Can be used to […]

The Case for Continuous Chest Compressions

A recent editorial Surviving Cardiac Arrest: Location, Location, Location. JAMA. 2008 Sep 24;300(12):1462-3 examined survival rates for cardiac arrest in various communities around the country. This comment in particular caught my eye: In a small study from rural Wisconsin, Kellum et al. implemented an EMS protocol consisting of an initial series of uninterrupted chest compressions, […]

Prehospital ECG Activation of the Cardiac Cath Lab

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*** Kept for historical purposes only *** In case you missed it, there’s an outstanding webinar available at the D2B Alliance website that discusses Prehospital ECG Activation of the Cardiac Cath Lab. It’s hosted by Dr. Ivan Rokos, Dr. Christopher Granger, Dr. Robert O’Connor, and Dr. William French. The webinar discusses Regional STEMI networks in […]

Cardiac Axis Determination – Part 6

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By now you can predict the QRS axis in the frontal plane within 15 degrees as long as you have an equiphasic (or isoelectric) lead in the frontal plane. So what constitutes a normal QRS axis? What is a left axis deviation? A right axis deviation? If you don’t have a copy of the hexaxial […]

Cardiac Axis Determination – Part 5

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In Part 4 I promised that I’d show you a fascinating relationship between the standard 12-lead ECG and the hexaxial reference system. You will recall that to use the hexaxial reference system, you find the most equiphasic (or isoelectric) lead in the frontal plane (first 6 leads of the 12-lead ECG) and look for the […]

Cardiac Axis Determination – Part 4

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By now you should have a fairly good grasp of how the hexaxial reference system is derived from the first 6 leads of the 12 lead ECG. Before we break down the finished diagram, let’s look at the hexaxial reference system laying on top of the patient’s anterior chest, with the arrows and leads in […]

Cardiac Axis Determination – Part 3

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In Part 2 we discussed the heart’s mean electrical vector and how Einthoven’s Triangle (leads I, II, and III) can be redrawn to form the first 3 spokes of the hexaxial reference system. Essentially, we ended up with a shape like the one on the right. When leads I, II, and III are drawn this […]

Cardiac Axis Determination – Part 2

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In Part 1, we looked at Einthoven’s Equilateral Triangle and Einthoven’s Law, and I told you that it was the key to understanding the formation of the hexaxial reference system. But before we delve further into the hexaxial reference system (the instrument we’ll be using to calculate the heart’s QRS axis) we need to address […]

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