12-lead ECG interpretation
12-lead ECG – Lead placement diagrams
Contiguous and reciprocal lead charts
Muscle tremors, your patient's dignity, and staying organized
Artifact in the limb leads: which electrode is responsible?
The Six Step Method for 12-lead ECG interpretation
Large block method for heart rate calculation
Precordial leads – the transition, R-wave progression, R/S ratio in lead V1
Differential diagnosis of tall R-waves in lead V1
Treat the patient not the monitor?
Computerized interpretive statements
Computerized interpretive statements – false positives #1
Computerized interpretive statements and bundle branch blocks
Data quality and computerized interpretive statements
Comparing 12-Leads: Common problem or common disease?
Comparing 12-Leads: Discussion
Prehospital 12-leads
Prehospital 12-lead ECG programs (also posted at JEMS Connect)
Prehospital 12-lead ECG – what are the indications?
Top 10 myths about prehospital 12-lead ECGs
McLearning and 12-lead ECG interpretation
Prehospital 12-lead ECG quiz for the kitchen table
2013 STEMI Guidelines: EMS is Accountable
Axis determination
Right bundle branch block
Right bundle branch block – Part I
Right bundle branch block – Part II
Right bundle branch block – Part III
"Funky trouble looking" RBBB with AMI
50 year old male CC: Respiratory distress, chest pain
88 year old male CC: Chest Pain
Conclusion to 88 year old male CC: Chest Pain
64 year old male CC: indigestion
64 year old male CC: indigestion-Discussion
An unusual case of right bundle branch block
An unusual case of right bundle branch block-Discussion
Left anterior fascicular block
Left anterior fascicular block (LAFB)
Bifascicular block
82 year old male CC: Chest pain
63 year old male CC: Sudden onset shortness of breath (computer says >>>>ACUTE MI<<<<)
88 year old male CC: Chest pain
Right ventricular infarction
Right ventricular infarction – Part I
Right ventricular infarction – Part II
Right ventricular infarction – Part III
Mimics of Acute STEMI
The problem of ST-segment elevation
ECG Challenges from AACN Advanced Critical Care (links to article about STEMI mimics)
Mimics of acute STEMI (left ventricular aneurysm)
Left ventricular hypertrophy – Part I
Left ventricular hypertrophy – Part II
41 year old male CC: Chest pain
41 year old male CC: Chest pain – Answer
Wolff-Parkinson-White Syndrome (WPW) – STEMI Mimic
41 year old male CC: Chest pain (looks like BER, proves to be acute STEMI)
23 year old male CC: Chest pain (benign early repolarization)
76 year old female CC: Chest pain
76 year old female CC: Chest pain – The case for this being an acute anterior STEMI
76 year old female CC: Chest pain – Conclusion (Tako-Tsubo Cardiomyopathy)
90 year old male CC: "Possible Stroke" (LVH with Strain Pattern)
90 year old male CC: "Possible Stroke"-Conclusion
63 year old male CC: Shortness of breath (LVH with Strain Pattern)
63 year old male CC: Shortness of breath- Conclusion
57 year old female CC: Shortness of breath and chest pressure (LVH with Strain Pattern)
57 year old female CC: Shortness of breath and chest pressure-Discussion
39 year old male CC: "sick" (pericarditis)
39 year old male CC: "sick"- Discussion
68 year old female unresponsive on the kitchen floor
Osborn waves (j-waves) of hypothermia
Left ventricular aneurysm vs. acute anterior STEMI
The early repolarization experiment
Acute inferior STEMI
49 year old male CC: Weakness, nausea
66 year old male CC: Chest pain (ST-elevation disappears by arrival to the hospital)
58 year old male CC: Chest pain
62 year old male CC: Chest discomfort
62 year old male CC Chest discomfort – Update (Angiograms)
Acute inferior STEMI – RCA or LCX?
65 year old female CC: Chest pain
39 year old male CC: Syncope while playing tennis
81 year old male CC: "Cold and shaky"
81 year old male CC: "Cold and shaky" – Conclusion (angiograms)
The missed STEMI (case study with angiograms)
58 year old male CC: Chest discomfort
53 year old female CC: Chest discomfort and shortness of breath
46 year old female: Injuries from a fall
46 year old female: Injuries from a fall-Discussion
49 year old male CC: Chest pain
49 year old male CC: Chest pain-Conclusion
54 year old female CC: BLS intercept
54 year old female CC: BLS intercept-Conclusion
79 year old female CC: Chest pain
79 year old female CC: Chest pain- Conclusion
The Bait and Switch (switched leads)
The Bait and Switch- Conclusion
47 year old male: Holiday Indigestion
47 year old male: Holiday Indigestion- Conclusion (Inferoposterior)
59 year old male- "Lifting Boxes"
59 year old male- "Lifting Boxes", Part II- With a Twist! (Infero-postero-lateral)
"What Happened?"- Discussion (Atypical Wenckebach)
Acute posterior STEMI
48 year old male CC: Chest discomfort, shortness of breath
Anterior ischemia or posterior STEMI? (at Paramedicine 101)
50 year old male CC: Respiratory distress, chest pain
74 year old male CC: Chest pain
74 year old male CC: Chest pain – Update
74 year old male CC: Chest pain – Final update (angiograms)
26 year old male CC: Chest pain
Right ventricular hypertrophy vs. isolated posterior STEMI
66 year old male CC: Chest pain (postero-lateral)
66 year old female CC: Chest pressure
66 year old female CC: Chest pressure- Conclusion
63 year old male CC: Substernal chest pain (Guest Brooks Walsh)
63 year old male CC: Substernal chest pain- Discussion (Guest Brooks Walsh)
Acute anterior STEMI
82 year old male CC: Chest pain (bifascicular block RBBB/LAFB)
76 year old male CC: Shortness of breath while walking (early acute anterior STEMI)
Found on the Lifenet Receiving Station
52 year old male CC: Syncope, chest pain
52 year old male CC: Syncope, chest pain – Update (angiograms)
82 year old female CC: "Flu-like" symptoms
54 year old male CC: Chest pain (unusual looking STEMI)
66 year old male CC: Chest pain (ST-elevation starts to resolve to arrival to the hospital)
66 year old male CC: Chest pain – Update (angiograms)
57 year old male CC: Chest pain
69 year old male CC: "Indigestion" (codes en route to the hospital)
54 year old male CC: Chest pain
54 year old male CC: Chest pain – Discussion
Elderly female: Chest Pain-Discussion
41 year old female: Chest pain
Conclusion to 41 year old female: Chest pain
Discussion to 63 year old male: Chest Pain–Wellens' Syndrome? Or something else…
58 year old female CC: Chest pain
58 year old female CC: Chest pain-Conclusion
77 year old female CC: Chest pain
77 year old female CC: Chest pain-Conclusion
71 year old male CC: Chest pain (antero-lateral)
71 year old male CC: Chest pain- Conclusion
81 year old male CC: Palpitations
Conclusion to 81 year old male CC: Palpitations (LVA vs STEMI)
51 year old female CC: Near syncopal episode
51 year old female CC: Near syncopal episode- Conclusion
62 year old male: Chest Discomfort
62 year old male: Chest Discomfort- Part II
62 year old male: Chest Discomfort- Conclusion
Discussion for 51 year old male: Chest Pain
Semi-STEMI (borderline cases)
59 year old male CC: Chest discomfort (very subtle)
45 year old male CC: Chest pain (very subtle – patient left hospital AMA)
43 year old female CC: "Indigestion-like" chest discomfort
37 year old male CC: "Light-headedness"
37 year old male CC: "Light-headedness" – Discussion
53 year old male with a suspicious ECG
53 year old male with a suspicious ECG-Conclusion
55 year old male CC: Chest pain?
55 year old male CC: Chest pain?- Conclusion
53 year old male: Severe leg pain
53 year old male: Severe leg pain- Conclusion (Aortic dissection)
Snapshot: 64 year old male- Chest Pain
Snapshot Discussion: 64 year old male- Chest Pain
Identifying acute STEMI in the presence of LBBB or paced rhythm
80 year old male CC: Chest pain (*a Tom Bouthillet favorite)
Excessive discordance as a marker of acute STEMI in LBBB
80 year old male CC: Chest pain – Conclusion
58 year old female CC: Chest pain
58 year old female CC: Chest pain – Conclusion (meets all 3 of Sgarbossa's criteria)
62 year old male CC: Chest pain (LBBB with ST-elevation > 0.2 the QRS complex)
Identifying AMI in the presence of LBBB – Sgarbossa's Criteria Part I
Identifying AMI in the presence of LBBB – Sgarbossa's Criteria Part II
"New" LBBB – What's the big deal?
Discordant ST-segment elevation in LBBB or paced rhythm
Sgarbossa's Criteria – New Graphic
Found on the Lifenet Receiving Station (LBBB with concordant ST-depression in leads V3 and V4)
88 year old female CC: Chest pain
88 year old female CC: Chest pain-Conclusion
50 year old male CC: Chest Pain
50 year old male CC: Chest Pain-Discussion (unusual LBBB or IVCD)
An unusual case of left bundle branch block (60 year old male CC: shortness of breath)
An unusual case of left bundle branch block-Discussion
88 Year old male CC: Chest Pain
88 Year old male CC: Chest Pain-Conclusion(paced STEMI)
Left main coronary artery lesion/ subendocardial ischemia
63 year old male CC: Chest pain
63 year old male: "Dental Pain"
63 year old male: "Dental Pain"-Discussion
Wellens and Reperfusion T Waves
Name that ECG: 66 year old female
Name that ECG: 66 year old female- Findings
62 year old male: Chest discomfort- Conclusion
Pulmonary Embolus
56 year old female CC: Short of breath
56 year old female CC: Short of breath- Conclusion
Hyperkalemia and other Sodium Channel Blockades
29 year old female: Unresponsive
29 year old female: Unresponsive- Conclusion
Life-threatening hyperkalemia: do you recognize the ECG signs?
76 year old female CC: Diminished LOC
76 year old female CC: Diminished LOC- Discussion
HyperK and Shades of Grey: Myths and facts about Hyperkalemia Part I (Guest Brooks Walsh)
HyperK and Shades of Grey: Myths and facts about Hyperkalemia Part II (Guest Brooks Walsh)
Atrial fibrillation
35 year old male CC: Palpitations (Holiday Heart)
Brugada's
79 year old female CC: Unresponsive (final diagnosis was not verified)
Importance of serial 12-lead ECGs
The Only Constant is Change (review of Tim Phalen's article)
82 year old male CC: Chest pain
41 year old male CC: Chest pain
Found on the Lifenet Receiving Station
43 year old female CC: "Indigestion-like" chest discomfort
54 year old male CC: Chest pain (unusual looking STEMI)
57 year old male CC: Chest pain
54 year old male CC: Chest pain
54 year old male CC: Chest pain – Discussion
58 year old male CC: Chest discomfort
Elderly female: Chest Pain-Discussion
41 year old female: Chest Pain
Conclusion to 41 year old female: Chest Pain
Implantable Medical Devices
Inappropriate or ineffective ICD shocks – Part I
Inappropriate or ineffective ICD shocks – Part II
Inappropriate or ineffective ICD shocks – Part III
81 year old female CC: ICD shocks x6
Incredible video of soccer player saved by ICD (links to YouTube video)
Scientist shocked by ICD at Copenhagen summit (links to YouTube video)
Evaluating the pacemaker patient – Part I
94 year old male CC: Chest pain (perfectly normal looking paced rhythm)
A Change of Pace: What Happened?
Discussion for "A Change of Pace: What Happened?"
Transcutaneous pacing (TCP)
Transcutaneous pacing (TCP) – The problem of false capture
Transcutaneous pacing (TCP) with a Lifepak 12
Wide complex tachycardias
Differential diagnosis of wide complex tachycardias – Part I
Differential diagnosis of wide complex tachycardias – Part II
Differential diagnosis of wide complex tachycardias – Part III
Differential diagnosis of wide complex tachycardias – Part IV
Differential diagnosis of wide complex tachycardias – Part V
Differential diagnosis of wide complex tachycardias – Part VI
More on wide complex tachycardias
Should you ever give a calcium channel blocker to a wide complex tachycardia?
The Prehospital 12-Lead ECG blog receives its first hate mail
44 year old male CC: Palpitations
Stump the Experts – Case of the Tachy Trucker
78 year old male CC: "Chest heaviness"
78 year old male CC: "Chest heaviness" – Update
77 year old male CC: Palpitations
64 year old male CC: Chest pain
68 year old male CC: Chest pain
12 year old male CC: Palpitations
46 year old male CC: Chest pain (heart rate > 250)
90 year old female CC: Abdominal pain
79 year old male CC: Shortness of breath
90 year old male CC: Chest Discomfort
90 year old male CC: Chest Discomfort–Discussion
90 year old female CC: Seizure
90 year old female CC: Seizure- Conclusion
47 year old male CC: Crushing chest pain (V-Fib)
47 year old male CC: Crushing chest pain-Conclusion
60 year old male CC: "I don't feel well"
Discussion to 60 year old male CC: "I don't feel well"
74 year old female CC: Chest pain
74 year old female CC: Chest pain-Conclusion
85 year old female CC: Respiratory Distress
85 year old female CC: Respiratory Distress-Discussion
78 year old male CC: Dizziness
78 year old male CC: Dizziness-Conclusion
Snapshot: 32 year old male-Chest Discomfort
Snapshot Discussion: 32 year old male-Chest Discomfort
Name that ECG: 51 year old male
Name that ECG: 51 year old male- Findings
65 year old male CC: Fall with injury
65 year old male CC: Fall with injury- Conclusion
Narrow complex tachycardias
Narrow complex tachycardias – Part I
Narrow complex tachycardias – Part II
Narrow complex tachycardias – Part III
83 year old male CC: "Cardiac patient in distress"
83 year old male CC: "Cardiac patient in distress"-Conclusion
68 year old male CC: Chest Pain
68 year old male CC: Chest Pain-Conclusion
Atrial Flutter can cause false-positive ***acute MI suspected*** interpretive statements
The Trouble with Sinus Tachycardia
24 year old male: "Anxiety attack"
24 year old male: "Anxiety attack"- Conclusion
57 year old male: Chest Discomfort
57 year old male: Chest Discomfort- Conclusion (Flutter)
88 year old female: Weakness- Discussion (Lewis Lead)
77 year old female: Unresponsive
77 year old female: Unresponsive- Discussion (Artifact)
52 year old male CC: Seizure- Discussion
Bradycardias
81 year old female CC: Chest Pain
81 year old female CC: Chest Pain-Conclusion
89 year old female CC: Sick (3rd degree AV block, huge inverted T waves)
89 year old female CC: Sick-Discussion
82 year old male CC: Shortness of breath
82 year old male CC: Shortness of breath- Conclusion
Name that ECG: 88 year old male
Name that ECG: 88 year old male- Findings
Stump the Chumps: Atropine and Complete Heart Block
Stump the Chumps: Atropine and Compete Heart Block- Discussion
Pediatrics
17 year old male CC: Syncope-Discussion
15 year old male CC: fall from vehicle
Part 1 of the Conclusion to 15 year old male CC: fall from vehicle
Part 2 of the Conclusion to 15 year old male CC: fall from vehicle
13 year old female CC: Syncope
13 year old female CC: Syncope- Discussion
Rhythm challenge
Rhythm challenge #2 (life-threatening hyperkalemia)
Rhythm challenge #4 – Discussion
Second Degree or Third Degree Atrioventricular Block?
Tweet about ECG leads to mystery- Is this a mimic or the real thing?
Is this a mimic or the real thing?- Discussion
Found on the LifeNet-January, 2011
Airway management
Prehospital advanced airway – should paramedics be intubating?
Patient Safety
Peter Pronovost – The Science of Safety
Man dies at home after paramedics diagnose acid reflux
Code STEMI Web TV Series
Code STEMI Web TV Series in South Dakota-That's a Wrap!
Code STEMI Web Series- EMS 12-Lead Podcast episode #6
Episode 2 of the Code STEMI Web Series-Race Program in North Carolina
Episode 3 of the Code STEMI Web Series- Dearborn, Michigan
Jamie Davis interviews Ted Setla about the Code STEMI Web Series at the EMS 10 Awards
Code STEMI Web Series- London to premier at EMSToday in Washington DC
Code STEMI- London Ambulance Service
Regional PCI for STEMI, and STEMI systems of care
If "Time is Muscle" What's Taking So Long? (review of David Jaslow, MD's article)
Prehospital 12-Lead ECG (review of supplement in JEMS magazine – July 2006)
Prehospital ECG Activation of the Cardiac Cath Lab (links to D2B Alliance webinar)
False positive cardiac cath lab activations (review of “False-Positive” Cardiac Catheterization Laboratory Activation Among Patients With Suspected ST-Segment Elevation Myocardial Infarction, JAMA 2007;298(23):2754-2760)
Are you up for the E2B Challenge? (review of Ivan Rokos's article)
AHA Scientific Statement on Prehospital 12 Lead ECGs (review of Implementation and Integration of Prehospital ECGs Into Systems of Care for Acute Coronary Syndrome – published online ahead of print on August 13, 2008)
Drs. Jacobs and Gibson discuss AHA Mission: Lifeline (links to MD TV and TCT 2008)
ACC/AHA 2008 Statement on Performance Measurement and Reperfusion Therapy (review of same in J Am Coll Cardiol, 2008; 52:2100-2112)
Who receives the most benefit from reperfusion therapy? (based on data from thrombolytic trials)
Physio-Control – Voice of Life Saving (Tom discusses 12-leads and STEMI care with Physio-Control)
SC Chapter of AHA Mission: Lifeline (Tom praises the highly trained professionals involved with AHA Mission: Lifeline)
Angioplasty with Bezold-Jarisch reflex (links to BBC news story)
AHA Mission: Lifeline survey reveals problems
Dr. Rokos and Dr. Gibson discuss prehospital STEMI activation pathways (links to MD TV and video from LUMEN 2009)
Any delay in D2B time associated with increased mortality (review of Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: a national cohort study. BMJ 2009; 339:b1807)
Prehospital ECGs have big impact on door-to-balloon times
Chicago ambulances lack EKG machines
Congratulations to Dr. Michel LeMay (discusses Ottawa, Canada's regional STEMI program)
ACC/AHA focused update for STEMI and PCI
How to establish a multi-hospital STEMI transfer system (links to D2B Alliance webinar)
AHA changes acceptable time to primary PCI from 90 to 120 minutes for acute STEMI
10 Questions with Jodi Doering RN- South Dakota AHA Mission: Lifeline Director
Fun and games with response time reporting
Survivor gives us a lens into regional systems of care for acute ischemic stroke in North Dakota
The Importance of Data Collection
The importance of data collection and sharing
Cardiac arrest
The case for continuous chest compressions (review of Surviving Cardiac Arrest – Location, Location, Location – JAMA 2008; Vol 300, No. 12)
Time lapse video of heart in VF (video no longer active on YouTube due to a "terms of use" violation but this was the video they show in the LUCAS compression device presentation). The concept is discussed.
Agonal breathing predicts survival from cardiac arrest (review of Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation. Published online before print November 24, 2008)
Politics vs. Patient Care (links to Jeffrey Guy's ICU Rounds podcast about therapeutic hypothermia)
ECG Grand Rounds (contains an interesting ROSC case)
65 year old male CC: Cardiac arrest
No advantage seen with drugs in out-of-hospital cardiac arrest
Why you need to strengthen your community's chain-of-survival
Cardiac arrest – are you ready to save one of our own?
57 year old male CC: Cardiac arrest
69 year old male CC: "Indigestion" (codes en route to the hospital)
60 year old male CC: Sudden cardiac arrest
Conclusion to 60 year old male CC: Sudden cardiac arrest
Sudden Cardiac Arrest podcasts from EMS Today 2011
Wake County EMS cardiac arrest survival rate among the highest in the country
High Performance CPR- Seattle Style!
91 year old female CC: Seizure (a strange situation)- Discussion
56 year old female with a "cardiac disorder"
Transcutaneous pacing (TCP) for asystole
the "pit crew" concept in cardiac arrest
63 year old male CC: Chest Pain
63 year old male CC: Chest Pain- Conclusion
Must-watch video of cardiac arrest save!
The "Save a Life" Simulator by the Heartrescue Project
Firefighter health and safety
Firefighter job stress and heart attacks
Cardiac arrest – are you ready to save one of our own?
The politics of transporting a patient in a fire engine
18 year old male: Structure Fire Rehab
18 year old male: Structure Fire Rehab-Conclusion
Cardiac-related medical devices
Philips introduces the HeartStart FR3 Defibrillator
RescueNet 12-Lead by Zoll Medical Corporation at EMS World Expo 2011
ReadyLink 12-Lead ECG by Physio-Control (Update)
12-Lead ECG Challenge App now available for Android and Apple IOS
New device allows you to assess BP with iPhone
AliveCor's iCard ECG for iPhone 3G, iPad, and Android
LifePak 12 Li-ion battery and Redi-Charge battery charger now available
iPhonECG turns the iPhone 4 into a cardiac event monitor
Physio-Control demos how to incorporate the LUCAS into a "pit crew" approach to resuscitation
Just for fun
Mad scientist teaching arrhythmias (YouTube video)
Fishin' with Fuzzy! (Tom takes the crew of Engine 6 out fishing with a legend)
What ever happened to good ol' Bretylium?
Watch your own heart attack (British PSA for heart attacks)
Infographics
New infographic: Left Anterior Fasicular Block (LAFB)
Everything else
FEMA Structural Collapse Technician Course
Horse and buggy to space shuttle! (Tom gets an iPhone)
Who knew that statcounter could be so entertaining?
Happy 4th of July weekend (my parents house on Lake Huron)
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Continuing the Discussion