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 […]

People actually do read my blog!

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A few days ago, I added a statcounter to the Prehospital 12 Lead ECG blog. At the time, only two people had left a comment, so for all I knew, that was my entire readership! From the very beginning I’ve said that I would start with a tutorial on axis determination, and then possibly continue […]

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 […]

E2B Challenge at EMS Expo 2008

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*** Preserved for historical purposes only. *** Are you going to EMS Expo 2008 in Las Vegas October 13-17? If so, please attend “EMS and STEMI: The Evolution of a Major Paradigm Shift” on Thursday, October 16, at 3:00 p.m. It will be presented by Ivan Rokos, MD, FACEP. Dr. Rokos had done a terrific […]

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 […]

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