If you’ve been following the Prehospital 12-Lead ECG blog for a while, you know that I’m advocate of using Sgarbossa’s criteria to help identify acute STEMI in the presence of left bundle branch block (LBBB) or paced rhythm. According the Sgarbossa’s original criteria, 5 mm of discordant ST-segment elevation is required to identify AMI in […]

Here’s an interesting rhythm strip that was captured in the days before my EMS system had 12-lead ECG monitors. What do you think? *** Update 01/20/2010 *** Here is the rhythm strip taken on arrival at the hospital. Here is the 12-lead ECG that was captured at the hospital. Does that change anything?

Here is a graphic I created to help explain Sgarbossa’s criteria for identifying acute myocardial infarction (AMI) in the presence of left bundle branch block (LBBB) or paced rhythm. In a previous article I showed this graphic which was created using PowerPoint. Here is a similar graphic I created this morning by cropping actual ECGs […]

EMS is called to the residence of a 77 year old male complaining of palpitations. Upon arrival, paramedics find the patient lying in bed. He is awake but lethargic. He is oriented to person, place, and time. The patient’s skin is cool, pale, and diaphoretic. He admits to chest discomfort and mild shortness of breath. […]

EMS is called to the parking lot of a local fast food restaurant for a 66 year old male complaining of chest pain. On arrival, the patient appears acutely ill. His skin is pale/ashen but dry. He is rubbing his chest and there is a grimace on his face. He is not conversant but he […]

EMS is called to the doctor’s office to evaluate a 54 year old male complaining of chest pain. On arrival, the patient is alert and oriented to person, place, time, and event. However, he is anxious and his skin is pale and diaphoretic. He is on oxygen via NC @ 4 LPM. An IV has […]

EMS is called to a tennis club to assess a 39 year old male who experienced a syncopal episode while playing tennis. On arrival, the patient is lying down on the ground next to a bench. He appears lethargic and pale. Bystanders are laying ice cold towels around his head and chest and tell you […]

65 year old male collapses while playing tennis. The scene is less than 1 minute from the fire station. On arrival, bystanders are providing rescue breaths but no chest compressions. Medical history is unknown. Initial rhythm: First shock: Return of spontaneous circulation (ROSC) noted. Rhythm strip: 12 lead ECG: The patient is still unconscious. LMA […]

EMS responds to a 81 year old female who was implanted with “a pacemaker” 2 weeks ago. She complains that the device has shocked her 6 times. On arrival the patient is found sitting in a chair. She is anxious but alert and oriented to person, place, time and event. Vital signs: Resp: 18 Pulse: […]