Tag Archives: 12-Lead ECG

72 year old male CC: "Unknown problem"

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EMS is dispatched to a 72 year old male patient. Third party call. History of Parkinson's Disease. Patient is conscious. No further information. On arrival, EMS finds a 72 year old Spanish-speaking male. Through an interpreter the lead paramedic determines that the patient became dizzy, fell down, and hit his head. A small hematoma is […]

Discordant ST-Segment Elevation in LBBB or Paced Rhythm

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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 […]

Rhythm Challenge #2

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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?

"New" LBBB – What's the big deal?

In the January 2010 EMCast at EMedHome.com, Amal Mattu MD reviews Chang AM, Shofer FS, Tabas JA, et al. Lack of association between left bundle-branch block and acute myocardial infarction in symptomatic ED patients. Am J Emerg Med 2009;27:916-921. His comments confirm what I have suspected for a long time with regard to LBBB in […]

Sgarbossa's Criteria – New Graphic

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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 […]

77 year old male CC: Palpitations

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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. […]

66 year old male CC: Chest pain

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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 […]

54 year old male CC: Chest pain

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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 […]

39 year old CC: Syncope while playing tennis

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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 CC: Cardiac arrest on the tennis court

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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 […]

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