EMS 12-Lead: Spot the STEMI #1

You have a 50/50 shot at getting this one right. Are you feeling smart… or lucky?

Two 50-year-old men present complaining of chest pain x 1 hour. One patient is suffering from a very subtle acute STEMI while the other has a non-cardiac cause for his chest pain.

For the conclusion of this challenge please follow this link or click on the ECG above.

EMS 12-Lead: 43 Year Old Female – Chest Discomfort After Eating

A 43-year-old female presents feeling like there’s a knot behind her sternum. It began suddenly just after eating lunch. This is her initial ECG:

For the description of the patient’s initial presentation and reader comments please follow this link.

For the conclusion to this case please follow this link or click on the ECG above.

EMS 12-Lead: 59 Year Old Male – Unwell

It’s the middle of the afternoon when you are dispatched to the residence of a 59 year old male with a chief complaint of general illness.

When you arrive on scene you encounter a middle-aged man in obvious distress, lying on a couch. He is pale, gray, diaphoretic, and drowsy. He states that he has felt drained for the past 8 hrs—unable to catch his breath or get up off the couch—with a heavy sensation in his chest. 30 minutes prior to your arrival he vomited and felt like he was going to pass-out so he decided to call 911.

For the details of the initial case description and reader comments please follow this link.

For the conclusion of the case and its discussion please follow this link or click the ECG above.

EMS 12-Lead: What If We’re Wrong? Prehospital ECG Interpretation

This article is part of a special one-day EMS blogging event called the What If We’re Wrong a-Thon. Spearheaded by Brandon Oto over at EMS Basics, the WIWWAT is an exercise in self-reflection where EMS writers examine a topic on which that they’ve historically taken a strong stance, but from the opposite point-of-view. For more posts from around the EMS community as part of the What If We’re Wrong a-Thon, check out this page.

What if we’re wrong about the utility of prehospital interpretation of 12-lead ECG’s? What if they don’t actually improve patient outcomes and lead to better prehospital care?

For my critical examination of those questions follow this link or click on Dr. Perry Cox’s face above.

EMS 12-Lead: Snapshot Case – What Happened?

This is a patient who required emergent cardioversion for unstable rapid atrial fibrillation. What happened?

For comments and discussion of this tracing follow this link or click the rhythm strip above.

EMS 12-Lead: Transcutaneous Pacing Success!!! Part 2

This is the second half of a two-part case presentation examining transcutaneous pacing. If you didn’t see yesterday’s post I highly suggest checking out Part 1 before continuing, but if you hate learning I suppose you can start here.

Yesterday we examined a series of tracings that depicted transcutaneous pacing (TCP) in all its stages: initiation, false-capture, intermittent capture, successful capture, and finally, spontaneous resolution of the bradycardia that necessitated pacing in the first place. It was a whirlwind!

For the rest of this article follow this link or click the rhythm strip showing intermittent capture above.

EMS 12-Lead: Transcutaneous Pacing Success!!! Part 1

Anyone trained in transcutaneous pacing (TCP) needs to be able to identify the rhythm below instantly.

It shows a patient being transcutaneously paced at 80 bpm and 125 mA on a LifePak 12 [the strip is labelled 130 mA but that refers to a point just past the end of the paper, I promise].

Well, actually, it shows attempted pacing. Despite the generous current being delivered there is no evidence of successful electrical capture. Without electrical capture there cannot be mechanical capture, so the patient’s pulse at the moment is only 10 bpm.

For the rest of this article click the rhythm strip above or follow this link.

EMS 12-Lead: The 12 Leads of Christmas – V3

This is the eleventh and penultimate article in our latest series, The 12 Leads of Christmas, where each day we examine an individual electrocardiographic lead.

Today we’re going to discuss V3, and there’s no way I can do that without talking about isolated posterior myocardial infarction. Of all twelve, fifteen, eighteen, or even twenty leads you may examine on the ECG, V3 usually shows the most prominent ST/T-wave abnormalities during isolated posterior STEMI. Sometimes V2 is more dramatic, or less often V4, but in the grand scheme of things the ST-depression we see during acute posterior injury tends to be centered on V3.

For the rest of this article please follow this link or click the ECG above.

EMS 12-Lead: The 12 Leads of Christmas – V2

This article is the tenth in our latest series, The 12 Leads of Christmas, where each day we examine a new finding particular to an individual electrocardiographic lead.

I love V2.

It’s probably been my favorite lead to examine and ponder this past year. The cool thing is that it doesn’t seem all that special way at first. I mean, the precordial leads form what is essentially a smooth sigmoid curve across the chest; what could one lead tell us that’s so unique compared to its neighbors? As it turns out, in the right situation, V2 can hold some surprises when it comes to infarct localization.

For the rest of this article follow this link or click the image above.

EMS 12-Lead: The 12 Leads of Christmas – V5

This article is the ninth in our latest series, The 12 Leads of Christmas, where each day we examine a new finding particular to an individual electrocardiographic lead.

We’re getting into the home-stretch in our little series. I wasn’t entirely sure if we were going to make it through since a few of the leads, though they are useful, don’t bring much that is particularly unique to the table. V5 is one of those—like aVF and V4—and while there is still plenty to discuss, it’s not as exciting as lead III, aVL, or aVR.

Don’t lose faith, however, as I have saved three of my favorites—V2, V3, and V6—for last.

Anyway, let’s get on with this V5 business.

One of my favorite tricks for showing off to new techs (and letting them know that I’m keeping an eye on their work) is to guess that they were sloppy with their precordial lead placement without even seeing the patient. How do I do that?

For the rest of this article please follow this link or click the image above.