6-Step Method for 12-Lead ECG Interpretation
New video on the 6-step method for 12-lead ECG interpretation!
Rate and rhythm
Axis determination
Intervals (PR, QRS, QT)
Morphology (BBB, IVCD)
STEMI mimics
Ischemia, Injury, Infarct
Correlate to history and clinical presentation!
(Source: EMS 12-Lead)
Source: EMS 12-Lead - November 12, 2020 Category: Cardiology Authors: Tom Bouthillet Tags: 12 lead ecg Source Type: research
80 Year Old Female: “ Rapid Heart Rate ”
You are dispatched to a nursing home for an 80 year old female with a “rapid heart rate.” You arrive on scene and the charge RN gives you report.
Per the RN, assistive staff were checking the patient’s vitals this morning when they noted her heart rate to be elevated. They consulted the RN, who found the patient to have a rapid and irregular pulse, so he in-turn consulted the nursing home physician, who requested the patient be transported to the community emergency department approximately 30 min away for further workup and management.
When you walk in the room, you find a pleasant-appearing woman sittin...
Source: EMS 12-Lead - January 22, 2019 Category: Cardiology Authors: Vince DiGiulio Tags: Cases Vince DiGiulio Source Type: research
80 Year Old Female: “ Rapid Heart Rate ”
You are dispatched to a nursing home for an 80 year old female with a “rapid heart rate.” You arrive on scene and the charge RN gives you report.
Per the RN, assistive staff were checking the patient’s vitals this morning when they noted her heart rate to be elevated. They consulted the RN, who found the patient to have a rapid and irregular pulse, so he in-turn consulted the nursing home physician, who requested the patient be transported to the community emergency department approximately 30 min away for further workup and management.
When you walk in the room, you find a pleasant-appearing woman sittin...
Source: EMS 12-Lead - January 22, 2019 Category: Cardiology Authors: Vince DiGiulio Tags: Cases Vince DiGiulio Source Type: research
Electrocardiographically Silent High Lateral STEMI Equivalent
Conclusion
“His EKG was unrevealing of acute myocardial injury current and initial troponin was negative. However, the patient had ongoing intermittent chest pain during the night despite intravenous nitroglycerin and blood pressure control and serial troponin levels have become elevated. Coronary angiography is recommended for further evaluation….”
“LCX — Left circumflex coronary artery is large in caliber, lateral wall obtuse marginal system, which is bifurcating along the lateral wall to the apex. A secondary stented branch is subtotally occluded with what appears to be left-to-left collate...
Source: EMS 12-Lead - August 11, 2018 Category: Cardiology Authors: Tom Bouthillet Tags: 12 lead ecg electrocardiographically silent high lateral stemi equivalent ischemia does not localize Source Type: research
Is epinephrine harmful in cardiogenic shock?
Discussion cites several papers which support the impression of lactate I describe above; those citations even share some authors with this trial! But this article then goes on to discuss lactate as a monitor of tissue perfusion, so I’m at a loss for where the authors actually stand.
What I do know, with reasonable certainty, is that lactate should not be the sole driver that labels patients with “refractory cardiogenic shock.” Unless the authors can provide data showing there were other factors at play, I have to throw out their argument that epinephrine caused any measurable harm in these patients with ...
Source: EMS 12-Lead - July 6, 2018 Category: Cardiology Authors: Vince DiGiulio Tags: Original Articles Vince DiGiulio Source Type: research
Is epinephrine harmful in cardiogenic shock?
Discussion cites several papers which support the impression of lactate I describe above; those citations even share some authors with this trial! But this article then goes on to discuss lactate as a monitor of tissue perfusion, so I’m at a loss for where the authors actually stand.
What I do know, with reasonable certainty, is that lactate should not be the sole driver that labels patients with “refractory cardiogenic shock.” Unless the authors can provide data showing there were other factors at play, I have to throw out their argument that epinephrine caused any measurable harm in these patients with ...
Source: EMS 12-Lead - July 6, 2018 Category: Cardiology Authors: Vince DiGiulio Tags: Original Articles Vince DiGiulio Source Type: research
58 Year Old Male, Workout Worry
Your Paramedic crew is called to the home of a 58 year old male, “possible heart”
Upon arrival to the home, you are greeted by the gentleman’s wife, who directs you to your patient. You find him sitting in a chair in the living room, appearing concerned, but in no serious distress.
He tells you that while he was excercising on his treadmill, he experienced sudden onset of chest discomfort in the middle of his chest, described only as “pain”. He also tells you that is right arm started hurting at the same time, with some “pins and needles”. Almost as an afterthought, he tells you that he immediately s...
Source: EMS 12-Lead - July 5, 2018 Category: Cardiology Authors: David Baumrind Tags: 12 lead ecg ems-health-safety ems-topics patient-management training-development Uncategorized 12-Lead ECG case study David Baumrind EMS 12-Lead ems12lead.com Paramedic sudden cardiac arrest Source Type: research
71 Year Old Male: Chest Discomfort- Discussion
Here is the discussion for “71 year old male: chest discomfort”
let’s review the prehospital 12 lead:
Here are the precordial leads blown up:
There is slight ST elevation in V1, ST elevation in V2 (saddleback morphology), as well as slight ST elevation in V3 and V4. The STE in V3 and V4 is between 1 and 2 millimeters at 60 milliseconds after the J-point. This looks like what we might see in normal variant, but we have no idea what the baseline ECG would look like, and with the patient’s presentation must be suspicious. Additionally, the T wave in V3 has a “hyperacute” feel to it.
The P...
Source: EMS 12-Lead - May 5, 2018 Category: Cardiology Authors: David Baumrind Tags: 12 lead ecg Cases ems-health-safety ems-topics patient-management Training training-development 12-Lead ECG acute anterior STEMI David Baumrind EMS 12-Lead Occlusion Myocardial Infartion (OMI) Paramedic Source Type: research
