No, these are not all from the same anonymous reader! :)
EMS responds to a 58 year old male complaining of chest discomfort.
Onset: 30 min ago while mopping hot tar on roof
Provoke: Nothing makes the pain better or worse
Quality: Dull pressure
Radiate: The discomfort does not radiate
Severity: 4/10
Time: Persistent with no previous episodes
The patient is found supine on the ground appearing acutely ill and diaphoretic.
The patient was moved to air conditioned room, skin dried.
Pt denies SOB, allergies, meds, history.
GCS: 15
Vital signs:
Pulse: 66
BP: 116/78
RR: 16
SpO2: 99 on RA
BGL: 92
Breath sounds: clear bilaterally
12-lead ECG was captured.
Crew initiates CP protocol to include O2, ASA, NTG.
The patient declines intravenous access.
Vital signs remained unchanged.
The patient stated that he felt better and did not want to be transported to the emergency department.
The EMS crew was concerned about the patient's decision and spent the next 40 minutes persuading the patient to be seen at the hospital.
Finally the patient agreed.
The patient was loaded for transport, the monitor was re-attached, and en route other 12 lead ECG was captured.
Are you noticing a trend here?
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Sign in nowOutside of ectopic atrial activity (or maybe a Tp wave in 3AVB) you wouldn't normally see biphasic P-waves in III. Usually biphasic P-waves are appreciated in V1-V2.
As for incomplete-LBBB, while the QRSd is 0.10-0.12, V1/I/V6 don't really fit the LBBB morphology. Note how "fast" the initial slope of the R wave is in I and V6 showing that conduction through the left bundle probably went as designed.
I do agree: V4R, Posterior, line/labs, early STEMI notification!
You're right! The trend I was talking about is "serial ECGs".
As for the ST-depression in leads V1-V3 I think it's safe to assume it's posterior extension.
Incomplete LBBB is not present and I wouldn't get too caught up in the P-wave morphology.
The P-wave in lead II looks a little long, flat, and notched, but as a stand-alone finding it's not particularly helpful.
Tom
You don't even need me anymore! Hahaha!
Tom
To be honest I don't see anything in the first ECG that would worry me.
I'd call it non-diagnostic.
Tom
Tom