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Disable tachy therapy with a ring magnet (if you don't have a magnet then sedate the patient). Make sure it's a regular wide complex tachyardia and not AF with BBB since AF is the most common reason for inappropriate ICD shocks. Whether or not to give an antiarrhythmic is a judgment call. I'm...

That's true. Without posterior leads showing ST-elevation you may not be able to convince ED personnel that it's a STEMI. On the other hand, ST-depression in the right precordials leads is more likely to represent posterior STEMI than anterior ischemia and in some cases acute isolated posterior...

One of the best comments I've seen in this forum.

Bifascicular block suggests that a patient with a chief complaint of syncope or chest pain may be at risk of sudden complete heart block which may not have an escape rhythm especially if the patient takes oral antiarrhythmics. On the other hand many patients live for years and years with...

Typically we associated LAD with anterior, RCA with inferior and LCX with lateral (occasionally inferior). One would think that acute STEMI would be documented as evenly distributed in the distribution of the three main epicardial coronary arteries (33%, 33%, 33%) but he reality is that the...

I'm assuming you're referring to rate control in the setting of AF/WPW. From what I've seen 99.9% of paramedics will not recognize this phenomenon in the field making it a moot point. Procainamide is a great drug but it's difficult to administer. It seems much more sensible to me to shock it if...

I'd also like to know the bandwidth. If low frequency / high pass filter is set to 0.05 Hz then my guess it pericarditis but it could be a STEMI. I'd like to see the entire 12-lead ECG but I'm also in agreement that clinical correlation is important.

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TOTWTYTR - What's up my brotha! Just for the record the pacer detector needs to be turned on for little box arrows to appear. In my experience most LP12s default to them being turned off (but of course I have no idea how this one is configured). It's the timing cycles that give the answer away...

Even with the P-wave superimposed on top, the ST-segment should be slightly depressed. If you look very carefully the J-point is elevated about a isoelectric line width above the expected position which is significant because of the very small amplitude of the QRS (rule of proportionality). In...

The rhythm strip speaks for itself but I'm certainly not going to get in an argument over it. Thanks for the interesting case!

Today is my last day of vacation in Northern Michigan and I have to come back home to the grind today. Ugh! Anyone have a suggestion for early onset post-vacation depression??? Anyway, it appears this patient has a very sick heart and a pacemaker with the lower rate limit set to just under...

That's a myth. You can conclude acute STEMI in the presence of LBBB by using Sgarbossa's criteria including the modified form suggested by Stephen Smith, M.D. of Dr. Smith's ECG Blog (serial ECGs are also helpful)...

Yes. Left atrial enlargement which implies LVH (as does the LBBB).

The Utstein template is the accepted academic standard for resuscitation research. Those who say that King County Medic One (or any of the top performing EMS systems in the United States) are somehow acting unethically or being deceitful by using it simply don't understand resuscitation research...

I'm not sure if you consider chest compressions and shocking ACLS or not but IMHO it's a mistake to move the patient unless you've achieved ROSC or completed at least four or five 2-minute cycles. What's the rush?

Meets Sgarbossa's criteria with concordant ST-elevation in the inferior leads and ST-depression in the right precordial leads but I would like to know more about the history and clinical presentation as hyperkalemia is one of the "great imitators".

With a complete block, when the atrial rate exceeds the ventricular rate we call it 3AVB. When the ventricular rate exceeds the atrial rate we call it AV dissociation. On rare occasions (for example, acute inferior STEMI with 3AVB and narrow complex escape rhythm where the block is caused by the...

I would suggest that TdP is encountered far more often than it's recognized.

Thanks for the encouragement guys! Maybe I will.