EKG TIPS ANYONE ?!?!

ALS AXE

ALS AXE

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What are some EKG tips that you have acquired over your career?
 
I learned that if you read a lot about them, you get better at them...

What kind of tips are you looking for?
 
This morning I had a call for ( 56 Y/OM VOMITING) c/c sudden onset 10/10 neck pain radiating to his left shoulder. The pain came on as he was working out with heavier weight than usual at the gym. As I got out of the ambulance I was approached by two people ( man and women) who said that they were the next-door neighbors who happened to be off duty Paramedics. As I walked up to the PTs house these two told me that the PT had an irregular pulse, N/V and was diaphoretic. And that they gave him 324 ASA. I found the PT inside vomiting. Assessment reveals PT A/O4, - on the CPSS, BP 189/98, P 130, R 18 non labored, 4 and 12 lead showed sinus arrhythmia bouncing between 40 and 70 BPM, PT denies any medical hx or meds. PT denies any ALOC, CP H/N/B PAIN, or any recent illness or infections. PT denies any use of drugs, alcohol or work out supplements. It turned out that my PT had a subarachnoid hemorrhagic stroke. I did some research and only 13-18 percent of strokes are hemorrhagic and of that only around seven percent of hemorrhagic strokes are subarachnoid. So I was wondering if things like these could be seen on an EKG. Although this was a low frequency call it was a big sick call. I hope this was some what clear and readable. thanks for your time/ advice.
 
The problem with looking for increased ICP on a 12 lead is this: they'll generally be showing obvious brain bleed symptoms before you see anything on the 12 lead. So it is interesting, but not a particularly useful finding (though I suppose it could help to narrow down the problem if you find someone unresponsive with no historian present).
Learn to identify common abnormalities like early repolarization and LVH so that you don't go calling STEMI alerts left and right.
 
Last edited:
ALS AXE said:
This morning I had a call for ( 56 Y/OM VOMITING) c/c sudden onset 10/10 neck pain radiating to his left shoulder. The pain came on as he was working out with heavier weight than usual at the gym. As I got out of the ambulance I was approached by two people ( man and women) who said that they were the next-door neighbors who happened to be off duty Paramedics. As I walked up to the PTs house these two told me that the PT had an irregular pulse, N/V and was diaphoretic. And that they gave him 324 ASA. I found the PT inside vomiting. Assessment reveals PT A/O4, - on the CPSS, BP 189/98, P 130, R 18 non labored, 4 and 12 lead showed sinus arrhythmia bouncing between 40 and 70 BPM, PT denies any medical hx or meds. PT denies any ALOC, CP H/N/B PAIN, or any recent illness or infections. PT denies any use of drugs, alcohol or work out supplements. It turned out that my PT had a subarachnoid hemorrhagic stroke. I did some research and only 13-18 percent of strokes are hemorrhagic and of that only around seven percent of hemorrhagic strokes are subarachnoid. So I was wondering if things like these could be seen on an EKG. Although this was a low frequency call it was a big sick call. I hope this was some what clear and readable. thanks for your time/ advice.
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I assume the ASA was given because of MONA associated with the neck and shoulder pain, diaphoresis. However with the wide pulse pressure and vomiting I would have suspected something other than an AMI. As for EKG changes associated with an intracranial bleed, they are not diagnostic or definitive. Looking for Cushing's triad coupled with symptomology associated with a bleed is more indicative than looking for EKG changes. There are possible EKG changes associated with PE (flipped T waves in V1-V4) but they don't always happen and again, aren't diagnostic.

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If you want to bite the bullet and dive into Chou's and Marriott's, there's some awesome gold-nuggets for EMS in there. Heavy reading though...but these are the definitive texts.
 
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