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ECG - Opinions Needed - 91yo woman The ECG is clearly of concern. As per Christopher - could be a 1st diagonal occlusion given ST elevation in lead aVL. In addition - there is some reciprocal ST flattening in leads III, aVF. Lead V2 is definitely of concern with its q and ST elevation. That...

---------------- Sorry for my delay in responding - Yes, a picture is worth a 1,000 words - and a beauty of current cell phones is that they enable reasonable quality photos very easy on-the-scene ... There are a number of causes of T wave peaking not due to infarction - including hyperkalemia...

IF the patient has a pacemaker - then no need for Atropine. On the other hand, an AICD without lower rate regulation won't be protected. The "concept" that I would use remains the same - namely that Atropine is the drug to consider first for symptomatic bradycardia. Whether or not the QRS is...

Atropine is the drug indicated for "symptomatic bradycardia". That said - it is important to be aware of when atropine is or is not likely to work. It works best in cases of excess parasympathetic tone (ie, during the early hours of acute inferior MI). It works best for narrow QRS rhythms...

Unfortunately - ACLS has become a big (money-making) business - ergo mandating use of expensive course materials regardless of the quality and experience of those who are putting on the course. In the "old days" - we were able to tailor our courses for the needs of participants (ie, special...

Hypotension in a Patient with Pulmonary Edema Hypotension with chest pain or heart failure is a "bad sign" - especially if not due to something you can "fix" (like a tachyarrhythmia or immediately post-intubation). I'd be interested in what this patient's 12-lead ECG showed - since pulmonary...

Hypotension with chest pain or heart failure is a "bad sign" - especially if not due to something you can "fix" (like a tachyarrhythmia or immediately post-intubation). I'd be interested in what this patient's 12-lead ECG showed - since pulmonary edema with hypotension not due to new-onset rapid...

Two points: i) Whether or not there is ST segment deviation is based on the PR segment baseline. In view of this - the ST segment in lead III is clearly elevated (albeit not by a lot) - and the ST segment in lead aVF is probably also up a tad. Point ii) More important than "amount" is ST...

If I understand correctly- there was an initial hospital ECG (done an hour earlier) - that showed ST elevation in V3,V4,V5 - and then you repeated the ECG and got the following: First: - As stated by others, one cannot used ST elevation on a 1- or 3-lead rhythm strip as definitive for ECG...

Lead Placement for Monitoring Rhythm vs 12-Lead Assessment -------------------------------------------- Excellent point by Mike. When monitoring - one is principally concerned with the rhythm - so the need is primarily for good quality P wave and QRS complexes (for which torso may provide...

------------------------------------------------------ Wow- It's difficult for a newcomer to follow the energized flow of EMTLIFE conversation . . . . Re Amio - my impression is that the 30-90 day half-life following oral loading is as you say different from initial IV loading which has more...

--------------------------------------------------- At the risk of mentioning my own material - I believe it is an answer "for those who need (want) to push a bit further" - ACLS-2011-PB - ACLS: Practice Code Scenarios - ECG-2011-PB - Ken Grauer, MD

To get back to Sharktooth's original question - whether or not to hang the IV Amio drip after ROSC - I think it gets down to one's understanding of the arrest - What caused it? (if a cause can be determined ... ) - Have you "fixed" whatever predisposed to the arrest, or is it likely to recur? -...

Large ongoing discussion . . . but my Gestalt is that there MAY be a difference in the ECG when lead placement is different (torso vs limbs). A bigger question of course is how much this matters ... with the answer depending on the setting. In most cases - the difference will be minimal, and...

--------------------------------------------------------- I believe that the more you know - the better you are in your particular role (even if it is not a "decision-making role" at the scene). As stated - you get a much better idea of what is needed and what may be coming next - AND you may...

Yes - This is me. THANK YOU for your kind words - Ken Grauer, MD

Atropine for 3rd Degree AV Block (KG) ----------------------- "As with everything - there needs to be clinical correlation to answer this. The thought on Atropine as "1st line treatment" is that it is usually pretty easy to give quickly - therefore still to be considered first. That said -...

EKG Interprs Part 2 ALS Discussion Sinus rhythm - LBBB - acute inferior STEMI (with primary ST elevation in inferior leads). Reciprocal ST depression in aVL, if not I, V4. This is one for the cath lab - Ken - 72 yr old male presents to ED with SOB for 5 hrs here ya go