281mustang Posted May 22, 2012 Posted May 22, 2012 I have five. Here they are: 1. 2. 3. 4. 5. Gracious.
Kiwiology Posted May 22, 2012 Posted May 22, 2012 Tips Remove the name of your hospital from the ECG posting Remove your initials from the ECG before posting Very importantly remove the machine interpretation from the ECG before posting! 1 - ST elevation II, III, aVR, aVF, V4-V6; consistent with inferior ischaemia and ? anterior 2 - Concur with machine interpretation 3 - Concur with machine interpretation 5 - Do not concur with machine interpretation, looks like a poor quality ECG with a lot of artefact, some ST abnormality noted I'll get back to you on 4
paramedicmike Posted May 22, 2012 Posted May 22, 2012 Remove the name of your hospital from the ECG posting Remove your initials from the ECG before posting Very importantly remove the machine interpretation from the ECG before posting! Seriously! Do you want to get yourself fired? While the machine interpretation should always be suspect, it kinda' kills the scenario to ask us to interpret the EKG when you give us what the machine thinks it is. Are some of these from the same patient? Or are they all from different patients?
nypamedic43 Posted May 22, 2012 Posted May 22, 2012 I tried to ignore the machine interpretation...but here goes. 1. The elevation in leads II, V3, V4, V5 and V6 are just 1 box. Could be the beginning of an inferior infarct, depending on patient presentation. 2. Sinus rhythm with PAC's 3. Left Bundle Branch Block in AVF but a Right BBB in II, III and AVL. No reciprocals in the V leads though except for may V5 but its wide throughout, which leads me to maybe a fast junctional rhythm as there are few P waves. 4. Left Bundle Branch Block in III, V2, and V3 but not in any other leads. Inverted T waves. could be old ectopy or the beginning of a new problem. 5. There is too much artifact to really see but its not atrial flutter. It isnt atrial fib either as its regular. Sinus Tach with peaked t waves which leads me to think about an electrolyt imbalance or maybe sepsis. I just kind of typed out my thoughts as I was looking at them. I also ignored the bottom 3 tracings for the most part.
Bieber Posted May 23, 2012 Posted May 23, 2012 1. Regular sinus rhythm, normal axis. ST elevation in leads I, II, II, AVF, V3, V4, V5, V6. T wave inversion in V1. 2. Regular sinus rhythm with premature atrial complexes, normal axis. No ST elevation/depression. T wave inversion in leads III, AVF. 3. First degree AV block (P waves are difficult to see, but I'm catching a few of them in V5, AVF and lead II; plus the rate), normal rate, left axis deviation and a left bundle branch block. T wave inversion in leads I, AVL, V6. 4. Regular sinus rhythm with what I'm going to call a first degree AV block and possibly right axis deviation (?) and a (possibly incomplete?) right bundle branch block. No ST elevation/depression. T wave inversion in leads III, V1 (appropriate discordance), V2. 5. Lot of artifact. It's normal axis, irregular, narrow complex, tachycardic, and I'm not seeing any P waves. I would love to have a better ECG, but from this I see no ST elevation and I see ST depression in leads AVF, V3, V4, V5. I'm going to say atrial fibrillation for now.
DwayneEMTP Posted May 23, 2012 Posted May 23, 2012 1) I see no issues with the name of the hospital being on the ECG as long as it's not attached to any patient information. How would a person get fired for that? (I swear to God that if someone claims HIPAA, or even worse, HIPPA, I'm going to hunt you down and kick your balls up by your tonsils!) 2) I see no issues with the initials being on the ECG. How would a person get fired for that? (I swear to God that if someone claims HIPAA, or even worse, HIPPA, I'm going to hunt you down and kick your balls up by your tonsils!) 3) I think that it's awesome that the machine interpretation is on the ECG because many medics trust it, plus, what's wrong with it being misleading? You should be interpreting it separate from that information, shouldn't you? I think that that's an excellent lesson learned. Great thread that's way past due Biebs... Otherwise no time to take a good look at these now...
Just Plain Ruff Posted May 23, 2012 Posted May 23, 2012 HIPPA or HIPAA OH NO you are violating HIPPA or HIPAA There someone said it. Now Dwayne, you don't know where I live and besides that electricity facebook I had puts you paddling a long long time so I think I have time to prepare for your arrival to kick my balls to my tonsils so I'll wear a cup when you get here. But seriously, Biebs, great thread, and I agree with the majority on the interpretations. Plus how many medics do you know that will take the machine interp and go with it and when they get to the hospital the cardiologist will say "nope, it's actually this"? I know a lot and I've actually fallen into that trap myself. So For number 4 Biebs, can you explain how you got the discordance finding in V1? I'm a little confused how you came to that confusion as I'm not seeing it. Thanks and great thread. Bring it on Dwayne but you better start paddling. For those of you who are confused as to the paddling reference, if you aren't facebook friends with me then you wouldn't have gotten the reference.
paramedicmike Posted May 23, 2012 Posted May 23, 2012 So are Biebs and 281Mustang one in the same? I think that it's awesome that the machine interpretation is on the ECG because many medics trust it, plus, what's wrong with it being misleading? You should be interpreting it separate from that information, shouldn't you? I think that that's an excellent lesson learned. That's exactly why it shouldn't be there. So many medics look at it and blindly trust the interpretation or let their own interpretation be influenced by what the computer prints out. Remove the computer interpretation and it removes the incentive for some to "cheat". I see no issues with the name of the hospital being on the ECG as long as it's not attached to any patient information. Some of the hospitals at which I've worked or rotated through have not allowed material like EKGs with the hospital name on it released outside the facility. Is this a widely accepted industry practice? Beats me. I'm just going off my own recent experiences. I'm also a little curious what the OP, who recently posted about finding cadaver intubation sessions, is doing by posting these. What's the motivation? What's the goal? Furthering his/her own education? Perhaps. With only three posts and not a lot of background info it's hard to tell. Perhaps recent events have left me a little jaded.
Bieber Posted May 23, 2012 Posted May 23, 2012 (edited) So For number 4 Biebs, can you explain how you got the discordance finding in V1? I'm a little confused how you came to that confusion as I'm not seeing it. Sure, man. What I'm seeing in lead V1 is a QR complex about 100-120 ms wide with a T that is deflected opposite of the R wave (discordant), which is appropriate for a RBBB. Tell me what you're seeing, I could be wrong, but that's my take on this ECG. So are Biebs and 281Mustang one in the same? Nay! Sorry, folks, I'm just here to give my own take (and to look pretty), the ECG's belong to someone else. Edited May 23, 2012 by Bieber
scott33 Posted May 23, 2012 Posted May 23, 2012 Sure, man. What I'm seeing in lead V1 is a QR complex about 100-120 ms wide with a T that is deflected opposite of the R wave (discordant), which is appropriate for a RBBB. Tell me what you're seeing, I could be wrong, but that's my take on this ECG. I agree. I will add that number 2 does look a little 'strainy'. A little unusual though given the absence of the large QRS' often found with strain pattern.
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