EKG Practice #3

By Ray Fowler, MD
Professor of EM / EMS
UTSW / Parkland

Edited by Alex Koyfman, MD

Case #1

This 77 female presents with chest discomfort of several hours duration. She has a hx of stable angina, and she has not had any coronary intervention. On this evening, her discomfort worsened, and she called 911 and EMS responded.

En route you are contacted through BioTel that they would like for you to come and look at the transmitted ECG. They are worried that the patient may need cardioversion (see V1) or to at least go onto an antiarrhythmic drip. The following 12-lead is handed to you as you walk into the radio room. Look at V1. You have to make a decision NOW. Make your decision as to what to do.

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Case #2

An 80 year-old male presents in acute distress with the worsening of chest tightness over the last few hours of the afternoon. He has had this before, he has stable angina, he has had a previous stent placed in the LAD, and he is compliant with his daily Plavix use. The ED is packed, the triage nurse has brought him back in a wheelchair, and he speaks only Burmese. What would you do?

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