Guest guest Posted February 20, 2010 Report Share Posted February 20, 2010 Nope. All the leads are in the right place. Here are some more hints! There is a 1st degree block. There is ST depression in II, III, and AVF, V3, V4, V5, and V6. T waves are inverted in aVR and aVL. There are Q waves in aVR, V1, and V2. GG Subject: Puzzler Date: February 20, 2010 8:12:42 PM MST To: " texasems-l " texasems-l > Limb lead reversal? Gene Bates Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 20, 2010 Report Share Posted February 20, 2010 Gene, Is the patient hypotensive?? I believe I saw a study awhile back in regards to aVR elevation and it involved the left main coronary artery preventing oxygenation of the left ventricle?? Not exactly sure how the septal wall is involved unless the occlusion is really high up. > Nope. All the leads are in the right place. > > Here are some more hints! > > There is a 1st degree block. There is ST depression in II, III, and > AVF, V3, V4, V5, and V6. T waves are inverted in aVR and aVL. > There are Q waves in aVR, V1, and V2. > > GG > > > > Subject: Puzzler > Date: February 20, 2010 8:12:42 PM MST > To: " texasems-l " texasems-l > > Limb lead reversal? > > Gene Bates > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2010 Report Share Posted February 21, 2010 I don't know whether the patient was hypotensive. You are correct that aVR ST elevation shows problems with the Left Maim Coronary Artery. If the LMCA is occluded, circulation to the whole left ventricle is compromised. The LAD supplies the front and bottom part of the septum. The RCA supplies the top and back of the septum. GG Subject: Re: Puzzler Date: February 20, 2010 11:40:18 PM MST To: texasems-l Gene, Is the patient hypotensive?? I believe I saw a study awhile back in regards to aVR elevation and it involved the left main coronary artery preventing oxygenation of the left ventricle?? Not exactly sure how the septal wall is involved unless the occlusion is really high up. > Nope. All the leads are in the right place. > > Here are some more hints! > > There is a 1st degree block. There is ST depression in II, III, and > AVF, V3, V4, V5, and V6. T waves are inverted in aVR and aVL. > There are Q waves in aVR, V1, and V2. > > GG > > > > Subject: Puzzler > Date: February 20, 2010 8:12:42 PM MST > To: " texasems-l " texasems-l > > Limb lead reversal? > > Gene Bates > > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted February 21, 2010 Report Share Posted February 21, 2010 STEMI - Probable poseterior septal infarct, possibly going toward the right side. Recommend a right sided 12 Lead EKG and transport patient to a facility with catherization capabilities ASAP. Pre-hospital care is limited to ASA, oxygen PRN to adequate SP02% of 95% or greater and go easy on the nitro until you get the right sided 12 Lead to verify there is no right sided infarction which would lead to significant hypotensive reaction to nitro. IV NS TKO unless hypotensive and begin with 20cc/kg boluses if systolic pressure is less than 90 mmHg or if radial pulses are not present. Further pain mangement can be conducted using morphine or other analgesic depending on hemodynamic stability of the patient. > > > > From: " Gene Bates " > > Subject: Puzzler > > Date: February 20, 2010 8:12:42 PM MST > > To: " texasems-l " texasems-l > > > Limb lead reversal? > > > > Gene Bates > > > > > > > > > > Quote Link to comment Share on other sites More sharing options...
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