Wednesday, 28 March 2018

ECG of the Week - 26th March 2018 - Interpretation

The following ECG is from a 45 yr old male who presents following an Out-of-Hospital Cardiac Arrest (OOHCA). He regained cardiac output en route to the Emergency Department.



Click to enlarge
Rate:
  • 96 bpm
Rhythm:
 
  • Irregular
  • Nil P waves 

Axis:
  • LAD
Intervals:
  • QRS - Normal
Segments:
  • ST Elevation leads I (6mm), aVL (7mm), V6 (1mm)
  • ST Depression leads II, III, aVR, aVF, V1-5

Additional:
  • Late R wave transition

Interpretation:
  • High lateral STEMI
  • Atrial fibrillation 

What happened ?

The patient was transferred for urgent angiography and underwent stenting of a 1st Diagonal branch occlusion.
 
Further reading
 
All EM Physicians should be aware of their relevant National resuscitation guidelines.
The Australian Resuscitation Council has a set of comprehensive guidelines which can be found here:
 Here is a concise and quick review regarding some of the key considerations in a post-ROSC care plan from R.E.B.E.L.EM:
 References / Further Reading
 
Life in the Fast Lane
 
Textbook
 
  • Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.