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Home > EMS Products > Patient Monitoring
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EMS 12-Lead
by Tom Bouthillet

Mirror on the wall

Can you interpret these ECGs?

By Tom Bouthillet

Editor's note: Check out this month's ECG case study and submit your treatment plan in the comments below. Get it right and you could win an EMS1 T-shirt and bottle opener. Good luck!

--> UPDATED: 03/31/2011 - Patient Follow-Up Posted.  CLICK HERE FOR THE ANSWER

Here's a great case submitted by a faithful reader named Joshua Nackenson, NREMT-P from New York (@MedicJosh on Twitter). Some changes have been made to preserve patient confidentiality.

EMS is called to the residence of a 68-year-old female with chest pain.

On arrival the patient is found lying in a left lateral recumbent position in the hallway outside the bedroom.

Fire department first responders are on scene and have already applied oxygen via NRB @ 15 LPM.

The patient appears acutely ill.

Skin is warm but pale and diaphoretic.

Past medical history: Hypertension, MI with stents x2 years ago
Medications: Not available at the time of assessment

The patient confirms that she is having severe chest pain.

Onset: Sudden onset while watching TV
Provoke: Nothing makes the pain better or worse
Quality: Poorly localized pressure in the center of the chest
Radiate: The pain does not radiate
Severity: 7/10
Time: 30 minutes duration with no previous episodes

Vital signs are assessed.

RR: 20
Pulse: 140 and irregular
BP: 82/42
SpO2: 100 on O2 via NRB @ 15 LPM

Breath sounds: clear bilaterally

No jugular venous distension or pitting edema is noted.

The cardiac monitor is attached.

A 12-lead ECG is captured..

What is your interpretation of this ECG? Describe your treatment plan in the comments below.

About the author

Tom Bouthillet is a Fire Captain/Paramedic with Hilton Head Island Fire & Rescue, Editor-in-Chief of the, Chief Content Architect of, host of the Code STEMI web series at First Responders Network, a member of the Editoral Advisory Board of EMS World Magazine, and developer of the 12-Lead ECG Challenge smartphone app. He has taught nationally in the Critical Care Transport (CCEMT-P) program out of UMBC and his writings have been referenced in the American Heart Journal, the Journal of the American College of Cardiology: Cardiovascular Interventions and the EP Lab Digest. Contact Tom at
The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Mauro Rodriguez Mauro Rodriguez Wednesday, February 26, 2014 5:17:12 AM Confirm its the correct 12 lead for my female pt in the scenario not male. Pt has atria fibrillation having an acute septal anterior mi c3 tx, stemi alert, ASA, withhold nitro or morphine due to hypotension, iv fluid bolus titrated to clear lungs
Peter Faulds Peter Faulds Wednesday, February 26, 2014 5:51:18 AM AF,posterior mi ,entonox for pain ,aspirin 300mg,fluid titrated to correct hypotension 02 only if spo2 on ra low contact cath if go ahead clopidogrel 600mg and heparin 5000 units and get to quickly raise legs too for hypotension
Jim Sutton Jim Sutton Saturday, July 19, 2014 12:17:23 PM A fib, new onset given hx, there is also STEL in I and V6 with reciprocal depression in septal leads, the widened QRS and negative deflection in V1 would lead me to believe there is a new LBBB and lateral/posterior ischemia. Send someone to medicine cabinet - is she on BB's for the HTN? Continue O2, venous access x 2, cardizem drip in 1and 250 ml fluid bolus in 2, repeat until pressure improves, ASA if no allergy, consider NTG once BP improves, STEMI alert and nearest cath lab. Repeat 12 lead after tx.
Jared Thompson Jared Thompson Saturday, July 19, 2014 8:26:24 PM A-fib, Posterior STEMI. ASA, Plavix, fluid bolus
Larry Moore Larry Moore Monday, July 28, 2014 10:43:28 AM A-fib with posterior STEMI. Serial 12-leads. Titrate O2 to 94%-96%, ASA 161 mg, and fluid bolus for pressure (hopefully tachycardia decreases with bolus, but I wouldn't count on it with uncontrolled a-fib). If pressure increases above 100 systolic and no contras, NTG and maybe MS for perfusion and pain. CCB (verapamil or diltiazem) for a-fib and Clopidogrel if I have......and diesel therapy (a diesel powered ride to the nearest cath-lab).

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