Check out the original post to see a collection of excellent comments on this ECG.
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| Click to enlarge |
- 90
- Regular
- Sinus rhythm
- Normal (55 deg)
- PR - Normal (200ms)
- QRS - Normal (80ms)
- QT - 320ms (QTc Bazette ~ 400 ms)
- PR segment depression leads I and II
- Upsloping ST depression (minor) leads V3 and V6
Additional:
- Abnormal R wave progression across precordial leads
- Leads V1, V2, V5 predominantly negative QRS vector
- Magnitude of 'negativity' in vector V2>V1>V5
- Leads V3, V4, V6 predominately positive QRS vector
Interpretation:
- Misplaced precordial leads
- Likely V1 & V2 swapped and V3 & V5 swapped
The ECG was repeated with the lead misplacement corrected and was normal, sorry but I didn't keep the normal ECG for this case.
The pr segment changes were old, the patient had a normal CXR, and was subsequently discharged.
Blunt Cardiac Injury
I don't want to reinvent the wheel here so I'm simple going to point to the only guideline I could find on blunt cardiac injury, in addition to some related blog / podcast posts.
- Screening for Blunt Cardiac Injury - Eastern Association for the Surgery of Trauma - EAST Website.
- Screening for blunt cardiac injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma 73:(5) Supplement 4, S301-S306, 2012. - PDF
- EMCrit Episode 9 - Blunt Cardiac Injury from EAST
- Trauma Professional's Blog - Practice Guidelines Blunt Cardiac Injury
VAQ Corner
A 28yr old male presents to your ED following a fall from 2 metres.
He complains of left chest & arm pain.
His vital signs are normal.
An ECG is performed, see above.
a) Describe and interpret his ECG ? (50%)
b) Outline your risk stratification approach to blunt cardiac injury ? (50%)
References / Further Reading
Textbook
- Chan TC, Brady WJ, Harrigan RA, Ornato JP, Rosen P. ECG in Emergency Medicine and Acute Care. Elsevier Mosby 2005.
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