bosox2k1 Posted April 5, 2011 Share Posted April 5, 2011 So, just learned about how to read ECGs and distinguishing by ischemia, infarction and injury---however on every example we are given its always Posterior,Inferior, anteroseptal MI....I assume that MI is just myo infarction and not Myo. injury or Myo. ischemia. Even when the rules are met for ischemia or injury, it's still being labeled as MI.....is that accurate or when it's a non infarction are we supposed to write injury or ischemia out---or leave it as MI??? Trying to get some outside clarification. Link to comment Share on other sites More sharing options...
bosox2k1 Posted April 5, 2011 Author Share Posted April 5, 2011 To add on, can anyone clarify which leads should show reciprocity with each other? I have v1, v2 as showing reciprocal changes for posterior MI and II,III, avF will show reciprocal changes with I and avL...... Are there anymore, or is that it? Link to comment Share on other sites More sharing options...
andersenpa Posted April 5, 2011 Share Posted April 5, 2011 Rule #1 Never trust the machine's read! all kidding aside To me the read as MI is meant to flag the interpreting provider If you are asking how you should intepret it then just follow the criteria you mentioned The ECG machine will try to be specific about territory for injury/infarct but it will still read st segment deviations as abnormal and label them as MI regardless of ischemic vs infarct, transmural vs subendocardial etc. Link to comment Share on other sites More sharing options...
delco714 Posted April 5, 2011 Share Posted April 5, 2011 Buy dale dubin's rapid interpretation of ekgs, that'll save your life! Link to comment Share on other sites More sharing options...
andersenpa Posted April 6, 2011 Share Posted April 6, 2011 Buy dale dubin's rapid interpretation of ekgs, that'll save your life! To me, dubin didn't go into enough detail. Check out Goldbergers Clinical Electrocardiography. Link to comment Share on other sites More sharing options...
bosox2k1 Posted April 6, 2011 Author Share Posted April 6, 2011 Thanks guys, after a full night of looking over some basic ECGs, it's a lot clearer and easier to spot. Link to comment Share on other sites More sharing options...
Just Steve Posted April 6, 2011 Share Posted April 6, 2011 Please forgive me as I am into a few ounces of bourbon and enjoying the effects but I love cardiac work in a pre hospital setting. The first question that comes to mind is "are you asking about infarcs in an emergent setting or in a more post event setting? In an emergent setting, I see very little difference between infarction, (which is deprivation of oxygen to tissue) to injury (which is caused by deprivation of oxygen to tissue) or ischemia (which is caused by deprivation of oxygen to tissue). Ischemia leads to infarct which leads to injury. You can reverse ischemia, reduce injury by treating infarct. 12 lead ECG's are about 40% accurate for detecting MI's...that is because they do a GREAT job at sniffing out ST elevation MI's but have a vast number of mimicers that will hide a NON ST elevation MI (STEMI). Whenever I catch a fellow paramedic using the computer to diagnose their 12 lead for them, I chastise them once we have a private moment. When I see a higher level provider using the computer to diagnose, I dismiss the person as an incompetent idiot. (albeit, sometimes unfairly so)I do not speak to them about it, as I know my place in food chain but my point is LEARN TO READ 12 LEADS ON YOUR OWN. In the world of Reciprocal changes think of the heart in it's true 3 dimensional version. The leads are placed on an anterior aspect so there are angles of the heart that it reads through what is basically resembling a mirror. We know that in the case of acute ischemia we have ST elevation in the affected leads. If you imagine viewing that through a mirror then you could imagine how you may actually see that ST elevation as ST depression...the reciprocal change. So in your example of a posterior MI, you should expect to see ST depression in the V leads..as they are the anterior leads of the heart...the reciprocal of the posterior. So when you see elevation in some leads, with depression in leads that examine the mirrored side of the heart, it helps confirm what you already suspect. If you are discussing post MI management in an ICU or clinic setting...I have no idea. Enjoy! Link to comment Share on other sites More sharing options...
TraumawannabPAs Posted April 6, 2011 Share Posted April 6, 2011 Hope this helps for a quick reference. :) Link to comment Share on other sites More sharing options...
delco714 Posted April 6, 2011 Share Posted April 6, 2011 To me, dubin didn't go into enough detail. Check out Goldbergers Clinical Electrocardiography. Really? Gulp.. now I'm nervous! Haha. Just when I thought I had it all figured out! *sigh* Link to comment Share on other sites More sharing options...
ugh Posted April 6, 2011 Share Posted April 6, 2011 Really? Gulp.. now I'm nervous! Haha. Just when I thought I had it all figured out! *sigh* I loved Dubin's and had several cardiologists I worked with recommend it to me. Link to comment Share on other sites More sharing options...
acozadd Posted April 6, 2011 Share Posted April 6, 2011 Really? Gulp.. now I'm nervous! Haha. Just when I thought I had it all figured out! *sigh* Everything will be crystal clear for about 4 months until you think back on it and... suddenly it isn't so clear :( Link to comment Share on other sites More sharing options...
TraumawannabPAs Posted April 6, 2011 Share Posted April 6, 2011 Agree, Dubins is a good book to gain a basic understanding. If you read Goldbergers afterward you will be in good shape. ;) Link to comment Share on other sites More sharing options...
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