The ECG in Prehospital Emergency Care

William Brady, MD Professor of Emergency Medicine, University of Virginia Charlottesvile, VA USA Korin Hudson, MD Assistant Professor of Emergency Medicine, Washington Hospital Center Georgetown University Washington, DC USA Sabina Braithwaite, MD Assistant Professor of Emergency Medicine, University of Virginia Charlottesvile, VA USA Jeffrey Ferguson, MD Assistant Professor of Emergency Medicine, East Carolina University Greenville, NC USA Steven Mitchell, MD Assistant Professor of Emergency Medicine, University of Washington Seattle, WA USA

List of Contributors ix

Foreword xi

Preface xiii

Section 1 The ECG in Prehospital Patient Care 1

1 Clinical applications of the electrocardiogram (ECG) 3
Robert C. Schutt William J. Brady and Steven H. Mitchell

2 Clinical impact of the electrocardiogram (ECG) 7
Robert C. Schutt William J. Brady and Steven H. Mitchell

3 Interpretation of the electrocardiogram – single-, multi-, and 12-lead analysis 12
Robert C. Reiser Robert C. Schutt and William J. Brady

4 Variants of the normal, lead misplacement, and electrocardiographic artifact encountered in clinical practice 17
Robert C. Reiser Robert C. Schutt and William J. Brady

Section 2 Cardiac Rhythms and Cardiac Dysrhythmias 23

5 Cardiac rhythms with normal rates 25
Korin B. Hudson and William J. Brady

6 Narrow QRS complex tachycardia 29
Courtney B. Saunders and Jeffrey D. Ferguson

7 Wide QRS complex tachycardia 37
Michael Levy and Francis X. Nolan Jr

8 Bradycardia 44
Korin B. Hudson J. Aidan Boswick and William J. Brady

9 Atrioventricular conduction block 50
Steven H. Mitchell Korin B. Hudson and William J. Brady

10 Intraventricular conduction block: bundle branch block and other conduction abnormalities 54
Steven H. Mitchell Richard B. Utarnachitt and William J. Brady

11 Atrial and ventricular ectopic beats 62
Jeffrey D. Ferguson Michael Levy J. Aidan Boswick and William J. Brady

Section 3 Acute Coronary Syndrome and the 12-Lead ECG 67

12 Ischemic heart disease: anatomic and physiologic considerations 69
Peter Pollak Peter Monteleone Kelly Williamson David Carlberg and William J. Brady

13 Historical development of the prehospital electrocardiogram (ECG) 76
Erik Iszkula David Carlberg and William J. Brady

14 Electrocardiographic findings in acute coronary syndrome 79
Peter Monteleone Peter Pollak David Carlberg and William J. Brady

Section 4 Special Populations High-Risk Presentation Scenarios and Advanced Electrocardiographic Techniques 95

15 The electrocardiogram in the pediatric patient 97
Robert Rutherford Robin Naples and William J. Brady

16 The electrocardiogram in the poisoned patient 104
Steven H. Mitchell Christopher P. Holstege and William J. Brady

17 The electrocardiogram in hyperkalemia 112
Steven H. Mitchell and William J. Brady

18 Life-threatening electrocardiographic patterns 117
Steven H. Mitchell Richard B. Utarnachitt and William J. Brady

19 The electrocardiogram in patients with implanted devices 122
Amita Sudhir and William J. Brady

20 Electrocardiographic tools in prehospital care 127
Robin Naples Alvin Wang and William J. Brady

21 Wolff-Parkinson-White syndrome 134
William J. Brady

22 Cardiac arrest rhythms 138
Amita Sudhir and William J. Brady

Section 5 Electrocardiographic Differential Diagnosis of Common ECG Presentations 145

23 Electrocardiographic differential diagnosis of narrow complex tachycardia 147
Megan Starling and William J. Brady

24 Electrocardiographic differential diagnosis of wide complex tachycardia 152
Amita Sudhir and William J. Brady

25 Electrocardiographic differential diagnosis of bradyarrhythmia 161
Megan Starling and William J. Brady

26 Electrocardiographic differential diagnosis of ST segment elevation 165
Megan Starling and William J. Brady

27 Electrocardiographic differential diagnosis of ST segment depression 176
Amita Sudhir and William J. Brady

28 Electrocardiographic differential diagnosis of T wave abnormalities: the prominent T wave and T wave inversions 183
Amita Sudhir and William J. Brady

Index 195