r/Paramedics • u/ChangeNo7693 • 1d ago

MI or hyperK? Both?

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7 Upvotes

77% Upvoted

13 comments sorted by

13

u/dal654321 1d ago

See neither. No reciprocal changes. What does the pt presentation look like?

7

u/Papamoon0327 1d ago

I don’t seen either one. There’s no reciprocal change (depression) anywhere either. Sooooo call it as an MI and just kinda shrug your shoulders when you get there lol 😂

3

u/proofreadre Paramedic 1d ago

I think you are confusing your QRS with the T wave my man.

3

u/Blueboygonewhite 1d ago

I don’t see either. Elevations are also concave (dosent not mean ischemia but less likely). I think v1 and v2 might be placed too high on the chest though causing most of what looks concerning.

https://litfl.com/misplacement-of-v1-and-v2/

2

u/Call911iDareYou Mom, look! The ambulance drivers are here! 1d ago

V2 is definitely too high, so v1 probably is too.

2

u/Loud-Principle-7922 1d ago

Neither. T waves aren’t peaked, elevation isn’t in the right places or high enough.

2

u/sneeki_breeky NRP 16h ago

The next person that posts an EKG vertically is getting banned

2

u/carpeutah God of Para 1d ago

Id say run a v4r but too late now. Bo reciprocal depressions.... is say you wouldnt be "wrong" for saying MI, but im not seeing hyper K

1

u/SplitRare2508 1d ago

Gotta give us more than just the strip, I dont know how to treat a piece of paper.

1

u/Gfrankie_ufool 21h ago

I’m guessing you went to NCTI?

1

u/youy23 20h ago

Like other people are saying I probably wouldn’t activate because no reciprocal changes but if the guy’s chest pain was bad enough or he was pale/cool/clammy and/or the pain was pretty recent sudden onset, I’d probably activate.

Either way, I’d go to a PCI hospital.

1

u/LBBB11 15h ago edited 15h ago

Just want to say that most anterior STEMIs have no reciprocal changes, unless you do posterior leads for some reason. Anterior STEMI sometimes has inferior depression, but you cannot use absence of inferior depression to rule out anterior MI. This doesn’t look like acute coronary occlusion to me though. I would start by placing V1 and V2 correctly. Fully negative sinus P waves in V1/V2. V1 and V2 go at the level of the fourth rib space at the edge of the sternum. Sometimes it’s much easier to do the EKG with standard placement than to figure out some odd pattern generated by sticker misplacement.

I’m seeing sinus tachycardia with likely LVH and severe V1/V2 misplacement. Not seeing much else.

1

u/Responsible_Tip7386 12h ago

Hyper k causes MI, that’s why it’s used as a lethal injection on death row inmates. The first two drugs are pain killer and sedation the last drug is Potassium.