ECGs for the Emergency Physician 1 PDF

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ECGs for the Emergency Physician 2 PDF

Preface

Emergency and other acute care physicians must be experts in the use and interpretation of the 12-lead electrocardiogram (ECG). We have prepared this text with this basic though highly important thought in mind. This text represents our effort to further the art and science of electrocardiography as practiced by emergency physicians and other acute care clinicians.
A significant number of the patients managed in the emergency department and other acute care settings present with chest pain, cardiovascular instability, or complaints related to the cardiovascular system. The known benefits of early, accurate diagnosis and rapid, appropriate treatment of cardiovascular emergencies have only reinforced the importance of physician competence in electrocardiographic interpretation. The physician is charged with the responsibility of rapid, accurate diagnosis followed by appropriate therapy delivered expeditiously. This evaluation not infrequently involves the performance of the 12-lead ECG. For example, the patient with chest pain presenting with ST-segment elevation, acute myocardial infarction must be rapidly and accurately evaluated so that appropriate therapy is offered in prompt fashion. Alternatively, the hemodynamically unstable patient with atrioventricular block similarly must be cared for in a rapid manner. In these instances as well as numerous other scenarios, resuscitative and other therapies are largely guided by information obtained from the ECG.
The electrocardiogram is used frequently in the emergency department (ED) and other acute care settings; numerous presentations may require a 12-lead electrocardiogram. For instance, the most frequent indication for ECG performance in the ED is the presence of chest pain; other complaints include dyspnea and syncope. Additional reasons for obtaining an ECG in the ED include both diagnosis-based (acute coronary syndrome, suspected pulmonary embolism, and the “dysrhythmic” patient) and system-related indications (for the “rule-out myocardial infarction” protocol, for admission purposes, and for operative clearance).1 Regardless of the cause, the physician must be an expert in the interpretation of the 12-lead ECG. Interpretation of the ECG is as much an art as it is a science. Accurate ECG interpretation requires a sound knowledge of the electrocardiogram, both the objective criteria necessary for various diagnoses of those patients encountered in the ED as well as a thorough grasp of the various electrocardiographic waveforms and their meaning in the individual patient.
We have prepared this text for the physician who manages patients not only in the ED but also in other acute care settings – whether it be in the office, the hospital ward, critical care unit, the out-of-hospital arena, or other patientcare locale. We have used actual ECGs from patients treated in our EDs; a brief but accurate history has also been provided in each instance. In certain cases, the history may provide a clue to the diagnosis yet in other situations the clinical information will have no relationship to the final diagnosis – as is the case in the ED. We have made an effort to choose the most appropriate ECG from each patient, but as occurs in “real ED,” some of the ECGs are imperfect: the evaluation is hindered by artifact, incomplete electrocardiographic sampling, etc. We have also provided the ECGs in a random fashion, much the way actual patients present to the emergency department. We have endeavored to reproduce the reality of the ED when the reader uses this text to expand their knowledge of the 12-lead electrocardiogram and how it relates to patient care.

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