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First off, I need to see a 12-lead from this pt for further evaluation.

I see either you or your instructor is a fan of Bob Page and the "In lead two you don't have a clue" method. In lead two there is way to much missed. Better to monitor lead MCL1(V1) and get a 15 lead as 12 still leaves you blind to way to much of the heart.

Wow did I just pull all the fun out of this one? Sorry.

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Spenac, I don't know if I advocate a 15-lead on every patient. There are indications, which can be found on a 12-lead, for 15-leads.

EMS_Cadet

Where have you read that Mobitz 2 almost always originates in the bundle branches? Mobitz 2 is commonly an infranodal block, but of the his bundle above the bundle branches. .

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Edited by FL_Medic
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Spenac, I don't know if I advocate a 15-lead on every patient. There are indications, which can be found on a 12-lead, for 15-leads.

EMS_Cadet

Where have you read that Mobitz 2 almost always originates in the bundle branches? Mobitz 2 is commonly an infranodal block, but of the his bundle above the bundle branches. .

Click >>>THE ANSWER

Your link is broken!

Here is a working one:

Click >>>THE ANSWER

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Spenac, I don't know if I advocate a 15-lead on every patient. There are indications, which can be found on a 12-lead, for 15-leads.

EMS_Cadet

Where have you read that Mobitz 2 almost always originates in the bundle branches? Mobitz 2 is commonly an infranodal block, but of the his bundle above the bundle branches. .

Click >>>THE ANSWER

Actually I disagree. It costs you an extra 21 cents and an extra 30 seconds to add v4r and v8, v9. Plus there are many patients with no indications on 12 lead that end up having problems show up in one of the extra 3 leads. But even if it caught 1 person and kept you from pushing wrong drug or got them into cath lab quicker saving heart tissue that was a cheap way of helping a person survive.

Per Bob Page and sorry I don't have the link to the study he mentioned with Posterior Wall Infarction 23% had normal 12 lead but on 15 lead showed stemi.

Thats a big group of people we could miss to save so little time/money.

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http://www.medicine.nevada.edu/dept/IMNort...SKulick_001.pdf

Page 5, third point.

"Almost always located infranodal (the bundle branches), which means that the QRS duration is wide."

I do see your point and it is quite valid. I suppose you could have either.

The AHA also makes several interesting points on their website..

"This type of block [Type II second-degree AV block] most often occurs at the level of the bundle branches."

"Conducted P waves may display a normal QRS complex if the site of block is within the bundle of His, or a bundle branch block pattern if it is more distal, as in the bundle branches, which is more common."

Edited by EMS_Cadet
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http://www.medicine.nevada.edu/dept/IMNort...SKulick_001.pdf

Page 5, third point.

"Almost always located infranodal (the bundle branches), which means that the QRS duration is wide."

I do see your point and it is quite valid. I suppose you could have either.

The AHA also makes several interesting points on their website..

"This type of block [Type II second-degree AV block] most often occurs at the level of the bundle branches."

"Conducted P waves may display a normal QRS complex if the site of block is within the bundle of His, or a bundle branch block pattern if it is more distal, as in the bundle branches, which is more common."

Its moot anyhow, by my calculations the QRSd is 120ms

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