title: Prehospital diagnosis of ST-segment elevation myocardial infarction using an "all-posterior" 12-lead electrocardiogram.
abstract: A prehospital 12-lead electrocardiogram (ECG) is commonly used for patients with suspected ST-segment elevation myocardial infarction (STEMI). This case report describes how paramedics diagnosed inferior STEMI with all ECG leads positioned on a patient's back (i.e., "all-posterior" positioning). The patient was hemodynamically stable but morbidly obese and markedly diaphoretic. Owing to severe back pain, he refused to lie in the supine position for assessment or transport. At the emergency department, a 12-lead ECG with the patient in lateral recumbency confirmed the diagnosis of inferior STEMI. This case shows that an all-posterior 12-lead ECG can be used to identify STEMI when optimal patient positioning is not possible.
authors.affiliation: Department of Emergency Medicine, Gold Cross, Mayo Clinic, Rochester, Minnesota 55905, USA. russi.christopher@mayo.edu
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Russi
authors.forename: Lucas A
authors.initials: LA
authors.lastname: Myers
authors.forename: Logan J
authors.initials: LJ
authors.lastname: Kolb
authors.forename: Kevin
authors.initials: K
authors.lastname: Steever
authors.forename: David M
authors.initials: DM
authors.lastname: Nestler
authors.forename: Mary Christine
authors.initials: MC
authors.lastname: Bjerke
authors.forename: Roger D
authors.initials: RD
authors.lastname: White
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
mesh_terms: D001416:Back Pain; D000077144:Clopidogrel; D004562:Electrocardiography / Q000295:instrumentation / Q000379:methods*; D004632:Emergency Medical Services / Q000379:methods* / Q000706:statistics & numerical data; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000188:drug therapy / Q000473:pathology; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D000077785:Tenecteplase; D013988:Ticlopidine / Q000031:analogs & derivatives / Q000627:therapeutic use; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D005343:Fibrinolytic Agents; D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D010959:Tissue Plasminogen Activator; D013988:Ticlopidine; D000077785:Tenecteplase