[Rookie]

I have been a cardiac technologist 22 years (new grad RN) and recently saw my first tombstone ST elevation. If you have seen alot of ST elevation, you know most ST elevation won't start looking like tombstone until the elevation almost equals the height of the R wave. Kind of spooky when you see it and learn what it is called. I start my new job in the cath lab tomorrow (12-28-04), hope not to see it there.

[bobnurse]

Originally Posted by Dinith88

Where i work, we generally reserve the term 'tombstones' for impressively elevated ST segements. The subtle or less impressive stuff isnt granted the ominous title...

Tombstone ST Segments are the most hyperacute stage of the MI and last very short.......Most people miss this stage and catch the MI in the latter acute stages.....

[cpeubob]

Had a patient discharged, D/C instructions given - IV out - telemetry off - waiting on family to transport, started saying "Oh my God I'm gonna die" "help me, help me" sent MONA in (Morphine,oxygen,nitro, OK not the ASA) was already on ASA. By the time (short time) she got to ICU she had "tombstone T waves" was a NSR on the floor prior to transfer. Patient saw Jesus ( I hope) two days later.

[mommatrauma]

This is what tombstones would look like on the EKG...usually seen in anterior wall MI's...Also, you can sometimes see it after you give thrombolytics...it's a reperfusion injury..usually goes away in a couple of seconds to minutes during reperfusion...

[cpeubob]

RULE #1 treat the patient not the monitor !!!!!!!!!!

[dianah]

Amen, bob!!

[Dinith88]

Originally Posted by mommatrauma

Also, you can sometimes see it after you give thrombolytics...it's a reperfusion injury.....

When discussing reperfusion patterns w/12-leads (or standard tele), you're most likely to see PVC's and other ectopic (usually ventricular) beats, rhythms, etc...rather than severe st-elevation.

And this ugly elevation can be seen anywhere the heart is injured..not just anterior...

Good picture you've posted...

[mommatrauma]

Originally Posted by Dinith88

When discussing reperfusion patterns w/12-leads (or standard tele), you're most likely to see PVC's and other ectopic (usually ventricular) beats, rhythms, etc...rather than severe st-elevation.

And this ugly elevation can be seen anywhere the heart is injured..not just anterior...

Good picture you've posted...

You are right about the PVC's and other ectopic beats...however you can also very well see severe st-elevation with reperfusion. It actually happens quite frequently...It is usually very transient however. You also can see elevation any where the heart is injured, however the classic "tombstone" appearing elevations are most frequently seen in the anterior leads.