[proudmommielpn]

I am not very knowledgable when it comes to understanding EKG strips but I hope someone can help. I was listening to my scanner at home today and I heard one of the EMS squads en route to the hospital with a man that had been at a MD's office and said apparently he was having an MI. It said on the monitor he was showing tombstones. What does that mean? I just knew it didn't sound good. Anyone have a clue?

[VizslaMom]

Elevated S-T segments on an EKG are called "tombstones".
In short, it shows that there is injury to the myocardium in an Acute MI.
The reason they are called "tombstones"...well, you can figure that one out. <the sound of 'Taps' being played in the background.>

[proudmommielpn]

thanks for the help!

[dianah]

Interestingly, one of our pts post cardiac cath, still lying on the exam table, developed tombstones - no catheter was in him (just the introducer sheath, as the Cardiologists were gathered in the control area studying the images), no c/o chest pain or pressure, BP OK -- The Cards rushed out, we gave a NTG (as a reflex), they advanced a catheter to what they figured was the culprit lesion, and lo, it was open -- still stenotic, but open. The STs came back down within a minute. The Cards surmised the pt had just thrown a little emboli or placque, and then it scooted on its way. I believe they ultimately sent him for a stent. So, moral of the story is: Don't ALWAYS play taps for tombstones!
Carry on!

[VizslaMom]

Originally Posted by dianah

Interestingly, one of our pts post cardiac cath, still lying on the exam table, developed tombstones - no catheter was in him (just the introducer sheath, as the Cardiologists were gathered in the control area studying the images), no c/o chest pain or pressure, BP OK -- The Cards rushed out, we gave a NTG (as a reflex), they advanced a catheter to what they figured was the culprit lesion, and lo, it was open -- still stenotic, but open. The STs came back down within a minute. The Cards surmised the pt had just thrown a little emboli or placque, and then it scooted on its way. I believe they ultimately sent him for a stent. So, moral of the story is: Don't ALWAYS play taps for tombstones!
Carry on!

OK, so maybe no Taps in the Cath Lab then.

[dianah]

lol, ViszlaMom!

[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...

[paraloco]

Originally Posted by proudmommielpn

I am not very knowledgable when it comes to understanding EKG strips but I hope someone can help. I was listening to my scanner at home today and I heard one of the EMS squads en route to the hospital with a man that had been at a MD's office and said apparently he was having an MI. It said on the monitor he was showing tombstones. What does that mean? I just knew it didn't sound good. Anyone have a clue?

I've been a paramedic 17 years plus change, have only seen the tombstone phenomena in the field once.

[Biffs25]

For other EMS/Fire people, the tombstone ST segments look amazingly similar to a fire helmet...check it out next time you see someone with it. Not that i hope you have a patient in that bad of shape anytime soon...good luck, stay well, happy holidays....

[Angie O'Plasty, RN]

You might find this story informative. Another source of the tombstone EKG, with pictures.

http://www.acc.org/education/online/...1/Nov03_01.htm