Morning Report: 1/30/2014

Dr. Freedman is back again with another Morning Report!

To “P” or not to “P”

Ddx for a regular, fast, narrow (or not) rhythm?

• ST
• AVNRT
• AVRT
• AVRT
• A Flutter
• A Tach
• +/- Abberancy

What’s the atria doing and Where to look?

Diagnostic tools at our disposal

• Adenosine
• Altered velocity recordings
• The Lewis Lead

The Lewis Lead

• Described by Sir Thomas Lewis in 1937
• To amplify atrial oscillations during A Fib
• How to make it?
  • Get comfy with your ECG machine
  • Move RA to R 2^nd IC space
  • Move LA to R 4^th-5^th IC space
  • Voila, new lead 1, the Lewis Lead
• Any data?
• • Case reports and 1 prospective cohort

Reference:

• Lewis T. Auricular fibrillation. In: Clinical Electrocardiography. 5th ed. London, UK: Shaw and Sons; 1931: 87–100.
• Bakker AL, Nijkerk G, Groenemeijer BE, Waalewijn RA, Koomen EM, Braam RL, et al
• The Lewis lead: making recognition of P waves easy during wide QRS complex tachycardia. Circulation 2009;119:e592.
• http://emcrit.org/wee/lewis-lead/

The following two tabs change content below.

• Bio
• Latest Posts

Jay Khadpe MD

• Editor in Chief of "The Original Kings of County"
• Assistant Professor of Emergency Medicine
• Assistant Residency Director
• SUNY Downstate / Kings County Hospital

Latest posts by Jay Khadpe MD (see all)

• Save of the Month! December 2015 - December 23, 2015
• Morning Report: Unprovoked First Seizure in Adults - September 11, 2015
• Morning Report: Extramural Deliveries in the Emergency Room - September 10, 2015