1what are the indications in the cardiac ischemia medical directive?
suspected cardiac ischemica
2what are the conditions for ASA in cardiac ischemia?
Age: > = 18
Loa: unaltered
Other: needs to be able to chew and swallow
3what are the conditions for nitroglycerin in cardiac ischemia?
Age: > = 18
Loa: unaltered
Hr: 60-159 bpm
SBP: normotension (at all times)
other: prior history of nitro or IV acess obtained
4what are the contraindications to ASA ?
- allergy or sensitivity
- current active bleeding
- asthmatic with no prior use
-CVA OR TBI in last 24 hours
5what are the contraindicitions for nitroglycerin in cardiac ischemia?
- allergy or sensitivty to nitrates
-phosphodiesterase inhibitor use in last 48 hours ( pulmonary hypertension)
- SBP drops by 1/3 or more post administration
- 12-lead show right ventricular MI
6what is ASA's route, dose, max single dose, dosing interval and max number of doses?
route: PO
dose: 160-162 mg
max single dose 162 mg
dosing interval : n/a
max number of dose: 1
7what is defined as normotension
systolic of 100 mmHg
8After a STEMI has been positivly identified on a 12-lead what is the immediate next step?
apply d-fib pads
9What are nitroglycerin's (cardiac ishechemia) route, dose, max single dose, dosing interval, and max number of doses in an NSTEMI?
route: SL
dose: 0.3 or 0.4 mg
max single dose 0.4 mg
dosing interval: 5 minutes
max # of doses: 6
10What are nitroglycerin's (cardiac ishechemia) route, dose, max single dose, dosing interval, and max number of doses in an STEMI?
route: SL
dose: 0.3 or 0.4 mg
max single dose 0.4 mg
dosing interval: 5 minutes
max # of doses: 3
11Pertaining to max doses of ASA and nitro, if you were told by dispatch that a patient took ASA or nitro prior to arrival, are those counted in the max number of doses?
no, always assume there incompetent
12what 3 factors does myocardia o2 supply depend on?
- coronary blood flow
- diastolic time
- coronary artery patency
13what is the proces from unstable angine to a infarct?
plaque rupture -> thrombus -> supply/demanfe mismatch -> ischemua -> infarct
14what is the goal time to do a 12-lead after patient contact?
6 minutes
15Before administering nutriglycerin in a STEMI what needs to be verified?
V4R ( no right side involvment)
16Where is V4R placed?
5th intercostal place, right midclavicular line
17Why do right ventricular infarcts crash after nitro administration (theoretically)?
preload dependent - nitro venodilation causes severe refracotry hypotension
18what is ASA's max theraputic index?
1500 mg
19what are two abnormal ischemia mimics?
aortic disection and PE
20What is ASA's onset, peak effect, and duration?
onset: 5-10 min
peak effect: 30 min
duration: life of a platelet (7-10 days)
21What is ASA mechanism of action?
Irreversibly inhibits COX-1 in platelets, blocking thromboxane A2 production, leading to no platelet aggregation
- limits clots growth + helps preserve blood flow that is present
22what are the adverse effects of ASA?
- gi upset
- increased bleeding risk
- bronchospams
- tinitus
23why to we have patients chew ASA tablets?
- increases surface area + speed of absortion ( bypassing first pass metabolism)
24What is cardiac ischemias patho?
O2 supply + demand inbalance
- Na+/K+ pump fails -> cells swelling + extra K
- symptomatic pain
25what is nitroglycerins onset, peak effect, and duration?
onset: 1-3 minutes
peak effect: 5 min
duration: 20-30 min
26what is nitroglycerin's MOA during cardiac ischemia and why is its MOA important?
converts to nitric oxide inside the vasculature ->
- vasodilation of smooth muscle
-reduced preload + afterlod
all above reduces myocardial demande
27what are the adverse effects of nitroglycerin?
-heache
- hypotension
- reflex tachycardia
- flushing/dizzines
28what occurs if you mix phosphodiesterase inhibitors and nitrates?
profound, sudden hypotension (low blood pressure) that can precipitate heart attacks or strokes
29how should you have a patient positioned when giving nitro?
laying down due to sudden blood pressure drop
30define cardiogenic pulomnary edema?
fluid backing up because left ventricle can't keep up with venous return
31What is the patho behind ACPE?
left ventircle dysfuntion causes fluid to back up into pulmonary veins/capillaries
-> increased capillary hydrostatic pressure exceeds plasma oncotic pressure -> fluid move into alveoli
32What two things need to be reases after every nitro dose in ACPE?
- Lungs
- BP
33define non-cardiogenic pulmonary edma?
fluid accumulation in the lungs caused by damage to the small blood vessels
34why is non-cardiogenic pulmonary edema not treated with nitro?
capilary leak issue not backwards pressure issue
35in the case of ACPE, if nitro drops the SBP what can be done to increase the pressure ( with crackles)?
- fluid bolus and no further nitro
36what is nitroglecerins MOA in ACPE?
venodilation rapidly reduces preload on left ventricle, pulling fluid pressure down and out of pulmonary capilaries
37what does a severe case of ACPE look like?
pink forthy sputum + pt gasping at the door + rapid decline over hours
38what are the indications in acute pulmonary edema?
-modereate to severe respiratory distress
-suspected ACPE
39What are 4 conditions that can mimic ACPE?
- cardiogenic pulmonary edema
- asthma
- pneumonia
- COPD
40what are the conditions to give nitro glycerin in ACPE?
age: > or = 18 year
HR: 60- 159 bpm
SBP: normotension
41what are the contraindication to nitroglycerin in ACPE?
-allergy or sensitivity
- phosphodiesterase inhibitor in last 48 hours
- SBP drops 1/3 or more post nitro use
42what is nitroglycerins (ACPE) route, dose, max single dose, dosing interval and max number of doses with someone who bp is between 100-140 and HAD PRIOIR IV ACESS?
route; sublingual
dose: 0.3-0.4 mg
max single dose: 0.4 mg
dosing interval: 5 minutes
max # doses: 6
43what is nitroglycerins (ACPE) route, dose, max single dose, dosing interval and max number of doses with someone who bp is over 140 and DOES NOT HAVE PRIOIR IV ACESS?
route; sublingual
dose: 0.3-0.4 mg
max single dose: 0.4 mg
dosing interval: 5 minutes
max # doses: 6
44what is nitroglycerins (ACPE) route, dose, max single dose, dosing interval and max number of doses with someone who bp is over 140 and DOES HAVE PRIOIR IV ACESS?
route; sublingual
dose: 0.6-0.8 mg
max single dose: 0.8 mg
dosing interval: 5 minutes
max # doses: 6
45what needs to be done after giving nitro in ACPE?
12-lead
46If a patients vitals fall outside of a directive parameter at any point can the following dose be administered?
patient can no longer recive meds, even if vitals normalize again
47Do the ACPE and cardiac ischemia nitro directives stack?
no they do not
48what are some atypical presentations of STEMIs and who would present with them?
-nausea, fatigue, jawack pain, no chest pain
- women, diabetics, elderly
49Is a 12-lead needed prior to the first dose of nitro in ACPE?
no
50What are the indication for cardiogenic shock?
STEMI postive 12 -lead
AND/OR
Cardiogenic shock
51What are the conditions for a fluid bolus in cardiogenic shock?
> or = 18
SBP: hypotensive
other: clear chest auscultation
52What are the contraindications for a fluid bolus in cardigenic shock?
- fluid overload
- SBP = 90 mmgh
53What is a fluid bolus (cardiogenic shock) route, dose, reassesment interval and max volume?
route: IV
Dose: 0.9 NaCL at 10 mL/kg
reasses: every 250 mL
max volume: 1000 mL
54what drug can ACP give in cardiogenic shock to raise BP?
dopamine
55define cardiogenic shock?
failure to meet hemodynamic demands, aka pump problem secondary to STEMI
56what are early signs of hypoperfusion?
cool, molttled extremities, delayed cap refill
57what is the RED RULE of medication administration?
Zero-Tolerance Protocol: Mandatory 2-person independent double-check (or deliberate verbalized self-check if solo) before drug administration.
• Verify "7 Rights": Right Patient, Drug, Dose, Route, Time, Expiry/Integrity, Contraindications/Allergies.
• Stop the Line: Either provider must pause administration if any discrepancy or ambiguity exists.
58What are the indication for supraglottic airway directive?
need for ventilatory assisting or airway control
OR
airway control is ineffective
59what are the conditions for a supraglottic airway?
absent gag reflex
60what are the contraindications of a supraglottic airway?
- airway onstruction by foriegn object
- known esophageal varices
- trauma to the oripharynx
- cautic ingestion
61what are the max supraglottic airway insertions attemps?
2
62What are the 3 methods to confirm supraglottic airway placement?
- etco2
- auscultaion
- chest rise
63what are the indications for the bronchoconstirction directive?
respiratory distress
AND
suspected bronchoconstriction
64What are the conditions for salbutamol (bronchoconstriction)?
None
65What are EPIS conditions (bronchocontriction)?
RR: BVM ventilations
other: history of asthma
66What are dexamethasone conditions (bronchoconstriction)?
history of asthma
COPD
20 pack-year smoking
67What are the contraindications for salbutamol (bronchoconstriction)?
allergy or sensitivty
68what are EPIS contraindications ( bronchoconstriction)?
allergy or sensitivity
69what are dexamethasones contraindications (bronchoconstriction)?
-Allergy or sensitivity
- on PO or parenteral steriods
70Salbutomal by inhaler (Pt weighs < 25 kg) what is the dose, max single dose, dosing interval and max doses?
Dose: up to 600 mcg (6 puffs)
Max single dose: 600 mcg
Interval: q5–15 min PRN
Max doses: 3
71Salbutomal by inhaler (pt weighs > or = 25 kg) what is the dose, max single dose, dosing interval and max doses?
Dose: up to 800 mcg (8 puffs)
Max single dose: 800 mcg
Interval: 5–15 min
Max doses: 3
72Salbutamol by neb (pt weighs < 25 kg) what is the dose, max single dose, dosing interval, and max doses?
Dose: 2.5 mg
Max single dose: 2.5 mg
Interval: 5–15 min
Max doses: 3
73Salbutamol by NEB (pt weighs > or = 25 kg) what is the dose, max single dose, dosing interval and max doses?
Dose: 5 mg
Max single dose: 5 mg
Interval: 5–15 min
Max doses: 3
74Epi for bronchoconstriction, what is the route, dose, concentration, max single dose and max doses?
Route: IM
Dose: 0.01 mg/kg
Concentration: 1 mg/mL (1:1,000)
Max single dose: 0.5 mg
Max doses: 1
75Dexamethasone for bronchocontriction, what is the routes, dose, max single dose, dosing interval and max doses?
Route: PO / IM / IV
Dose: 0.5 mg/kg
Max single dose: 8 mg
Dosing interval: N/A
Max doses: 1
76When is nebulizing contraindicated in bronchoconstriction?
- known/suspected fever ( where known respiratory febril illness outbreak)
77When administering salbutamol MDI, the rate of administration should be ___?
100 mcg approximately every 4 breaths.
78when ventilating a patient with asthma how should it be done?
-6-8 small breaths a min
1:6 ratio
79what is the target ETCO2 targer or exceptable ETCO2 for an asmathic?
50-60 mmhg
80do anabolic steroids or hormone replacement count as a steriod containdication for dexamethazone?
no only cortico steriods
81define silent chest?
quiet chest due to air trapping
82what is salbutomols onset, peak and duration?
onset: under 5 min
peak: 30 min
duration: 3-6 hours
83what is EPIs onset, peak and duration for IM (bronchoconstriction + allergic reaction)?
IM - onset: 3-10 min, peak: 20 min, duration: 20-30min
84what is EPIs onset, peak, duration NEB ( bronchoconstriction)?
NEB- onset: 3-5, peak: 5-20 min, duration: 1-3 min
85what is dexamethasone onset, peak, duration (PO/IV/IM)?
onset: PO 30 min/ IV rapid
Peak: 1–2 hrs (PO)/30-120 mins (IM)/5-10 mins (IV)
Duration: 36-72 hours
86what is diphenhydramine's onset (IM/IV), peak, and duration?
Onset: 30-60 min (IM), 5-10 min (IV)
peak: about 2 hours
duration: 10-12 hours
87what is the patho for bronchoconstriction?
narrowing of the bronchi and bronchioles caused by the contraction of surrounding airway smooth muscle from mast cells releasing histamine.
88what is the patho of croup?
viral or bacterial invation of upper airway epithelium causing diffuse edeme + stridor
89what is the patho of anaphylaxis?
Windspread mast cells release causing massive vasodilation leading to capillary leakage, distributive shocks, bronchospasm, and laryngeal edema
90define dead space
inhaled air that undergoes no gas exchange
91define stable vs unstbale angina?
stable: fixes plaque
unstable angina: plaque rupture with partial clot
92define an NSTEMI?
partial occlusion causing necrosis, st depression, and t-wave inversion
93define a STEMI
total occlusion causing necrosis, ST elevation in 2 contigioud leads
94Explain the phases of an electrical system of cardiac cells.
Phase 4 (resting): -90 mV
Phase 0 (rapid depolarization) - Na goes in and bring to +20/30
Phase 1 (early repolarization): Na shuts, drops to 0mv
Phase 2 (plateau): Ca in K out, holds at 0mv
Phase 3 (repolarization) : Ca shuts, K keeps going out, leads to final back at -90mv
95how do ACE inhibitors work in heart failure?
blakc angiotensin 2 + aldosterone, decreasing afterload + preload and stoping structural ventircular remodeling
96how do beta blockers act in heart failure?
block sympatheic overdirve therefore lowering HR + myocardial 02 demande, increases filling time, protectign againts fatal arrhythmias and reverses remodling
97what are the signs of left sided heart failure?
-fluid back up into the lungs
- crackles
- orthopnea
- pink frothy sputum
- SPO2 drop
98what are the signs of right sided heart failre?
-fluid back up into the body
- JVD
- peripheral pitting edema
- weight gain
99what are the effects of Adrenergic receptor effects on the heart and which receptor primarily works on the heart?
B1 primary -80%
increased chronotrophy (HR)
increased Inotropy (Contractility)
increased Dromotropy (AV Conduction Speed)
increased Lusitropy (Relaxation Rate)
100what are causes of prehospital death after MI?
- Lethal Arrhythmias (V-Fib / pVT)
- Pump Failure:
- Mechanical Rupture:
- Papillary Muscle Rupture
101what are the indication for the moderate to servere allergic reaction directive?
-exposure to possible allergen
AND/OR
- signs/symtoms of modereate-severe allergic reactions
102what are the conditons for EPI ( allergic reaction)?
anaphylaxis only
103what are the conditions for diphenhydramine ?
weight more the 25 kg
104what are the contraindications for EPI ( allergic reaction)?
allergy or sensitivity
105what are the contraindications of dyphenhydramine?
allergy/sensitivty
106what is EPIs (allergic reactions) route, dose, max single dose, dosing interval and max number of doses?
route - IM
dose - 0.01 mg/kg ( round to nearest 0.05 mg)
max single dose - 0.5 mg
dosing interval - minimum 5 minutes
max # doses - 2
107what is diphenhydramiens ( > or = 25 kg to < 50 kg) route, dose, max single dose, dosing interval, and max number of doses?
route - iv/im
dose - 25 mg
max single dose - 25 mg
dosing interval : N/A
max # doses - 1
108what is diphenhydramiens ( > or = 50 kg) route, dose, max single dose, dosing interval, and max number of doses?
route - iv/im
dose - 50 mg
max single dose - 50 mg
dosing interval : N/A
max # doses - 1
109what is the prefered site for EPIs IM injection?
anterolateral mid thigh
110what are the signs of anaphylaxis pertaning to each body system relevant?
skin: hives, itching, flushing, swelling, angioedema
cardio: increased HR, decreased BP, syncope, decreased LOC, hypoxia
resp: SOB, wheeze, cough, stridor
GI: cramping, nausea, vomiting, diarrhea
111when can anaphylaxis only involve one system?
hypotension and severe resp
112define a biphasic reaction and what is its timeline
inital reaction meeting anaphylaxis criteria, then asymptomatic period followed by return of symptoms without further exposure
- 1-48 hours later
113how do beta blockers effect EPI?
may have a blunted responce and pt will require more dosing
114what is salbutomals MOA?
selectively binds to B2 receptros on bronchial smooth muscle
115what are salbutomols adverse effects?
-reboud tachycardia
- palpitations
- hypokalemia
116what is EPIs MOA?
stinulates alpha 1, beta 1, and beta 2
117what are EPIs adverse effects?
-tachycardia
- hypertension
- anxiety
-headache
118what is dexamathasones MOA?
binds intracellular altering gene transcription and supressing inflammation
119what are dexamethasones adverse effects?
- hyperglycemia
120when is diphenhydramines MOA?
blocks H1 receptors and crosses BBB
121what are diphenhydramine adverse effects?
-sedation
-dry mouth
- mild hypotension
122what are the indications for the croup directive?
currenty history of upper respiratory infection
AND
barking cought/ recent history of barking cough
123what are the conditions for EPI (croup)?
age: 6 months - 8 years
HR: under 200 bpm
Stridor at rest
124What conditions for dexmathazone ( croup)?
age : 6 months - 8 years
LOA: unaltered
125what are the contraindications for EPI (croup)?
allergy/sensitivity to epi
126what are the contraindications for dexamethasone (croup)?
- allergy or sensitivty to steriods
- steriod recived within the last 48 hours
- unable to tolerate oral meds
127what is EPI (croup) (< 10 kg) route, dose, max single dose, dosing interval and max number of doses?
route: NEB
dose: 2.5 mg
max single: 2.5 mg
dosing interval: N/A
max # doses: 1
128what is EPI (croup) (> or = 10 kg) route, dose, max single dose, dosing interval and max number of doses?
route: NEB
dose: 5 mg
max single: 5 mg
dosing interval: N/A
max # doses: 1
129what is Dex (croup) (6 months - 8 years) route, dose, max single dose, dosing interval and max number of doses?
route: PO
dose: 0.5 mg/kg
max single: 8 mg
dosing interval: NA
max # doses: 1
130what differentiates treating with epi and dex or just dex for croup patients?
stridor present at rest + retractions qualifies for both
131what is nebulized EPIs onset, peak, duration?
onset: minutes
peak: 10-30 min
duration: about 2 hours
132what is the pediatric weight formula for med math calculations?
weigth(Kg) = (age x2) +10
133what are the suction directives indications?
PT with ETT, SGA, or trach
AND
airrway obstruction or increased secretions
134what are the conditions for suctioning throught an SGA port?
- known/suspected gastric secretions/emesis after placement
OR
- persistent difficult ventilations despite other efforts
135what are the conditions for ETT suctioning?
none
136what are the conditions for emergency tracheostomy reinsertion?
patient with existing trach where the inner/outer cannula(s) have been removed
AND
Respiratory distress
AND
Inability to adequetly ventilate
AND
paramedics are presents with a cannual identified as the patients
137what are the contraindications to emergency tracheostomy re-insertion?
inablity to landmark or visualize the stoma
138what are the max reinsertion attemps in emergency tracheostomy?
2
139What are the suctions pressue for a PT (< 1 year, > or = 1 to < 12 years, and > and = 12) in ETT and SGA?
<1 - 60-100 mmgh
> or = 1 to < 12 - 100-120 mmhg
> or = 12 - 100-150 mmhg
140what is the max time a suction can be done with an ETT and what is the interval between suctions?w
10 seconds with a 1 minute interval between
141what is the max time a suction can be done with an SGA ?
-until fluid disappears
OR
- after 15 seconds of no fluid return
142what are the CPAP indications?
severe respiratory distress
AND
signs/symptoms of ACPE or COPD
143what are the conditions for CPAP?
> or = 18
RR: tachypnea
SPB: normotension
SPO2: under 90%
OR acessory muscle use
144what are the 7 contraindications of CPAP?
1. asthma exacerbatin
2. suspected pneumothorax
3. unprotectedntable airway
4. major traumaurns to head, neck, torso
5. tracheostoma
6. inability to sit upright
7. unable to cooperate
145what is CPAP initial setting, how much can you increase the pressure and at what time intervals and what is the max setting?
intial: 5cm h20
increase: 2.5 cm h20 every 5 minutes
max: 15 cm h20
146what is CPAP FiO2 settings?
inital: 50-100%
increaseL=: when SPO2 under 92%
max: 100%
147how does CPAP work?
recruits collapsed alveoli, improves oxygenation, reduces work of breathing
148how often should CPAP be reased?
5 minutes
149what are the tachydysrhythmia indications?
symtomatic tachydysrythmia
150what are the conditions for the valsalva maneuver?
age: > or = 18
LOA: unaltered
HR: > 150 bpm
SPB: normotension
other: narrow complexegular
151what are the contraindications to the valsava manuver?
-sinus tach
-a-fib
-a-flutter
152what are the max attemp at the valsava manuver?
2 attemps
153what are the steps to preforming the valsava manuver?
1. place pt sittign againts couch
2. have them make a seal arounf a 10 ml syring
3. have them blow as hard as possible for 15 seconds on said syringe
4. you +partern turn them legs up
5. repeat if unsucsesfull
154what is the Valasava's MOA?
forced expiration against a closed glottis raises intrathoracic pressure, leading to slowing AV conductions
155what are complications to the valsava manuver?
- rupture of ear
- lightheadedness,dizzines, syncope
-chest pain
- nausea/vomiting
156if you sucessfully convert a patient out of SVT with valsava and then they re-convert, how many attemps do you have at valsava again?
a new 2
157what are the treat and discharge patient criteria post tachydysrythmia?
- age 18-65
-prior history of SVT
- narrow complex regular SVT
- only single SVT episodes
- returned to NSR and asymtomatic
- normal LOC
-norval nitals
-not pregnant
- not related to alchool/subsatcne withdralws
- no fever/preceding ilness
158what are additional criteriea to the treat and dyscharge post tachydysrythmia?
-responsible adults stays home 4+ hours
- questions/care plan made up
- follw up with primary care physican
-ability to call 911 back
- consent to discharge
159what are TXA indications?
suspected hemmorhage due to trauma
AND/OR
hymodynamic instablity
160what are the conditions for TXA?
> or = 16
HR > 110 bpm or hypotension
161what are the contranidications for TXA?
-allergy/sensitivty to TXA
- 3 hours since injury or unknown injury time
- isolated head injury
162what is TXA route(s), dose, max single dose, dosing interval, and max # of doses?
route: IV or IM
dose: 1000mg
max single: 1000 mg
dosing interval : N/A
max # doses: 1
163how should TXA be prepared to be given?
add to 50 ml bad of NS and run over 5 minutes
164what is TXA MOA?
antifibrinolytic - reversibly blocks plasminogen to plasmin stablizinf fomed clots and slowing breakdown
165what is TXA onset, peak, duration?
onset: within minutes
peak: about 1 hours
duration: several hours
166what are TXA adverse effects?
hypotension
167what are the three factors of the trauma triad of death?
acidosis, coagulopathy, hypothermia ( all feed into each other)
168EPI receptor effects (alpha-1, alpha-2, beta-1, beta-2) and which one does what
clinically.
alpha1 (vasoconstriction): Increases SBP/MAP, reverses shock, and reduces upper airway edema
alpha2 (presynaptic):
beta 1: (cardiac stimulation)
beta 2 (Bronchodilation):
169what is the proper pelvic binder placement?
center the device directly over the patient's greater trochanters (the bony outer hip prominences) rather than the higher iliac crests to ensure proper circumferential compression
170what are the 5 steps for giving a sucessfull patch?
1. identify (unit/level resuqest)
1. pateint + presentation
3. treatment given
4. the ask
5. read-back
171Pertaining to inferior MI's, which leads would show it, which artery is that looking at and which side of the heart is it?
leads: II, III, aVF
Artery: right coronary artery
side: left or rigth ( always right ventricular involvment)
172Pertaining to septal MI's, which leads would show it, which artery is that looking at and which side of the heart is it?
leads: V1-V2
artery: left anterior descending
side of heart: left
173Pertaining to anterior MI's, which leads would show it, which artery is that looking at and which side of the heart is it?
leads: V3-V4
Artery: Left anterior desending
side of heart: Left
174Pertaining to lateral MI's, which leads would show it, which artery is that looking at and which side of the heart is it?
leads: I, aVL, V5-V6
artery: circumflex
side of heart: left
175which leads show reciprocal change?
III and aVL
V3-V5
176what criteria on a 12-lead would present a Left ventircular hypertrophy?
(SV2+ RV6 = > 35 mm)
aVR flipped/negative from electrical shift
Left ventricucal strain patter with ST depression
T-wave inversion in lateral leads
177what criteria on a 12-lead would show positive left bundle branch block?
Wide R-wave in I and V6
discordance (QRS+T= inverse relationship)
All QRS are wide, ugly, bizzare
M-wave/nothcingunny ears from ventricles depolarizing at different times
178what criteria on a 12-lead would show positice begnin early repolarization?
Widespread concave (smiley) ST elevation
notching/slurring art J-point early repolarization
NO reciprocal ST depression