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well welcome to another MedCram lecture weve got another EKG that we want to go over and with this case this is a patient that presents to the emergency room via ambulance for chest pain thats been going on for about 45 minutes and this is the EKG that is done in the field you quickly review it and you notice that there is a report from the field of a ST segment depression here in the precordial leads now this was done about 10 minutes ago the patient is quickly moved into another room and an EKG is done and here is the EKG that you get lets go through our evaluation as we go through this remember our five-step process here the first thing that we want to look at is rates we can pick the easiest place to look at which is the QRS complex here for instance well look at these two and we can see here clearly that weve got one box two boxes three boxes and then four and maybe a little bit extra again lets look at another one up here we can look at the tier one two three four and a lit