Spot the STEMI #1

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You have a 50/50 shot at getting this one right. Are you feeling smart… or lucky? Two 50-year-old men present complaining of chest pain x 1 hour. One patient is suffering from a very subtle acute STEMI while the other has a non-cardiac cause for his chest pain. Which patient is experiencing the subtle STEMI? […]

Conclusion to 43 Year Old Female – Chest Discomfort After Eating

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This is the conclusion to our case from last Saturday. I suggest reviewing the original case presentation before diving into the discussion here. A 43-year-old female presents feeling like there’s a knot behind her sternum. It began suddenly just after eating lunch. This is her initial ECG: There is apparent ST-elevation in leads V1–V3. The […]

“You Make the Call” — 86 Year old Female: Dizzy

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  It is a beautiful September morning when the tones go off for a 86 year old female, “altered mental status”. “Guess breakfast will have to wait”, as you and your partner head towards the residence. As you enter the one level home, you are directed to a back bedroom where you find your patient […]

43 Year Old Female – Chest Discomfort After Eating

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You respond to an office workplace for a 43-year-old female with a chief complaint of chest discomfort. On arrival you are greeted by the patient who is pleasant and well-appearing. Her skin is warm, pink, and dry and pulse strong at the radials. Respiratory effort is normal with clear lung sounds bilaterally and she does […]

I “over-diagnosed” an ECG. Maybe you should too.

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It’s important to be wrong now and then. Not just for the usual blather about being humble, understanding cognitive biases, or even nailing the Kobayashi-Maru test. No, it’s important to be wrong in the right sort of way, a willingness to be humble in the interest of patient care. Let me explain! Case #1: I […]

Nitro paste is NOT an emergency medicine drug – The Evidence

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Many paramedics argue strongly for including nitroglycerin paste as an arrow in their pharmacologic quiver when treating acute congestive heart failure. Baffles me. True, you don’t need to break the seal of the CPAP to give it, and you don’t need to use an IV. But this medication hardly belongs in the emergency department, let […]

30 Day Challenge

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Today is July 11 and I have not had a drink in 30 days. Some of you may know that my mother suffers from advanced dementia and requires round-the-clock care. She is on hospice and I have been out on FMLA leave helping with her care (which is why I missed SMACC in Chicago). This time […]

Computer misses it, but the medic catches it.

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True fact: I failed out/dropped out of grad school in mathematics. But despite having little enthusiasm for topology or complex analysis, nothing drives me more nuts than people who say stuff like “I’m not good at math – just not a math person, I guess.” This attitude is not just incorrect, it’s harmful. Most mathematics […]

Conclusion to 59 Year Old Male: Unwell

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This is the conclusion to our latest case, 59 Year Old Male: Unwell. I suggest starting there and reviewing the scenario before diving into this discussion. I was glad to see our latest case generated quite a bit of debate. This is a difficult tracing coupled with an equally difficult clinical scenario, so it wasn’t […]

59 Year Old Male: Unwell

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**UPDATE** The conclusion to this case is now posted here. It’s the middle of the afternoon when you are dispatched to the residence of a 59 year old male with a chief complaint of general illness. When you arrive on scene you encounter a middle-aged man in obvious distress, lying on a couch. He is […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Conclusion: 38 Year Old Male – Chest Pain and Leg Paralysis.
It was more informative if you did Chest X Ray for every patient with Chest pain .
2015-10-07 07:29:34
Darren Earley
Conclusion: 38 Year Old Male – Chest Pain and Leg Paralysis.
Ventricular pre excitation
2015-10-06 15:19:34
38 Year Old Male – Chest Pain and Leg Paralysis.
#3, drop BP, call chest cutter, fly pt. chest pain + neuro deficit= aortic dissection
2015-10-06 13:17:53
38 Year Old Male – Chest Pain and Leg Paralysis.
LVH with strain St depression in inf leads St elevation in avl ,v1 to v4 Here major problem is high B.P that causes focal neurological deficiet at the same time effect of hypertension on heart may results in st t changes but imp things here pain that's not responding so Aortic Disection also kept in…
2015-10-06 05:44:53
Darren Earley
38 Year Old Male – Chest Pain and Leg Paralysis.
Ventricular pre excitation.
2015-10-05 18:23:40

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