Is epinephrine harmful in cardiogenic shock?

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We’re only going to focus on one facet of today’s article in our discussion, but Dr. Sean van Diepen wrote an excellent editorial that covers several other important points. [1] There is more to the paper than I’m going to dive into here, so check out his editorial if you have access around the paywall. […]

58 Year Old Male, Workout Worry

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  Your Paramedic crew is called to the home of a 58 year old male, “possible heart” Upon arrival to the home, you are greeted by the gentleman’s wife, who directs you to your patient. You find him sitting in a chair in the living room, appearing concerned, but in no serious distress. He tells […]

71 Year Old Male: Chest Discomfort- Discussion

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Here is the discussion for “71 year old male: chest discomfort” let’s review the prehospital 12 lead:     Here are the precordial leads blown up:   There is slight ST elevation in V1,  ST elevation in V2 (saddleback morphology), as well as slight ST elevation in V3 and V4. The STE in V3 and V4 […]

71 year old male: Chest Discomfort

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  This very interesting case comes from Bryan F, a Paramedic from Long Island. A 71 year old male is cooking breakfast when he experiences sudden onset of 10/10 chest discomfort. He waits 20 minutes or so for it to subside, but it does not and he calls 911. EMS arrives to find him lying […]

In Defense of Morphine (Part 2)

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Yesterday, I introduced some of the history preceding the recent Thrombosis and Haemostasis study looking at morphine in patients experiencing ST-elevation myocardial infarctions (STEMIs). [For the curious, we’ll talk about that new article in Part 3. I have to work today, so I can’t guarantee that it’ll be up tomorrow, but soon!] We started with […]

In Defense of Morphine (Part 1)

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Every time I hope this debate is going to die out, or that science will swing back toward rationality, another study gets published and throws a wrench in things. I’ll type this very carefully: There is no convincing evidence that morphine causes harm to patients experiencing ST-elevation myocardial infarctions (STEMIs). As long as there isn’t […]

50 Year Old Male: Chest Pain, Hypotension, Pulmonary Edema (Conclusion)

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This is the conclusion to Friday’s post. If you haven’t seen it, I suggest checking out the original patient presentation and ECG first. We have reproduced this case courtesy of Dr. Musa A. Sharkawi (@MusaSharkawi on Twitter). A 50-year-old man presented with sudden-onset chest pain, respiratory distress, pulmonary edema, and hypotension. This was his ECG: […]

50 Year Old Male: Chest Pain, Hypotension, Pulmonary Edema

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Physician and cardiovascular fellow Dr. Musa A. Sharkawi shared this ECG on Twitter (@MusaSharkawi) and has graciously allowed us to reproduce it here. A 50-year-old male presents with a chief complaint of abrupt-onset severe chest pain. He is pale, diaphoretic, and ill-appearing—in moderate respiratory distress with extensive biateral crackles and a low blood pressure. Further […]

What are the Essential Elements of High Performance CPR?

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Adult High Performance CPR (HP-CPR) Demo at the South Carolina Resuscitation Academy! Hilton Head Island Fire Rescue: Tim Santini, Jon Ceiply, Shane Marstiller, Sean Kavlick What is High Performance CPR? High Performance CPR typically consists of expertly performed BLS with strict attention to: Minimally interrupted chest compressions Ensuring optimal rate (100-120) Ensuring adequate depth (2 […]

Rapid Prehospital Evolution of STEMI

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82 year old male, in good physical shape, stops at a cafe for lunch after cycling for an hour. Witnesses report a syncopal episode lasting approximately 30 seconds. Patient history significant for prior MI requiring 3 stents. No other significant history. Patient denies any CP, SOB, N/V, lightheadedness. In fact, he denies any complaints at […]

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