Archive for November2008

Chest pain, bifascicular block, and de Winter T-waves

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EMS is called to a 82 year old male with a chief complaint of chest pain. Onset: 30 minutes prior to EMS arrival Provoke: Nothing makes the pain better or worse Quality: Severe pressure Radiate: The pain radiates to both arms Severity: 6/10 Time: No previous episodes Past medical history: Hypertension, including pulmonary hypertension Medications: Aspirin, unknown […]

Agonal breathing predicts survival from cardiac arrest

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A recent by heartwire gives an overview of: Bobrow BJ, Zuercher M, Ewy GA, et al., Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation. Published online before print November 24, 2008. Among the highlights: Someone stricken with out-of-hospital cardiac arrest might still be gasping for air, but that’s no […]

Advanced Airway Management – Should Paramedics Be Intubating?

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It’s a shame that so little attention was paid to the 2003 ACLS Reference Textbook and Experienced Provider Manual. Part of the problem was the delayed release. By the time it finally came out, everyone knew the 2005 update was around the corner. In my opinion, it was the best set of ACLS books the […]

Computerized interpretive statements and bundle branch blocks

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Here’s an ECG that I used for many years in the 12-lead ECG course for the Critical Care Transport (CCEMT-P) program. I would show it to students right after teaching them to differentiate between right and left bundle branch block. The patient is an 80 year old male who was out jogging when he experienced a syncopal […]

Transcutaneous Pacing (TCP): The Problem of False Capture

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Transcutaneous pacing (TCP) is perhaps the most underutilized and misunderstood intervention in all of ACLS. Why? Simple. Because it’s impossible to simulate during training. From the 2010 AHA ECC Guidelines – Part 8:3: Management of Symptomatic Bradycardia and Tachycardia “It is reasonable for healthcare providers to initiate TCP in unstable patients who do not respond […]

Large block method for heart rate calculation

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Some paramedics are not proficient at estimating the heart rate using the large block method for heart rate calculation. I realize that modern ECG machines calculate the heart rate, but I my attitude toward machines is similar to Ronald Reagan’s attitude toward the Soviet Union. “Trust but verify.” I created the following image using nothing […]

ACC/AHA 2008 Statement on Performance Measurement and Reperfusion Therapy

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The ACC/AHA 2008 Statement on Performance Measurement and Reperfusion Therapy was published on 11/10/08. Here are some highlights (from the prehospital perspective) with comments: “Acute reperfusion therapy, either with fibrinolytic therapy or percutaneous coronary intervention (PCI), is one of the most important treatments for patients with ST-segment elevation myocardial infarction (STEMI)…The timeliness of reperfusion therapy […]

Chest Pain and ST-Segment Elevation in Lead aVR

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EMS is dispatched to a 63 year old male complaining of chest pain. On arrival you find the patient lying supine in bed, alert and oriented to person, place, time and event. His general appearance is poor. He is pale, but not diaphoretic. Skin temp is normal. His chest pain is substernal 6/10 and non-radiating. […]

The Transition, R-Wave Progression, R/S Ratio in Leads V1-V2

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We covered the first 6 leads of the 12 lead ECG in the 6-part tutorial on axis determination, so it’s time to discuss the precordial leads (V1-V6). These are the unipolar leads that are placed directly on the patient’s chest. The heart is a 3 dimensional object, and calculating the heart’s electrical axis in the […]

Fishin’ with Fuzzy

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I apologize for my absence, but I have a good excuse! Yesterday, my crew and I took advantage of a rare opportunity to fish with the legendary Captain Fuzzy Davis! The result? Lots of fish!

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