Archive for December2008

Differential Diagnosis of Wide Complex Tachycardias – Part 1

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There seems to be a lot of confusion with regard to wide complex tachycardias. For some reason, health care providers of all ranks and stripes forget the most basic rule. If it’s a wide complex rhythm (fast or slow) it’s ventricular until proven otherwise! Reasonable people can disagree as to what constitutes “proof” but you […]

Chest Pain, Dyspnea, Right Bundle Branch Block, and False Positive Acute MI

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Here’s an interesting case sent to me by Thomas Bernesser of Mint Hill Fire and Rescue. 50 year old male with an acute onset of sub-sternal chest pain and dyspnea. He states he was at rest when the sharp, tight feeling began in the center of his chest and radiated to his left side. A […]

Contiguous and Reciprocal Lead Charts

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Here are some charts to help you identify and localize acute STEMI on the 12 lead ECG. Contiguous leads What do we mean when we say leads are contiguous? Contiguous leads are next to one another anatomically speaking. They view the same general area of the heart (specifically the left ventricle). For example, these states […]

Identifying STEMI in the presence of LBBB – Sgarbossa’s Criteria Part 2

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This series has been updated and moved. Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 1 Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 2 Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 3

Physio-Control – Voices of Life Saving

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In August of 2007 I attended the Company Officer Leadership Symposium at the IAFC’s Fire Rescue International (FRI) in Atlanta, GA (which was awesome). Physio-Control had a large section on the conference floor, so I stopped by to say hello, pick up a really cool pen, and see what was new. I had an interesting […]

Identifying STEMI in the presence of LBBB – Sgarbossa’s Criteria Part 1

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This series has been updated and moved. Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 1 Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 2 Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 3

Prehospital 12 lead ECG programs

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I posted this series of questions today at JEMS Connect. Please feel free to respond here or there. Does your service perform prehospital 12 lead ECGs? Does the prehospital 12 lead ECG help determine your transport destination? Is the cath lab activated based on the prehospital 12 lead ECG? Does your program rely on the […]

Who receives the most benefit from reperfusion therapy?

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Patients with new bundle branch block receive the highest benefit from reperfusion therapy, followed by patients with acute anterior STEMI, and then acute inferior STEMI. When fibrinolytic therapy is administered to patients with ST segment depression only, we kill an additional 14 patients per 1000 treated. When fibrinolytic therapy is administered to patients with a […]

Early repolarization or LAD occlusion?

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41 year old male complaining of chest discomfort. Past medical history: Asthma Medications: Inhaler (unknown type) EMS finds the patient sitting in a chair. The patient appears acutely ill. His skin is cool, pale, and diaphoretic. Breath sounds clear bilaterally. Onset: At rest Provoke: Nothing makes the pain better or worse Quality: “Heavy” and “unrelenting” […]

Man Dies at Home After Paramedics Diagnose Acid Reflux

Thanks to Dave Statter for turning me on to this story from the Washington Post. Apparently a 39 year old male died a few hours after paramedics diagnosed his chest pain and shortness of breath as acid reflux and prescribed him Pepto-Bismol. Here’s a quote from the story. “Lolitha Givens said the firefighters asked her son […]

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