Archive for January2009

Angioplasty with Bezold-Jarisch Reflex

Entry Img

From the blog of Dr. Wes, check out this BBC news video of a STEMI patient receiving angioplasty. Interesting that he could localize his pain and the quality was “sharp” as opposed to dull. It just goes to show the limitations of the OPQRST for ACS patients. I’m assuming it was the RCA as reperfusion […]

SC Chapter of AHA Mission: Lifeline

Entry Img

I was recently invited to be on the EMS Advisory Committee for the South Carolina chapter of the AHA’s Mission: Lifeline (the AHA’s STEMI initiative). This is a collaborative partnership between the AHA, South Carolina Hospital Association, South Carolina Chapter of American College of Cardiology, South Carolina Chapter of the College of Emergency Physicians, South […]

FEMA Structural Collapse Technician Course

Entry Img

If you’re wondering why I haven’t posted anything in over a week, it’s because I was away at the South Carolina Fire Academy in Columbia, SC taking the 8-day FEMA Structural Collapse Technician Course. It consisted of: 3 days of collapse shoring 2 days of lifting and rigging heavy objects 2 days of breaching, breaking, […]

What are the indications for a prehospital 12-lead ECG?

Entry Img

The primary purpose of the prehospital 12 lead ECG is to detect acute coronary ischemia or injury in the prehospital setting. That’s not to say it’s the only purpose for a prehospital 12 lead ECG, but it’s the main reason we carry 12 lead monitors on the ambulance! Ideally, the early identification of STEMI patients […]

Differential Diagnosis of Wide Complex Tachycardias – Part 6

Entry Img

Let’s take a look at a couple of rhythms you never want to see on the monitor. First, from ABC of clinical electrocardiography – Broad complex tachycardia Part II, BMJ 2002; 324:776-779 This is an irregular and polymorphic wide complex tachycardia that appears to show a streamer effect, or “turning of the points.” Is it […]

Differential Diagnosis of Wide Complex Tachycardias – Part 5

Entry Img

Let’s switch gears a little bit and discuss irregular or polymorphic wide complex tachycardias. First I need to tell you a story. A few years ago I was teaching ACLS to a group of mostly nurses at the local community hospital. I volunteered to teach Bradycardias, Tachycardias, and the Hypotension/Shock/Acute Pulmonary Edema algorithm. At first […]

Differential Diagnosis of Wide Complex Tachycardias – Part 4

Entry Img

Let’s look at a more typical case of wide complex tachycardia. This case comes from Lt. Jason Kinley of Xenia Fire Division. Here’s the story. EMS is called for a 89 year old male with chest pain. Onset 30 minutes ago. Non-radiating. Patient is A+OX4. Skin is moist. Skin color is good. No increase in […]

Differential Diagnosis of Wide Complex Tachycardias – Part 3

Entry Img

Let’s look at another unusual case. This was the ECG of a chest pain patient in the emergency department. Let us assume for a moment that the patient is hemodynamically stable but diaphoretic and complaining of severe substernal chest pressure. What does this 12 lead ECG show? It’s a regular rhythm. The rate is 120. […]

Differential Diagnosis of Wide Complex Tachycardias – Part 2

Entry Img

By definition, a wide complex tachycardia is a heart rhythm with a QRS duration ≥ 120 ms (0.12 s) and a ventricular rate ≥ 100. When this criteria is met, and the the rhythm is regular (no variability in the R-R interval) then it’s a regular wide complex tachycardia. This is a very broad and inclusive definition […]