Archive for May2009

Chest pain and acute inferior-posterior-lateral STEMI

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EMS is called to the scene of a 58 year old male complaining of chest pain. Past medical history: Dyslipidemia (high cholesterol) Medication: Atorvastatin (Lipitor) On arrival, the patient is found tripoding in a chair. He is pale, diaphoretic, and appears acutely ill. He is anxious but alert and oriented to person, place, time and event. […]

Any delay in D2B time associated with increased mortality

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Rathore SS, Cutis JP, Chen J, et al. Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: a national cohort study. BMJ 2009; 339:b1807 “Any delay in primary percutaneous coronary intervention after a patient arrives at hospital is associated with higher mortality in hospital in those admitted with […]

Data quality and computerized interpretive statements

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There’s an important caveat when it comes to the GE-Marquette 12SL interpretive algorithm. It’s highly susceptible to errors when it interprets ECGs with poor data quality. Consider the following example. I don’t know anything about the history or clinical presentation. For my purposes here, I’m only interested in the interpretive statements. First, the rhythm strip. […]

Ineffective or inappropriate ICD shocks – Part 3

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How to disable tachy therapy with a ring magnet In an effort to make sure I was giving accurate information, I contacted the “Big 3″ implantable medical device companies (Boston Scientific, Medtronic, St. Jude Medical) and asked each of them how their ICDs would react to ring magnet application. So what did I find out? […]

Ineffective or inappropriate ICD shocks – Part 2

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Discussion Inappropriate ICD shocks are not benign events. They can have profound psychological consequences for the patient, they can trigger ventricular dysrhythmias, and perhaps most importantly, they deplete the battery life of the device. Each shock reduces the battery longevity by about 30 days. Often, paramedics (and many physicians) are reluctant to disable ICDs. That’s […]

Ineffective or inappropriate ICD shocks – Part 1

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Implantable Cardioverter Defibrillators (ICDs) Once upon a time, to receive an implantable defibrillator required that you survive not one, but two episodes of sudden cardiac death. You had to have ventricular arrhythmias refractory to drug therapy, and you had to be strong enough to undergo a thoracotomy. It’s astonishing that anyone qualified for the device! […]