Archive for October2009

65 year old female CC: Chest pain

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EMS is called to a hotel for a 65 year old female complaining of chest pain. On arrival, the patient is found sitting on the edge of the bed in her hotel room. She is alert and oriented to person, place, and time. Her skin is pink, warm, and dry. Onset: 30 minutes ago while […]

Update to: 78 yom CC: "Chest heaviness"

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Lots of interesting comments on this case. Here is the update. I opted to treat this patient as a presumed monomorphic ventricular tachycardia which is hemodynamically stable. I placed an 18 ga catheter in his left AC at a TKO rate. At approximately 1005 I administered 130mg (1.5mg/kg) of Lidocaine slow IV push which had […]

Left anterior fascicular block (LAFB)

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A reader by the name of Jesse contacted me and wrote: I have a question. I’m trying to learn more about fasicular and hemi blocks. I was curious if you have posted, or intend to post, any information regarding these. I understand this is all done on your free time, so no rush at all. […]

12-Lead ECG Case Studies

My department is starting a 12-lead ECG “case of the month” as part of our continuing education. Each month, I will select an ECG that was transmitted from the field and resulted in a cath lab activation. Whenever possible, I will include the “before” and “after” angiograms so that the paramedics receive feedback about the […]

False positive cardiac cath lab activations – PowerPoint

Here’s an interesting PowerPoint presentation that corresponds to a previous post. False Positive Cath Lab Activatin C R T Version from momiamd I found slide 14 to be particularly interesting. This is a topic that doesn’t get enough attention. Often the quarterly STEMI meetings go over the success stories but not the failures. It’s often […]

78 yom CC: "Chest heaviness"

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Here’s an interesting case submitted by Alex Kroeze. He is currently taking a sabbatical from blogging but was kind enough to share this interesting case with me. Here is the story in Alex’s own words. 78 year old male with a history of MI with cardiac arrest around 1975 as well as diabetes (metformin) and […]

Dr. Sanjay Gupta's "Cheating Death" series

Embedded video from CNN VideoEmbedded video from CNN VideoEmbedded video from CNN Video

Syncope, Chest Pain, and LAD Occlusion – Part 2

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This is the conclusion to Syncope, Chest Pain, and LAD Occlusion – Part 1. Let’s take another look at the 12-lead ECG. There is a regular rhythm at a rate of 60 (using the large block method there are 5 blocks between R-waves). The QRS complex is narrow at 86 ms. There are P-waves in […]

Narrow complex tachycardias – Part III

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Documenting the heart’s response to adenosine Let’s look at some different cases where adenosine was used. Rather than give you all the details about the age, gender, chief complaint, and vital signs, I’m just going to show you the rhythm strips. Right now I’m only concerned with how the heart behaves during the administration adenosine. […]

43 year old female CC: "Indigestion-like" chest discomfort

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Thanks to Jim Tarro for the following case study 43 year old female presents to EMS with “indigestion-like” chest discomfort. She states that it “feels like a previous heart attack.” Onset: Several hours ago Provoke: Antacids make the pain feel better Quality: “Indigestion-like” chest pain Radiate: The pain does not radiate Severity: She gives the […]

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