Archive for March2014

“Push Hard, Push Fast?”

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“Push Hard, Push Fast” We all know the mantra. It’s catchy. Compressions not deep enough? Push hard. Not fast enough? Push fast. Great. Except… One thing many of us have learned as professional rescuers is that the bigger issue is not pushing too slow, but pushing too fast. “But…push FAST!” I mean, faster has to be better […]

When to stop: Termination of Resuscitation in Pediatric Traumatic Cardiac Arrest

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Field termination of pediatric resuscitation is a difficult topic for EMS systems, prehospital providers, first responders, and the patient’s family. Clear guidelines exist for the termination of resuscitation of adults in cardiac arrest for both traumatic and non-traumatic etiologies, and routine transportation of adults in cardiac arrest all but guarantees poor outcomes. Unfortunately, for pediatric […]

Conclusion: 81 YOM with Chest Heaviness

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This is the recap and conclusion for the previous case: http://www.ems12lead.com/2014/03/11/81-yom-with-chest-heaviness/ Here’s the initial 12 lead ECG: What do we see? – Sinus rhythm with 1Left Atrial Abnormality or “Enlargement” – Wide complex QRS with a Right Ventricular Conduction Delay pattern or Right Bundle Branch Block (RBBB) morphology seen as rSR’ in V1 but abnormal […]

30 YOM with Chest Pressure: Reperfusion AIVR

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This the case of a 30 year old male, complaining of chest pressure 8/10 pain scale, for about a week. The patient was born with unknown cardiac complications, which led to multiple near death arrhythmias, which is why the patient has an on demand pacemaker/defibrillator in place. He also has a history of Hypertension (HTN), […]

81 YOM with Chest Heaviness

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It’s approximately 2000 hrs, right as you get comfortable in bed, when you are dispatched to a residence for Chest Pain (CP). You arrive on scene to find an 81 year old male, semifowler’s in bed, complaining of chest heaviness, 8/10, which started 2 hours ago, while in bed, watching tv. The patient also advised […]

Understanding ECG Filtering

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A common problem in ECG interpretation is the removal of unwanted artifact and noise. To help with this our cardiac monitors provide a means to filter the ECG recording. Most cardiac monitors will choose the appropriate filter based on the situation. When performing routine monitoring, where only the cardiac rhythm is important, the filters applied are known […]

Magnesium and Cardiac Action Potential

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Magnesium (Mg++) is the second most abundant intracellular ion. Normal Serum Mg++ is 1.8 to 2.5 mg/dL or .8 to 1.5 mmol/L (millimoles per liter) (This values may vary depending on sources) Keep in mind, the Mg++ concentration in the average adult is approximately 25g, but most of our Mg++ is found in bones and […]