Archive for June2014

45 year old male with “numb hands”

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This case illustrates both how good modern EMS can be at expediting emergency cardiac care, but also the challenges that still confront us. Yes, there is a “twist,” but only a small one. Note: I never saw this patient, but the ECGs and outcome were brought to my attention by a colleague, Dr K. Thrace, […]

Pediatric Pit Crew CPR

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A reader asks, “Does your Pit Crew CPR process work for pediatrics?” The answer is yes (with some minor modifications). Some things to keep in mind: Pediatric cardiac arrest is more likely to be respiratory or asphyxial so there is less emphasis on “patient’s side to first shock” as the arrest rhythm is more likely […]

Conclusion: 53 YOF with AMS: STEMI or Secondary ST-T changes?

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This is the conclusion to the previous case: 53 YOF with AMS: STEMI or Secondary ST-T changes? This female presented to the ED with Altered Mental Status (AMS), via ambulance, as STEMI ALERT, after completing approximately 3 hours of her usual dialysis. This was the 12 lead ECG provided by EMS…   We have a […]

53 YOF with AMS: STEMI or Secondary ST-T Changes?

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This is the case of a 53 year old female who presented to the Emergency Department (ED) via EMS, with Altered Mental Status (AMS). EMS was called to a local dialysis center due to the patient being unresponsive after  approximately 3 hours of dialysis. Upon arrival to the ED, the patient was unable to answer […]

The most awesome STEMI test on the internet!

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Sr. Editor Christopher Watford created an online STEMI test based on McCabe JM, et al. Physician Accuracy in Interpreting Potential ST-Segment Elevation Myocardial Infarction Electrocardiograms. J Am Heart Assoc. 2013; 2:e000268. The exam was in beta testing for a while (see this thread at EMTLife.com) but it’s ready for prime time! It was featured at the […]

Adult Pit Crew CPR – The Explicit Details

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Here is a description of Hilton Head Island Fire Rescue’s Pit Crew CPR process in bullet point form. It may help to think of it as a 4-phase process. Phase 1: Patient’s side to first shock Confirm pulselessness and announce “at patient, code blue” Start CPR – continuous chest compressions at the appropriate rate, depth, and recoil Power […]

Conclusion to Masters Case #02

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This is the conclusion to Masters Case #02: 60 Year Old Female – Chest Pain, Hx of Pericarditis. If you haven’t already done so, check out the original post there.   Your patient was a 60yo F who experienced significant 8/10 chest pain that was now down to a 1 or 2 and presented with […]

Just a paced rhythm… Or is it? Conclusion

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Ok, so I posted a 12 Lead ECG on Facebook this past Monday, June 2nd, 2014, which  generated some interesting comments and thoughts… EMS 12-Lead on Facebook: 67yom with Dyspnea and Diaphoresis  This ECG was obtained from a 67 year old male, complaining of difficulty breathing for the past 2 hours, and presented diaphoretic, with […]