Conclusion: Rate Related VS Primary ST-T Changes

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  This is the conclusion to our previous case, “RATE RELATED VS PRIMARY ST-T CHANGES“. Check it out before you read the final portion.   This was the initial 12 lead ECG obtained by EMS prior ED arrival: There is an irregularly irregular tachycardia with no signs of P waves, which the Lifepak 15 determined to […]

68 y.o. male with weakness: “Treat the monitor, not the patient?”

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A recent graduate of our hospital’s paramedic program brought this case to me. Leigh works for Stratford EMS, an excellent local service in Southwestern Connecticut. (A quick note on the specific details of the case: This patient did not necessarily come to my hospital. Additionally, several features of the case have been altered; some to […]

Rate Related VS. Primary ST-T Changes:

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A 56 year old black male presents to the Emergency Department via EMS, complaining of Chest Pressure, 10/10 pain scale. Pain started suddenly following sudden onset of palpitations, while mowing his lawn. All approximately 5 minutes prior calling EMS. Keep in mind, it was a hot and sunny day with temperature in the 90′s. He advised of prior episodes of chest pressure […]

The 360 Degree Heart – Part I

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The hexaxial reference system. If I asked you to imagine how the limb leads “look” at the heart, you would probably picture something like the image below: Notice those gaps in the limb leads? They don’t really exist. They’re an illusion. This isn’t something that is commonly emphasized when the cardiac axis is being taught, […]

Conclusion: “And then I gave her a NTG…”

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Recap: From  Part 1: A 64 y.o. woman with typical symptoms of ACS was given nitroglycerin by the paramedic. Her ECG: ECG Interpretation: As noted by many of our astute readers, there is obvious ST-segment elevation (STE) in leads III and aVF. Lead II doesn’t show much STE, but relative to the small R wave […]

64 y.o. Female with CP – “And then I gave her a NTG…”

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My apologies for the faded ECGs. Turns out the medic (a recent grad from our hospital’s program) had been carrying them in his work pants for over a week, waiting to catch me in the ED. The  patient had been brought to another hospital, but he wanted to review the ECGs with me. They had […]

Conclusion to 80 Year Old Male: Fall

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This is the conclusion to 80 Year Old Male: Fall. If you do not remember the particulars, check out the original post and then come back here to find the “answer” and summary. Case Review You arrived on scene to meet an 80 year old patient who was found on the floor after suffering what […]

“Bad heartburn” – Conclusion

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Recap In “Bad Heartburn” – 82 y.o. female without chest pain, the paramedic had obtained an ECG on an elderly woman who only complained of mild “heartburn.” An initial ECG was obtained: ECG interpretation : The degree of ST elevation is significantly higher in lead II than lead II, which usually supports an RCA occlusion. […]

“Bad heartburn” – 82 y.o. female without chest pain.

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This case is courtesy of paramedic Jason Cameron, who works for Stratford EMS in Connecticut. The ALS unit had been dispatched for an older female with “chest pain.” Upon arrival, however, the 80 y.o. patient denied any pain or pressure, and only endorsed some mild “heartburn,” localized to the epigastrium, non-radiating, and rated it at […]

Conclusion: 38 Year Old Male – Chest Pain and Leg Paralysis.

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Recap In the post yesterday , the paramedic crew was evaluating a 38 y.o. male who had sudden, severe chest pain, as well as leg numbness and paralysis, and whose vital signs showed a mild bradycardia and pronounced hypertension. The ECG obtained by EMS appears to be junctional, with an unclear contribution from the SA […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

JEMS Talk: Google Hangout

Comments
Billy Bob
68 y.o. male with weakness: “Treat the monitor, not the patient?”
Well I will lean with Dave and go with more education; this is a classic sine wave EKG and with more education hopefully we all could spot this from across the door because again as Dave said this is something rarely seen in EMS if at all; this is the ONE TIME I will advocate…
2014-10-02 02:49:58
david
68 y.o. male with weakness: “Treat the monitor, not the patient?”
Looks like sine wave. QRS >.15 tall peaked T waves prolonged PRI, indicative of hyperkalemia. Calcium, bicarbonate, 50% dextrose perhaps even some albuterol, insulin at the Ed
2014-10-02 02:44:55
Hollywood Mike
68 y.o. male with weakness: “Treat the monitor, not the patient?”
ALS weakness and fall. Mental status is such that he remembers falling. I'm not going to get all excited about this tracing. I'm treating the guy for his complaint and watching him like a hawk during transport. I've seen some aberrant conduction that makes this ECG look like NSR so I'm jaded by experience (need…
2014-10-02 01:51:00
PandaMedic
68 y.o. male with weakness: “Treat the monitor, not the patient?”
It's great to see so many different points of view and styles, it's sad that so many of us are being critical and condescending towards other practitioners. Dave has a point, in that more education is needed, but there is something to be said for everyone who is here, reviewing these case studies and actively…
2014-10-02 01:45:45
Nicole G
68 y.o. male with weakness: “Treat the monitor, not the patient?”
Potassium is the most likely the problem. There are 11 drug interactions with his meds. Seven are related to potassium and/or electrolyte imbalances. Treat your patient not the monitor.
2014-10-02 01:45:08

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