59 Year Old Male: Unwell

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It’s the middle of the afternoon when you are dispatched to the residence of a 59 year old male with a chief complaint of general illness. When you arrive on scene you encounter a middle-aged man in obvious distress, lying on a couch. He is pale, gray, diaphoretic, and drowsy. He states that he has […]

How to be successful at IV therapy – some advice for paramedic students

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Image credit: Wikimedia Commons In a recent thread at EMT Life a paramedic student wrote: Just entering my 2nd semester of paramedic school. So far I’ve found the coursework to be the easiest part. Instead of being stressed over tests I’m stressed over IV’s. 170 sticks in overall my % sucks. Granted most of those […]

DNRs, Falsifying Official Documents, and Compelling Reasons

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Image credit: Billie Ward – Creative Commons I originally posted this on my personal Facebook page but there appears to be a lot of interest so I decided to post it here also. The Staten Island Advance newspaper reported on May 22, 2015: Two FDNY paramedics are accused of lying about administering aid to a dying […]

What If We’re Wrong? Prehospital ECG Interpretation

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This article is part of a special one-day EMS blogging event called the What If We’re Wrong a-Thon. Spearheaded by Brandon Oto over at EMS Basics, the WIWWAT is an exercise in self-reflection where EMS writers examine a topic on which that they’ve historically taken a strong stance, but from the opposite point-of-view. For more […]

Snapshot Case: What Happened?

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Snapshot cases are tracings where we do not have good patient follow-up—or sometimes even clinical information—but still feel there are points worth discussing.   This is a patient who required emergent cardioversion for unstable rapid atrial fibrillation. What happened?   Tracing shared by Rob McDonald, and emergency department nurse in Queensland, Australia.

Proficiency vs Deficiency… The Art Of Electrocardiography Analysis

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Understanding the different types of  assessments, assessment tools, and findings acquired from these assessments, are all part of proper patient care in both acute and chronic emergency medicine management, in every realm of the term “PATIENT CARE”. One of the most important tools, in both the prehospital setting and long term care, is the 12 […]

Transcutaneous Pacing Success!!! Part 2

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This is the second half of a two-part case presentation examining transcutaneous pacing. If you didn’t see yesterday’s post I highly suggest checking out Part 1 before continuing, but if you hate learning I suppose you can start here. Yesterday we examined a series of tracings that depicted transcutaneous pacing (TCP) in all its stages: […]

Transcutaneous Pacing Success!!! Part 1

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Anyone trained in transcutaneous pacing (TCP) needs to be able to identify the rhythm below instantly. It shows a patient being transcutaneously paced at 80 bpm and 125 mA on a LifePak 12 [the strip is labelled 130 mA but that refers to a point just past the end of the paper, I promise]. Well, […]

Revolutionizing Pediatric Resuscitation, JEMS Games Finals, and a Very Serious Topic #EMSToday2015

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Friday, February 27 Okay, I admit it. I’m 43 years old and I can’t party like I used to. I needed a little help yesterday morning after ZOLL SHOCKFEST. But, I had an important meeting to attend with three amazing women who keep the trains running on time at EMS Today 2015 — MaryBeth DeWitt (@dewittmarybeth), […]

Meetings, Great Classes, and Celebration! #EMSToday2015

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Thursday, February 26 My day started early (these blog posts don’t write themselves you know!) and then I was off to my first ever JEMS Editorial Board meeting. As the “new guy” I had resolved not to cause too much trouble. A.J. Heightman (@AJHeightman) was suffering a bit of laryngitis which gave everyone good-natured laugh at A.J.’s […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

JEMS Talk: Google Hangout

Comments
Jared
59 Year Old Male: Unwell
Field Dx: Uncompensated cardiogenic shock. Tachycardia caused by compensation mechanism. Probable cause: Complete heart block due to the global nature of the changes. Tx: O2 @ 15 lpm NRB and possibly CPAP if pressure rises enough, 324 ASA, amio drip, possible norepi, and diesel. Put pads on in case he tanks. Definitive Tx: Needs cathed.
2015-07-02 17:46:57
Jonas
59 Year Old Male: Unwell
CPAP. IV. Nitro if BP can be controlled. Kidneys may be in acute failure causing extra fluid, or CHF, or both. Big ole triangular looking t-waves would have me thinking calcium. Monitor to see if conditions improve with CPAP. Place pads on patient, and have help with you in the ambulance.
2015-07-02 17:17:30
Brian Brubaker
59 Year Old Male: Unwell
At a quick glance it looks like tombstones (R on T). At closer look without calipers, it appears to be accelerated ideoventricular rhythm due to complete heart block. Not enough information to go off of, so cardioverting or pacing might just kill the patient quicker than anything. Transport immediately since his sick heart could stop…
2015-07-02 05:49:02
Holden
59 Year Old Male: Unwell
I've only studied cardiology for a few months and have read Dubin's book 1.5 times so I'm not an expert by any means. However, can a possible interpretation be a junctional tachycardia with aberrant ventricular conduction and a STEMI? No P waves and aberrancy causing a slightly wide QRS (but not wide enough for V-Tach).
2015-07-02 00:50:22
James
59 Year Old Male: Unwell
This is a ugly EKG. Wide complex irregular tachycardia around 150's. A-fib and a-flutter are possibilities. He's severely symptomatic. At this point, all treatment is same, electricity. If A fib, it may not want to "shock out" easily. This may be a case where initial cardioversion at max joules would be prudent. Pulmonary edema likely…
2015-07-01 22:00:13

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