43 Year Old Female – Chest Discomfort After Eating

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You respond to an office workplace for a 43-year-old female with a chief complaint of chest discomfort. On arrival you are greeted by the patient who is pleasant and well-appearing. Her skin is warm, pink, and dry and pulse strong at the radials. Respiratory effort is normal with clear lung sounds bilaterally and she does […]

I “over-diagnosed” an ECG. Maybe you should too.

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It’s important to be wrong now and then. Not just for the usual blather about being humble, understanding cognitive biases, or even nailing the Kobayashi-Maru test. No, it’s important to be wrong in the right sort of way, a willingness to be humble in the interest of patient care. Let me explain! Case #1: I […]

Nitro paste is NOT an emergency medicine drug – The Evidence

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Many paramedics argue strongly for including nitroglycerin paste as an arrow in their pharmacologic quiver when treating acute congestive heart failure. Baffles me. True, you don’t need to break the seal of the CPAP to give it, and you don’t need to use an IV. But this medication hardly belongs in the emergency department, let […]

30 Day Challenge

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Today is July 11 and I have not had a drink in 30 days. Some of you may know that my mother suffers from advanced dementia and requires round-the-clock care. She is on hospice and I have been out on FMLA leave helping with her care (which is why I missed SMACC in Chicago). This time […]

Computer misses it, but the medic catches it.

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True fact: I failed out/dropped out of grad school in mathematics. But despite having little enthusiasm for topology or complex analysis, nothing drives me more nuts than people who say stuff like “I’m not good at math – just not a math person, I guess.” This attitude is not just incorrect, it’s harmful. Most mathematics […]

Conclusion to 59 Year Old Male: Unwell

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This is the conclusion to our latest case, 59 Year Old Male: Unwell. I suggest starting there and reviewing the scenario before diving into this discussion. I was glad to see our latest case generated quite a bit of debate. This is a difficult tracing coupled with an equally difficult clinical scenario, so it wasn’t […]

59 Year Old Male: Unwell

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**UPDATE** The conclusion to this case is now posted here. 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 […]

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 […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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EMS 12-Lead: Transcutaneous Pacing Success!!! Part 1 - The Medial Approach
Transcutaneous Pacing Success!!! Part 1
[…] For the rest of this article click the rhythm strip above showing false capture or follow this link. […]
2015-09-05 10:45:00
EMS 12-Lead: Transcutaneous Pacing Success!!! Part 2 - The Medial Approach
Transcutaneous Pacing Success!!! Part 1
[…] 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 […]
2015-09-05 10:35:18
EMS 12-Lead: Snapshot Case - What Happened? - The Medial Approach
Snapshot Case: What Happened?
[…] for unstable rapid atrial fibrillation. For comments and discussion of this tracing follow this link or click the rhythm strip […]
2015-09-05 10:27:26
EMS 12-Lead: 43 Year Old Female - Chest Discomfort After Eating - The Medial Approach
43 Year Old Female – Chest Discomfort After Eating
[…] the rest of the case follow this link or click on the ECG […]
2015-09-05 09:59:09
Dominic
How to be successful at IV therapy – some advice for paramedic students
I learned from one of my field instructors to squeeze the arm on the opposite side of the insertion site rather than using your thumb to hold the vein straight/still. When you use your thumb you are more prone to not being able to drop the catheter to a proper angle, after flash, in order…
2015-09-03 20:10:24

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