36 YOM with Chest Pressure: Reperfusion AIVR

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This the case of a 36 year old, black male, complaining of chest pressure 8/10 pain scale, for 1 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), […]

80 Year Old Male: Fall

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A previously well 80-year-old experienced a fall at his home where he lives alone. He was walking from the living room to the kitchen when suddenly he found himself on the ground, which he attributes to tripping on the runner rug in the hallway. “My son has been telling me to get rid of that […]

Dont let your bradycardic patient D.I.E.

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At the risk of plagiarizing myself, I’d like to revisit a topic that I discussed on my personal blog a couple of years ago. The story goes that I am not very good with mnemonics. For me they are almost never useful in clinical practice, and as the patient gets sicker my chances of properly […]

45 year old male with “numb hands” – Discussion

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Go back to 45 year old male with “numb hands” to read about the presentation, and see the ECGs.   The culprit artery? After arriving at the hospital, the patient bypassed the ED, going directly to the cardiac catheterization lab. The patient was found to have a total occlusion of the proximal RCA, and the […]

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?” See also: Pit Crew CPR – The Explicit Details The answer is, “Yes!” with some minor modifications. We are developing a class for Pediatric Pit Crew CPR. It has not yet been implemented so consider this a beta version. I hate to give […]

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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Senior 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. It was in beta testing for a while (see this thread at EMTLife.com) but apparently it is now ready for prime time! I say that […]

Pit Crew CPR – The Explicit Details

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I’ve given an overview of my department’s Pit Crew CPR process many times at ems12lead.com, our Facebook page, the Resuscitation group, and various conferences around the country. (See also: Why do we send so many people to a cardiac arrest?) Even so, I’m frequently asked for specific details. People want to know exactly how we do it. […]

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