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 […]

From Precons to EMS 10 Awards and Nightwatch! #EMSToday2015

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Wednesday, February 25, 2015 What an awesome day at EMS Today 2015! Kelly and I headed over to the Convention Center to get registered and ran into our very good friends Nick Nudell (@RunMedic), Chris Montera (@geekymedic), and Anne Robinson Montera (@CaringAnne). Nick and I started the EKG Club many years ago as an email-based discussion […]

A visit to Johns Hopkins #EMSToday2015

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Tuesday, February 24, 2015 We arrived a day early into Baltimore and decided it would be a good idea to visit what is arguably the nation’s best hospital. Johns Hopkins Hospital’s core values include Excellence & Discovery, Leadership & Integrity, Diversity & Inclusion, and Respect & Collegiality and you sense when you’re walking around that […]

The Calm Before the Storm! #EMSToday2015

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In case you haven’t heard the good folks at PennWell and JEMS have selected yours truly as the Official Blogger of EMS Today 2015. The #EMSToday2015 hashtag is already buzzing! My wife Kelly @barefootNurse24 and I @tbouthillet flew into Baltimore yesterday and it was fun to follow our international colleagues gearing up for the JEMS Games! Here we have Hayden […]

The 12 Leads of Christmas: V3

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This is the eleventh and penultimate article in our latest series, The 12 Leads of Christmas, where each day we examine an individual electrocardiographic lead. Lead V3 Sorry about the huge delay since the last post in this series—work, life, and teaching took over for a few of weeks. Today we’re going to discuss V3, […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

JEMS Talk: Google Hangout

Comments
Greg
Snapshot Case: What Happened?
Unsynced cardioversion! I mirror the comments above wondering why this patient even required cardioversion for this afib as the rate doesn't seem particularly sinister. And after 4 shocks maybe consider that the afib might not respond at all and focus on other treatment avenues.
2015-05-27 02:56:05
Sam
Snapshot Case: What Happened?
The patient appears to have been unintentionally cardioverted during the relative refractory period, which can send the heart into v-fib. The first attempt looks to be 50J, under the 120J usually recommended for rapid a-fib, and did not work. Before the second attempt, it appears that there is no longer capture and the patient was…
2015-05-26 23:51:11
Wes Comstock
Snapshot Case: What Happened?
Great example of what happens if you dont sync prior to cardioversion, but I think it is also worth mentioning that its highly unlikely that this patients symptoms were rate related. In the top strip the rate was approx 114 over the 10 seconds and just prior to shock #5 the rate was right around…
2015-05-26 23:17:39
Justin White
Snapshot Case: What Happened?
After shock #4 they didn't sync the monitor again after it defaulted back to defib. They shocked on the T-wave.
2015-05-26 22:47:07
Proficiency vs Deficiency… The Art Of Electrocardiography | EMS 12 Lead
Understanding Amiodarone
[…] on the highlighted title for an Amiodarone breakdown, UNDERSTANDING AMIODARONE   One tool I use in these cases of bradycardia, is SPo2 monitoring. Remember, with every systole […]
2015-05-22 16:59:43

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