59 year old male: chest pressure

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It’s a hot summer night in the suburbs, most of which you’ve spent on standby for a local baseball game. After clearing up you’re put on a chest pain call a few blocks from your quarters. The local volunteer fire department has a squad on scene which is advising you to, “continue on emergency.” Upon […]

Masters Case #01: 50 Year Old Male – Severe Chest Pain

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Most of our cases here at EMS 12-Lead are designed to strike a balance between challenging experienced prehospital providers while also highlighting a couple of specific teaching points for those seeking to learn. It’s a difficult line to walk. We want to showcase EKG’s with specific findings that are apparent enough to make good teaching […]

70 Year Old Male: Short of Breath

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  Good morning sports fans! You are dispatched to the residence of a 70 year old male, complaining of “shortness of breath”. You pull up to a well kept home, and are met at the front door by the patient’s wife. She tells you that her husband came home from the hospital yesterday after cosmetic […]

“Push Hard, Push Fast?”

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“Push Hard, Push Fast” We all know the mantra. It’s catchy. Compressions not deep enough? Push hard. Not fast enough? Push fast. Great. Except… One thing many of us have learned as professional rescuers is that the bigger issue is not pushing too slow, but pushing too fast. “But…push FAST!” I mean, faster has to […]

When to stop: Termination of Resuscitation in Pediatric Traumatic Cardiac Arrest

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Field termination of pediatric resuscitation is a difficult topic for EMS systems, prehospital providers, first responders, and the patient’s family. Clear guidelines exist for the termination of resuscitation of adults in cardiac arrest for both traumatic and non-traumatic etiologies, and routine transportation of adults in cardiac arrest all but guarantees poor outcomes. Unfortunately, for pediatric patients […]

Conclusion: 81 YOM with Chest Heaviness

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This is the recap and conclusion for the previous case: http://www.ems12lead.com/2014/03/11/81-yom-with-chest-heaviness/ Here’s the initial 12 lead ECG:   What do we see?   – Sinus rhythm with 1Left Atrial Abnormality or “Enlargement” – Wide complex QRS with a Right Ventricular Conduction Delay pattern or Right Bundle Branch Block (RBBB) morphology seen as rSR’ in V1 […]

81 YOM with Chest Heaviness

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It’s approximately 2000 hrs, right as you get comfortable in bed, when you are dispatched to a residence for Chest Pain (CP). You arrive on scene to find an 81 year old male, semifowler’s in bed, complaining of chest heaviness, 8/10, which started 2 hours ago, while in bed, watching tv. The patient also advised […]

Understanding ECG Filtering

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A common problem in ECG interpretation is the removal of unwanted artifact and noise. To help with this our cardiac monitors provide a means to filter the ECG recording.  Most cardiac monitors will choose the appropriate filter based on the situation. When performing routine monitoring, where only the cardiac rhythm is important, the filters applied […]

Magnesium and Cardiac Action Potential

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Magnesium (Mg++) is the second most abundant intracellular ion. Normal Serum Mg++ is 1.8 to 2.5 mg/dL or .8 to 1.5 mmol/L (millimoles per liter) (This values may vary depending on sources)  Keep in mind, the Mg++ concentration in the average adult is approximately 25g, but most of our Mg++ is found in bones and […]

74 Year Old Male: Chest Discomfort

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  It’s a sunny winter afternoon when you and your partner are called to a local doctor’s office for an “adult male- possible heart”. When you arrive, you are led into room #3 where you find a 74 year old male, in no apparent distress. His color looks good. You introduce yourself, and find out […]

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Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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