Author Archives: Brooks Walsh MD

Brooks Walsh is a board-certified emergency physician working in Connecticut. He studied the philosophy of physics in college (Bell's Theorem anyone?), and attempted a masters-degree program in pure mathematics. He found far more success in an EMT-B class, however, and hasn't looked back since. He spent eight years in EMS (five of those as a paramedic) working for private, volunteer, and hospital-based EMS agencies. He once led a traditional 5.10 route in New Hampshire (since downgraded to 5.9+...), has summited Denali, can often correctly use the subjunctive mood in Spanish, finished a marathon in 4:37, has a 2K erg time of 6:46, and is never, ever, sick at sea.

Cardiac arrest and deep T-wave inversions

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The paramedic swung the stretcher into the resus bay, and started giving report. As the team of RNs, techs, and residents swung into action, I noted that the young adult patient didn’t look very sick at all. Confused, yes, and perhaps a bit anxious, but this seemed like an over-triage. “Paramedic Battistelli,” I called out, […]

AMS, hypotensive with HR > 150: Cardiovert?

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EMS was called for middle-aged man, found slumped over a table at restaurant. He had quite a poor mental status and could not offer any medical history. Per the staff he had just arrived, and not eaten or drank anything. Although he is carrying a home glucometer, his blood sugar is 160. He has a […]

Transcutaneous pacing: “Put it up to eleven!”

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Dramatic ECG! But there is a short answer, actually just a number. And as the title suggests, the answers to this case are (both literally and figuratively) 11. But what are the questions? The Case EMS brought in a middle-aged male with altered mental status and an ill appearance.Over the past 3-4 days he had […]

ST-segment elevation in lead aVR. Is this a STEMI equivalent?

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EMS was called for a young adult male who had collapsed at home. He had been walking through the kitchen when he complained of some chest discomfort, appeared to perhaps have trouble breathing, and then had a syncopal episode. He had a PMHx history of trisomy 21, sleep apnea, DM type 2, and right-sided CHF […]

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 […]

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 […]

Adenosine for sinus tachycardia: Try to avoid this!

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This is the feedback I gave the student on this case. (Recall that this was a young adult male who presented with dyspnea, chest pain, as well as pre-syncope, whose initial ECG showed a brisk tachycardia which went up to the 170s at points): Bottom line: “As you point out, this was sinus tachycardia. When […]

Adenosine given for a narrow-complex tachycardia over 150

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This case comes to me from a paramedic trainee. Many elements have been altered to preserve anonymity. In the following, the narrative from the run-form is interspersed with questions that I put to the student afterwards. I was trying to draw out how a student understood the evaluation and management of tachyarrhythmias. But I don’t […]

What it looks like: inferior STEMI

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No mysteries here today – this is an inferior STEMI! But I thought that prehospital provider might like to see what happens “on the inside” during an MI. The Case: A 60-something female had a few days of feeling not quite right, so she did some Googling, and she began to worry about a heart […]

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