Author Archives: Ivan Rios

Ivan is a Cardiology and Electrophysiology enthusiast from Orlando, Fl. He is a Critical Care Paramedic and Paramedic Instructor at First Response Training Group in Orlando Fl. He is an editor for the worldwide know sites, EMS12lead.com and its relate Facebook blogs and ECG & Cardiology blogspot. He has a great passion for Emergency Medicine and music, as an Acoustic Singer/Songwriter artist, know as Ivan J. Nash, by his local following.

Heroin Withdrawal: QT Prolongation & Torsade de Pointes

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This is the case of a 61 year old male who presented to the emergency department with a chief complaint of nausea and vomiting. The patient was alert and oriented, reporting intermittent chest pressure for the last 12 hours that he rated as a 9/10 pain level. He also reported multiple syncopal episodes within the […]

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 […]

The role of 12 lead ECG in Pediatric Pulmonary Hypertension

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An 11  year old male presents with complaint of substernal chest pain, 6/10, unable to describe the sensation but non-radiating, which  started while running. Primary assessment: Patent airway Adequate respiratory effort with no signs of distress skin is pink, warm and dry, with no signs of hypoperfusion Pertinent medical Hx: Chronic Interstitial Lung Disease Secondary  Pulmonary […]

Understanding Amiodarone

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Recently, I was part of a short discussion between fellow healthcare providers of different levels of care, about Amiodarone and its expected effects on the heart during Ventricular Tachycardia (VT). I figured, I could break it down and write a short summary of how it works.   Most healthcare providers are familiar, or at least have […]

Calcium and Hyperkalemia

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Calcium Chloride/Gluconate are used during Hyperkalemia induced ECG changes to reduce Serum Potassium. The answer is: False! The majority of Potassium in our body is found intracellular. Only a very small percentage (about 2%) is found extracellular, ranging between 3.5- 5.5 mEq/L. As extracellular Potassium levels increase, the action potential threshold decreases, for example, instead of […]

Conclusion: Rate Related VS Primary ST-T Changes

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  This is the conclusion to our previous case, “RATE RELATED VS PRIMARY ST-T CHANGES“. Check it out before you read this final portion.   This was the initial 12 lead ECG obtained by EMS prior ED arrival: There is an irregularly irregular tachycardia with no signs of P waves, which the Lifepak 15 determined to […]

Rate Related VS. Primary ST-T Changes:

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A 56 year old black male presents to the Emergency Department via EMS, complaining of Chest Pressure, 10/10 pain scale. Pain started suddenly following sudden onset of palpitations, while mowing his lawn. All approximately 5 minutes prior calling EMS. Keep in mind, it was a hot and sunny day with temperature in the 90’s. He advised of prior episodes of chest pressure […]

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 […]

Just a paced rhythm… Or is it? Conclusion

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Ok, so I posted a 12 Lead ECG on Facebook this past Monday, June 2nd, 2014, which  generated some interesting comments and thoughts… EMS 12-Lead on Facebook: 67yom with Dyspnea and Diaphoresis  This ECG was obtained from a 67 year old male, complaining of difficulty breathing for the past 2 hours, and presented diaphoretic, with […]

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