Author Archives: Tom Bouthillet

100 yof CC: Rib pain and intermittent spasms

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Here’s an interesting set of ECGs sent to us by Frank Intessimoni of Atlanticare EMS. You can follow Frank on Twitter: @njmedic3228. EMS is called to a local nursing home for a 100 year old female patient who had been complaining of rib pain and intermittent spasms for 3 days. Vital signs were assessed. RR: […]

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 […]

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. […]

Why do we send so many people to a cardiac arrest?

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I did a fair amount of traveling and teaching in 2013 and I've been struck by the number of people who have been gobsmacked by the number of rescuers my fire department sends to a sudden cardiac arrest (1 ambulance, 2 engines, and a battalion chief). I think there are several reasons for this. In […]

STEMI Mimics and STEMI Equivalents

Here’s my presentation from the VA EMS Symposium on 11/08/2013. STEMI Equivalents and STEMI Mimics from Tom Bouthillet

Survivor gives us a lens into regional systems of care for acute ischemic stroke in North Dakota

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I just got back from the North Dakota Mission: Lifeline STEMI and Acute Stroke Conference in Bismark, ND. I had a great time and I learned a lot. I often get asked to speak in various venues about acute STEMI and 12-lead ECG interpretation, but for this conference they wanted me to talk mostly about […]

Episode #11 – Are we harming patients with oxygen?

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EMS 12-Lead Podcast – Episode 11 – Are We Harming Patients With Oxygen? In this episode of the EMS 12-Lead podcast we’re joined by Kelly Arashin, ACNP, CCNS and Mike McEvoy, PhD, RN, CCRN, REMT-P at EMS Today 2013 in Washington D.C. We discuss the benefits and dangers of oxygen administration. Kelly is a dual […]

Code STEMI – London Ambulance Service

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Ivan Rokos, M.D. has referred to primary PCI for acute STEMI as “the most complex, multi-disciplinary, and time-sensitive therapeutic intervention in the world of medicine.” The emphasis on door-to-balloon times, and more recently, first medical contact or EMS-to-balloon times has transformed how acutely ill patients suffering heart attacks receive timely reperfusion in many communities, because […]

Code STEMI Web Series – London to premier at EMS Today in Washington, D.C.

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Seaon 2 of the Code STEMI Web Series is set to launch on March 7, 2013 at EMS Today in Washington, D.C.! This season starts out with our most exciting location ever — London, England as we feature the London Ambulance Service (LAS). You can follow the series at First Responders Network or at CodeSTEMI.tv. […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

JEMS Talk: Google Hangout

Comments
Dominic
Conclusion to 59 Year Old Male: Unwell
Great discussion on a difficult 12lead! I follow these very closely and based on pt presentation and 12lead tracing, this was a difficult or to treat with impending heart failure, hypotension, and trouble breathing. Thanks for the follow up and look forward to next week!
2015-07-06 20:53:35
Billy
Conclusion to 59 Year Old Male: Unwell
Hmmmm, I was fairly close. Sounds like most of the treatment occurred IN Hospital. Love case studies, and that one was good.
2015-07-06 20:28:25
Kori
59 Year Old Male: Unwell
There's the point! There is are no P waves, and the rhythm is irregulary-irregular-atrial fibrillation. If you look, it is rsR phenomen-RBBB, BUT there are huge ST elevations on all leads from V1-V5 (that's why the QRS complexes look so broad). I and aVL is clearly ST elevation suggesting STEMI. In limb leads you can…
2015-07-06 10:12:16
Vince DiGiulio
Conclusion to 59 Year Old Male: Unwell
I'll expand on this in the next post but unfortunately I actually wasn't present for this case so I can't give my direct account of how things happened. That said, from the notes I read and word-of-mouth from those involved (which I suspect painted things in a better light than I would have viewed them),…
2015-07-06 04:09:22
Matt King
Conclusion to 59 Year Old Male: Unwell
Hey Vince thanks for the through follow up with this case. I am curious how his rate was controlled since he was hypotensive and maybe an unknown onset of when his A-Fib stated(thinking anticoagulation first)? As you know the wrong approach could be devastating in this PT with risks of further infarction, stroke, or death…
2015-07-05 14:10:57

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