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Electrocardiographically Silent High Lateral STEMI Equivalent

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A 60s male woke up with chest pain and contacted 9-1-1 after self-administered nitro did not help. Past medical history: hypertension, chronic back pain, stents “10 years ago” Medications: hydrocodone, nitroglycerin O: 15 minutes prior to 9-1-1 activation P: Nothing makes the pain better or worse Q: Dull and heavy “same as 10 years ago” […]

58 Year Old Male, Workout Worry

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  Your Paramedic crew is called to the home of a 58 year old male, “possible heart” Upon arrival to the home, you are greeted by the gentleman’s wife, who directs you to your patient. You find him sitting in a chair in the living room, appearing concerned, but in no serious distress. He tells […]

71 Year Old Male: Chest Discomfort- Discussion

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Here is the discussion for “71 year old male: chest discomfort” let’s review the prehospital 12 lead:     Here are the precordial leads blown up:   There is slight ST elevation in V1,  ST elevation in V2 (saddleback morphology), as well as slight ST elevation in V3 and V4. The STE in V3 and V4 […]

71 year old male: Chest Discomfort

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  This very interesting case comes from Bryan F, a Paramedic from Long Island. A 71 year old male is cooking breakfast when he experiences sudden onset of 10/10 chest discomfort. He waits 20 minutes or so for it to subside, but it does not and he calls 911. EMS arrives to find him lying […]

Rapid Prehospital Evolution of STEMI

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82 year old male, in good physical shape, stops at a cafe for lunch after cycling for an hour. Witnesses report a syncopal episode lasting approximately 30 seconds. Patient history significant for prior MI requiring 3 stents. No other significant history. Patient denies any CP, SOB, N/V, lightheadedness. In fact, he denies any complaints at […]

Snapshot Case- No Day at the Beach

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It is a beautiful summer afternoon when you and your partner are called to the beach for a “swimmer in distress”. Upon your arrival, you find a 48 year old male sitting on a beach towel, appearing to be in some distress. You are told that he was swimming in the ocean when he began […]

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 […]

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 […]

“You Make the Call” — 86 Year old Female: Dizzy

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  It is a beautiful September morning when the tones go off for a 86 year old female, “altered mental status”. “Guess breakfast will have to wait”, as you and your partner head towards the residence. As you enter the one level home, you are directed to a back bedroom where you find your patient […]

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 […]

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