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76 year old male with chest pain and “peanut allergy” that turns out to be STEMI

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EMS is dispatched to the residence of a 76 year old white male with a chief complaint of chest pain. Upon patient contact the patient is found sitting on his couch, alert and oriented to person, place, time and event with GCS of 15. The patient appears to be in no distress, advising he believes […]

QRS AXIS DETERMINATION

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During ECG interpretation, cardiac axis, or direction of electrical impulses, may be normal (physiologic) or abnormal (pathologic), suggesting abnormal cardiac conductivity. Although every deflection obtained on the ECG will have an axis, we will focus on the ventricular axis. When we think of our cardiac monitoring lead placement, we have to understand cardiac Vectors, which is […]

Discussion for 70 Year Old Male: Short of Breath

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This is the discussion for “70 Year Old Male: Short of Breath“. Tough case. Lots of excellent comments and observations from our readers. Right off the bat, the patient’s presentation offered a major distraction: the recent eye surgery resulting in the old “eye patch presentation”. Confounding the situation further was the lack of any cardiac […]

30 YOM with Chest Pressure: Reperfusion AIVR

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This the case of a 30 year old male, complaining of chest pressure 8/10 pain scale, for about a week. The patient was born with unknown cardiac complications, which led to multiple near death arrhythmias, which is why the patient has an on demand pacemaker/defibrillator in place. He also has a history of Hypertension (HTN), […]

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 […]

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 with chest discomfort, right bundle branch block, and ST-segment elevation

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It’s a sunny winter afternoon when EMS is called to a doctor’s office for “an adult male with possible heart problem.” 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 that your patient was […]

CONCLUSION: 87YOM COMPLAINING OF CHEST DISCOMFORT AND DYSPNEA

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This is the conclusion of the previous case: http://ems12lead.com/2014/01/87-yom-complaining-of-chest-pain-and-dyspnea/ So, as mentioned before, you obtain this 12 lead ECG: A few minutes later, the LIFEPAK 15 prints out another 12 lead ECG: Although the computer suggests Atrial fibrillation, this irregular tachycardia has a group beating pattern with presence of P waves prior the QRS complexes and […]

87 YOM COMPLAINING OF CHEST DISCOMFORT AND DYSPNEA

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  It’s a sunny morning, and your EMS unit is dispatched to a residence for an 87 year old male with difficulty breathing.   You arrive on scene before the fire engine and enter the residence. Upon entering the bedroom, you find an elderly male, sitting on the edge of the bed, vomiting. He is alert and oriented x 4 (person, […]

The Six-Step Method for 12-Lead ECG Interpretation

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I am frequently asked exactly how I approach 12-lead ECG interpretation. I use what I call the Six-Step Method. It goes like this: 1.) Rate and rhythm 2.) Axis determination 3.) QRS duration (Intervals) 4.) Morphology 5.) STEMI mimics 6.) STEMI (Ischemia, Injury, Infarct) “Step 7” is a rule I started throwing in to remind students […]

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