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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 […]

High Performance CPR – Performance Not Protocol!

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[Español] This is a supplement to Adult Pit Crew CPR and Pediatric Pit Crew CPR. Specifically, this is how we have modified our training process since attending the Resuscitation Academy in Seattle / King County. Each rescuer should experience each position at least twice. In other words, you run the drill, stop and switch, run the drill, […]

“Seizures” prove to be recurrent arrhythmias with multiple ICD shocks

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EMS is called to the residence of a 71 year old male for “seizures.” On arrival the patient’s spouse meets the ambulance outside and hurries the paramedics along saying “Come quickly! Please help him!” The paramedics arrive at the patient’s side just in time to see him receive an ICD shock. They ask how long […]

Elderly female with abdominal pain and wide complex tachycardia

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EMS is called to the residence of a 90 year old female who awoke to an “uncontrolled bowel movement” that corresponded with sudden onset abdominal pain. On EMS arrival, the patient is alert and oriented to person, place, time, and event. She has a grimace on her face and appears acutely ill. When asked 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 […]

57 Year Old Male–Chest Discomfort

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  It is a bright Sunday morning when you and your partner are dispatched for an “adult male-chest pain”. You arrive at a well kept residence, noting a ladder and paint cans as you enter. You find your patient, a 57 year old male, sitting on the sofa in mild distress. “I was doing some […]

Pediatric Pit Crew / High Performance CPR

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A reader asks, “Does your Pit Crew CPR process work for pediatrics?” (See video on Vimeo). The answer is yes (with some minor modifications). Some things to keep in mind: Pediatric cardiac arrest is more likely to be respiratory or asphyxial so there is less emphasis on “patient’s side to first shock” as the arrest […]

Pit Crew / High Performance CPR – The Explicit Details

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Here is a description of Hilton Head Island Fire Rescue’s Pit Crew / High Performance CPR process in bullet point form. It may help to think of it as a 4-phase process. Phase 1: Patient’s side to first shock Confirm pulselessness and announce “at patient, code blue” Start CPR (continuous chest compressions at the appropriate […]

Revisiting Transcutaneous Cardiac Pacing

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Transcutaneous cardiac pacing is an effective procedure for patients experiencing unstable bradycardia. Or is it? If you’ve read Tom’s introduction to the subject of false capture you’re already ahead of the game. We’ve shown case after case of unstable bradycardia patients receiving ineffective transcutaneous pacing due to a lack of capture. In each case, phantom pacing impulses […]

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