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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 […]

59 year old male: chest pressure – Conclusion

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The conclusion has been combined with the original case study. http://www.ems12lead.com/2014/04/18/59-year-old-male-chest-pressure/

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 […]

Subtle STEMI, New Right Bundle Branch Block, and Cardiac Arrest

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It’s a hot summer night in the suburbs, most of which you’ve spent on standby for a local baseball game. After clearing up you’re put on a chest pain call a few blocks from your quarters. The local volunteer fire department has a squad on scene which is advising you to, “continue on emergency.” Upon […]

70 Year Old Male: Short of Breath

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Good morning sports fans! You are dispatched to the residence of a 70 year old male, complaining of “shortness of breath”. You pull up to a well kept home, and are met at the front door by the patient’s wife. She tells you that her husband came home from the hospital yesterday after cosmetic eye […]

“Push Hard, Push Fast?”

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“Push Hard, Push Fast” We all know the mantra. It’s catchy. Compressions not deep enough? Push hard. Not fast enough? Push fast. Great. Except… One thing many of us have learned as professional rescuers is that the bigger issue is not pushing too slow, but pushing too fast. “But…push FAST!” I mean, faster has to be better […]

When to stop: Termination of Resuscitation in Pediatric Traumatic Cardiac Arrest

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Field termination of pediatric resuscitation is a difficult topic for EMS systems, prehospital providers, first responders, and the patient’s family. Clear guidelines exist for the termination of resuscitation of adults in cardiac arrest for both traumatic and non-traumatic etiologies, and routine transportation of adults in cardiac arrest all but guarantees poor outcomes. Unfortunately, for pediatric […]

Understanding ECG Filtering

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A common problem in ECG interpretation is the removal of unwanted artifact and noise. To help with this our cardiac monitors provide a means to filter the ECG recording. Most cardiac monitors will choose the appropriate filter based on the situation. When performing routine monitoring, where only the cardiac rhythm is important, the filters applied are known […]

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 […]

All that wiggles isn’t Wellens’

This is the discussion for our Snapshot Case involving a 45 year old female complaining of chest pain. Here is the 12 lead for review: There is sinus rhythm at about 75 bpm. Slight ST elevation in V2. Biphasic T wave inversion in V2, inverted T waves in aVL, V3-V5. As we recall, the patient had complained of […]

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