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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 […]

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, […]

70s male with “seizures” proves to be incessant 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 […]

“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 […]

Rate Related VS. Primary ST-T Changes:

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A 56 year old black male presents to the Emergency Department via EMS, complaining of Chest Pressure, 10/10 pain scale. Pain started suddenly following sudden onset of palpitations, while mowing his lawn. All approximately 5 minutes prior calling EMS. Keep in mind, it was a hot and sunny day with temperature in the 90’s. He advised of prior episodes of chest pressure […]

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 […]

45 year old male with “numb hands”

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This case illustrates both how good modern EMS can be at expediting emergency cardiac care, but also the challenges that still confront us. Yes, there is a “twist,” but only a small one. Note: I never saw this patient, but the ECGs and outcome were brought to my attention by a colleague, Dr K. Thrace, […]

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 […]

Adult 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 […]

Pulsus Paradoxus: Cardiovascular Function and Assessment

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Cardiovascular Assessment: Pulsus Paradoxus Assessing cardiac function, blood pressure and hemodynamic status play an important role during our overall patient assessment and treatment. Although 12 lead ECG evaluation is an essential part of patient assessment, especially cardiac etiology, understanding basic cardiac function plays a major role during treatment and overall patient status. During normal hemodynamic […]

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