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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 […]

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 […]

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 […]

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