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Nitro paste is NOT an emergency medicine drug – The Evidence

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Many paramedics argue strongly for including nitroglycerin paste as an arrow in their pharmacologic quiver when treating acute congestive heart failure. Baffles me. True, you don’t need to break the seal of the CPAP to give it, and you don’t need to use an IV. But this medication hardly belongs in the emergency department, let […]

Calcium and Hyperkalemia

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“Calcium Chloride/Gluconate are used during Hyperkalemia induced ECG changes to reduce Serum Potassium.” The answer is:    False! The majority of Potassium in our body is found intracellular. Only a very small percentage (about 2%) is found extracellular, ranging between 3.5- 5.5 mEq/L. As extracellular Potassium levels increase, the action potential threshold decreases, for example, instead of […]

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 […]

53 YOF with AMS: STEMI or Secondary ST-T Changes?

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This is the case of a 53 year old female who presented to the Emergency Department (ED) via EMS, with Altered Mental Status (AMS). EMS was called to a local dialysis center due to the patient being unresponsive after  approximately 3 hours of dialysis. Upon arrival to the ED, the patient was unable to answer […]

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 […]

Understanding Atropine

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As requested, during our previous Adenosine discussion, we will briefly review, Parasympathetic stimulation and Atropine pharmacodynamics on the heart. ACETYLCHOLINE (ACh) is one of the Neurotransmitters, a chemical signal, used by the Central Nervous System, which has many effects on the body, from stimulating muscle contraction, inducing peristalsis (digestion), Bile release by the liver, and […]

Understanding Adenosine (Adenocard)

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So, recently, I was involved in a conversation, where the topic of Adenosine administration came up. It seems like there is a misunderstanding regarding its use and mechanism of action. Although this is not our classic ECG interpretation topic, I believe its worth talking about for a bit. Adenosine, a Class V antiarrhythmic from the […]

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 […]

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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