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Conclusion: 38 Year Old Male – Chest Pain and Leg Paralysis.

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Recap In the post yesterday , the paramedic crew was evaluating a 38 y.o. male who had sudden, severe chest pain, as well as leg numbness and paralysis, and whose vital signs showed a mild bradycardia and pronounced hypertension. The ECG obtained by EMS appears to be junctional, with an unclear contribution from the SA […]

38 Year Old Male – Chest Pain and Leg Paralysis.

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You are called for severe chest pain. The patient is a 38 year old male who describes the abrupt onset of a severe pain in his chest about 30 minutes before his wife called EMS. While sweat streams off his face, he tells you that he has never felt pain this intense. He isn’t sure […]

45 year old male with “numb hands” – Discussion

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Go back to 45 year old male with “numb hands” to read about the presentation, and see the ECGs.   The culprit artery? After arriving at the hospital, the patient bypassed the ED, going directly to the cardiac catheterization lab. The patient was found to have a total occlusion of the proximal RCA, and the […]

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, […]

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

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This is the conclusion to the previous case: 53 YOF with AMS: STEMI or Secondary ST-T changes? This female presented to the ED with Altered Mental Status (AMS), via ambulance, as STEMI ALERT, after completing approximately 3 hours of her usual dialysis. This was the 12 lead ECG provided by EMS…   We have a […]

The most awesome STEMI test on the internet!

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Sr. Editor Christopher Watford created an online STEMI test based on McCabe JM, et al. Physician Accuracy in Interpreting Potential ST-Segment Elevation Myocardial Infarction Electrocardiograms. J Am Heart Assoc. 2013; 2:e000268. The exam was in beta testing for a while (see this thread at EMTLife.com) but it’s ready for prime time! It was featured at the […]

Conclusion: 81 YOM with Chest Heaviness

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This is the recap and conclusion for the previous case: http://www.ems12lead.com/2014/03/11/81-yom-with-chest-heaviness/ Here’s the initial 12 lead ECG: What do we see? – Sinus rhythm with 1Left Atrial Abnormality or “Enlargement” – Wide complex QRS with a Right Ventricular Conduction Delay pattern or Right Bundle Branch Block (RBBB) morphology seen as rSR’ in V1 but abnormal […]

Code STEMI – London Ambulance Service

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Ivan Rokos, M.D. has referred to primary PCI for acute STEMI as “the most complex, multi-disciplinary, and time-sensitive therapeutic intervention in the world of medicine.” The emphasis on door-to-balloon times, and more recently, first medical contact or EMS-to-balloon times has transformed how acutely ill patients suffering heart attacks receive timely reperfusion in many communities, because […]

What Happened?

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A 68 year old male, with no significant medical history, presents to the local ED (non-PCI) with chest pain. He had been doing some gardening, when he suddenly felt chest discomfort (8/10), non-radiating with diaphoresis. His wife drove him to the ED. Once there, he was given ASA and NTG, and the following ECG was […]

Treat the patient not the monitor?

Here at the EMS 12-Lead Blog, we love case studies. We love to post them, you love to read them, and many of you love to comment on them. Not only on this blog, but on other very good blogs that are out there as well. I think it’s a great way to learn, and […]

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