Transcutaneous pacing: “Put it up to eleven!”

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Dramatic ECG! But there is a short answer, actually just a number. And as the title suggests, the answers to this case are (both literally and figuratively) 11. But what are the questions? The Case EMS brought in a middle-aged male with altered mental status and an ill appearance.Over the past 3-4 days he had […]

ST-segment elevation in lead aVR. Is this a STEMI equivalent?

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EMS was called for a young adult male who had collapsed at home. He had been walking through the kitchen when he complained of some chest discomfort, appeared to perhaps have trouble breathing, and then had a syncopal episode. He had a PMHx history of trisomy 21, sleep apnea, DM type 2, and right-sided CHF […]

Heroin Withdrawal: QT Prolongation & Torsade de Pointes

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This is the case of a 61 year old male who presented to the emergency department with a chief complaint of nausea and vomiting. The patient was alert and oriented, reporting intermittent chest pressure for the last 12 hours that he rated as a 9/10 pain level. He also reported multiple syncopal episodes within the […]

Spot the STEMI #1

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You have a 50/50 shot at getting this one right. Are you feeling smart… or lucky? Two 50-year-old men present complaining of chest pain x 1 hour. One patient is suffering from a very subtle acute STEMI while the other has a non-cardiac cause for his chest pain. Which patient is experiencing the subtle STEMI? […]

Conclusion to 43 Year Old Female – Chest Discomfort After Eating

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This is the conclusion to our case from last Saturday. I suggest reviewing the original case presentation before diving into the discussion here. A 43-year-old female presents feeling like there’s a knot behind her sternum. It began suddenly just after eating lunch. This is her initial ECG: There is apparent ST-elevation in leads V1–V3. The […]

“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 […]

43 Year Old Female – Chest Discomfort After Eating

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You respond to an office workplace for a 43-year-old female with a chief complaint of chest discomfort. On arrival you are greeted by the patient who is pleasant and well-appearing. Her skin is warm, pink, and dry and pulse strong at the radials. Respiratory effort is normal with clear lung sounds bilaterally and she does […]

I “over-diagnosed” an ECG. Maybe you should too.

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It’s important to be wrong now and then. Not just for the usual blather about being humble, understanding cognitive biases, or even nailing the Kobayashi-Maru test. No, it’s important to be wrong in the right sort of way, a willingness to be humble in the interest of patient care. Let me explain! Case #1: I […]

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 […]

30 Day Challenge

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Today is July 11 and I have not had a drink in 30 days. Some of you may know that my mother suffers from advanced dementia and requires round-the-clock care. She is on hospice and I have been out on FMLA leave helping with her care (which is why I missed SMACC in Chicago). This time […]

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