Tag Archives: wide complex tachycardia

77 year old female: Unresponsive – Discussion

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This is the discussion for 77 year old female: Unresponsive, if you have not read the case report we recommend you start there! First, a hat tip to our readers who were unafraid to tackle this challenging scenario. Second, we were very impressed to see a number of readers correctly identify this challenging rhythm! When we […]

65 year old male CC: Fall with injury – Conclusion

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This is the conclusion to 65 year old male CC: Fall with injury. You may wish to review the history and clinical presentation. When we left off the patient was in severe heart failure with the following 12-lead ECG. As we have mentioned before on several occasions, the most important thing when treating a patient […]

65 year old male CC: Fall with injury

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Here's a very interesting case submitted by a faithful reader who wishes to remain anonymous. Some changes have been made to preserve patient confidentiality. EMS is called to a local breakfast restaurant for a 65 year old male who fell in the parking lot. He was reported to have suffered a head injury. On arrival […]

Snapshot Discussion: 32 year old Male–Chest Discomfort

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Here is the discussion for the Snapshot Case: 32 year old male–Chest Discomfort. Sorry for the delay. If you recall, we have a young patient, a 32 year old male, with a heart rate too rapid to count. He is alert and oriented, and has a good pressure (126/70). He has been in the following […]

Discussion for 90 year old male CC: Chest pain– Revisited

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We are revisiting the Discussion for 90 year old male CC: Chest pain.  You may wish to review the case. You may recall we pointed out that the VT appeared be regularly irregular, with alternating cycle lengths: What follows is a "Guest Post" by Jason Roediger, CCT/CRAT, and Ken Grauer, M.D. (www.kg-ekgpress.com): "The rhythm represents […]

Discussion for 17 year old male CC: Chest pain and palpitations – WPW Part I

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This is Part I of the discussion for 17 year old male CC: Chest pain and palpitations. You may wish to review the case. If you recall from the case, our crew was performing an interfacility transport of a 17 year old male with a rapid, irregular tachycardia which required cardioversion. At the receiving facility […]

Discussion for 90 year old male cc: chest pain

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I hope you all had happy holidays! Here is the discussion for 90 year old male cc: chest pain.  You may wish to go back and review the case. So, let's get into the case!  There are the usual questions we need to answer as we try to determine the rhythm.  Is the rhythm wide […]

90 year old female CC: Seizure – Conclusion

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This is the conclusion to 90 year old female CC: Seizure. Be sure to start there first! When we left off, we had completed our initial assessment of a 90 year old patient who, based on bystander accounts, had a seizure. She is pale, cold to the touch, and feels lethargic. During our assessment she […]

90 year old female CC: Seizure

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This interesting case is thanks to Dana from Redmond Medic One, we hope you enjoy it as much as we did! You're dispatched with a nearby engine company to an assisted living facility for a 90 year old female who has had a seizure. Dispatch notes indicate the patient is alert at this time. You're by […]

Discussion to 60 year old male CC: "I don't feel well"

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This is the discussion for 60 year old male CC: "I don't feel well". Go back and familiarize yourself with the history and clinical presentation because it's important to the case (as it always is). Here is the rhythm strip and 12-lead ECG that was presented. You may recall from my series on ineffective or […]

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation
Comments
“Bad heartburn” – Conclusion | EMS 12 Lead
63 year old male CC: Substernal Chest Pain – Discussion
[…] upright T waves is actually not representative of acute occlusion – for more on this, read this discussion on old versus “new” teaching on recognizing posterior MIs. We do not see ST elevation in aVR or V1 that would suggest a concomitant RV infarct, […]
2014-08-22 16:49:18
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
Why give atropine at this time?
2014-08-22 15:42:18
Bryan Laviolette
“Bad heartburn” – 82 y.o. female without chest pain.
In addition to the above treatment consensus (ASA, Plavix, judicious NTG, fentanyl, fluid bolus, right sided leads), I would absolutely transport this patient to a PCI centre. Culprit artery is the RCA (STE lead III > II) leading to AV nodal ischemia and junctional bradycardia. In addition to the above treatment I would give 0.5…
2014-08-22 13:14:35
Jared
“Bad heartburn” – 82 y.o. female without chest pain.
Not much to add but my 2 cents...I'd definitely be careful with the nitro, not saying withhold it completely but absolutely use some common sense. I'd have to say probably RCA occlusion, and catch team needs to be activated for a stemi alert immediately. Treat it like a stemi until proven otherwise. If it walks…
2014-08-22 08:49:36
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
The option was indeed turned on! As for non-CP presentations of ACS, I absolutely believe that these warrant the same level of urgency as the "typical" presentations. Both men and women, young and old, all commonly present without classic chest pain. Besides, how much difference is there between "burning in the epigastrium," and "pain in…
2014-08-21 17:10:37

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