70 Year Old Male: Short of Breath
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 surgery.
You are led into the kitchen, and find your patient sitting in a chair at the kitchen table. There is an eye patch over his right eye. He appears to be in moderate respiratory distress. His color is ok, but you note he can only speak in short sentences.
He tells you that he was fine until this morn...
Source: EMS 12-Lead - April 7, 2014 Category: Cardiology Authors: David Baumrind Tags: ems-health-safety ems-topics patient-management Training training-development case study Source Type: research
“Push Hard, Push Fast?”
“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 right?
How many times have we witnessed CPR administered in a way that seems like a race to set the world record for fastest compression rate? How many times have we seen someone compress at an appropriate rate only to be chided to go faster?
While we know that c...
Source: EMS 12-Lead - March 31, 2014 Category: Cardiology Authors: David Baumrind Tags: ems-topics patient-management Training compression rates CPR resuscitation science Source Type: research
When to stop: Termination of Resuscitation in Pediatric Traumatic Cardiac Arrest
Field termination of pediatric resuscitation is a difficult topic for EMS systems, prehospital providers, first responders, and the patient’s family. Clear guidelines exist for the termination of resuscitation of adults in cardiac arrest for both traumatic and non-traumatic etiologies, and routine transportation of adults in cardiac arrest all but guarantees poor outcomes. Unfortunately, for pediatric patients no clear guidelines exist to help drive the decision, so practically all pediatric patients suffering from traumatic cardiac arrest receive on-going resuscitation during transportation to hospital.
In this m...
Source: EMS 12-Lead - March 23, 2014 Category: Cardiology Authors: Christopher Watford Tags: ems-topics patient-management pediatrics cardiac arrest Christopher Watford Do Not Resuscitate Paramedic resuscitation special resuscitation situations Source Type: research
Conclusion: 81 YOM with Chest Heaviness
Conclusion:
CAD and severe stenosis are more common causes of Subendocardial Ischemia rather than an active occlusion of the Left Main Coronary Artery, which often do not survive due to extensive Myocardial Infarct. (Source: EMS 12-Lead)
Source: EMS 12-Lead - March 14, 2014 Category: Cardiology Authors: Ivan Rios Tags: Uncategorized Source Type: research
81 YOM with Chest Heaviness
It’s approximately 2000 hrs, right as you get comfortable in bed, when you are dispatched to a residence for Chest Pain (CP). You arrive on scene to find an 81 year old male, semifowler’s in bed, complaining of chest heaviness, 8/10, which started 2 hours ago, while in bed, watching tv. The patient also advised he has vomited twice since he called 911 less than ten minutes ago.
He is alert and oriented to person, place, time and event, GCS of 15, denies dyspnea with clear bilateral lung sounds, strong and regular radial pulses, warm to touch, diaphoretic and normal skin color.
Medical history:
Hypertension (HT...
Source: EMS 12-Lead - March 11, 2014 Category: Cardiology Authors: Ivan Rios Tags: Uncategorized Source Type: research
Understanding ECG Filtering
A common problem in ECG interpretation is the removal of unwanted artifact and noise. To help with this our cardiac monitors provide a means to filter the ECG recording. Most cardiac monitors will choose the appropriate filter based on the situation. When performing routine monitoring, where only the cardiac rhythm is important, the filters applied are known as monitor mode filters. When performing a 12-Lead, which requires a high fidelity tracing, the filters applied are known as diagnostic mode filters. Beyond this, little emphasis is placed on understanding ECG filtering. This gap in education leads to problems fo...
Source: EMS 12-Lead - March 10, 2014 Category: Cardiology Authors: Christopher Watford Tags: ems-topics 12-Lead ECG Cardiac Monitoring Christopher Watford diagnostic filter EKG EMS 12-Lead filtering Source Type: research
Magnesium and Cardiac Action Potential
Conclusion:
Although not every Hypomagnesemia case will present with ECG changes, these changes may be seen often and have similar Hypokalemic characteristics, as Magnesium plays a role in Potassium regulation. (Source: EMS 12-Lead)
Source: EMS 12-Lead - March 5, 2014 Category: Cardiology Authors: Ivan Rios Tags: 12 lead ecg IVAN RIOS hypokalemia hypomagnesemia Source Type: research
74 Year Old Male: Chest Discomfort
It’s a sunny winter afternoon when you and your partner are called to a local doctor’s office for an “adult male- possible heart”.
When you arrive, you are led into room #3 where you find a 74 year old male, in no apparent distress. His color looks good.
You introduce yourself, and find out that your patient was suffering from left sided chest discomfort, 4/10, that radiated to his right arm.
“I can’t believe I have to go to the hospital, I thought it was something minor”, he tells you.
He admits that he has had short episodes like this for the last couple of days, but that ...
Source: EMS 12-Lead - February 17, 2014 Category: Cardiology Authors: David Baumrind Tags: 12 lead ecg ems-topics patient-management Training training-development 12-Lead ECG David Baumrind EMS 12-Lead ems12lead.com Paramedic Prehospital 12-Lead ECG blog Source Type: research
Conclusion to Snapshot Case: 44 Year Old Male – Chest Tightness
This is the conclusion to the Snapshot Case located here. You may want to review the initial description again.
As many readers correctly pointed out, this patient is experiencing a STEMI.
Let's start with the basics and work our way up to some pretty advanced topics.
First, there is anterior ST-elevation with upwardly-concave T-waves, as known as smiley-face T-waves.
Upwardly-concave T-waves are commonly taught as being associated with benign causes of ST-elevation, but that's only part of the story. For a more in-depth analysis, check out this quick review. While it's true that they are often seen with ...
Source: EMS 12-Lead - February 10, 2014 Category: Cardiology Authors: Vince DiGiulio Tags: ems-health-safety ems-topics patient-management Training training-development acute anterior STEMI vs. benign early repolarization case study concave up EMS 12-Lead ems12lead.com injury vector smile face ST-elevation smiley faced S Source Type: research
Conclusion to Snapshot Case: 44 Year Old Male – Chest Tightness
This is the conclusion to the Snapshot Case located here. You may want to review the initial description again.
As many readers correctly pointed out, this patient is experiencing a STEMI.
Let's start with the basics and work our way up to some pretty advanced topics.
First, there is anterior ST-elevation with upwardly-concave T-waves, as known as smiley-face T-waves.
Upwardly-concave T-waves are commonly taught as being associated with benign causes of ST-elevation, but that's only part of the story. For a more in-depth analysis, check out this quick review. While it's true that they are often seen with ear...
Source: EMS 12-Lead - February 10, 2014 Category: Cardiology Authors: Vince DiGiulio Tags: ems-health-safety ems-topics patient-management Training training-development acute anterior STEMI vs. benign early repolarization case study concave up EMS 12-Lead ems12lead.com injury vector smile face ST-elevation smiley faced S Source Type: research
All that wiggles isn’t Wellens’
This is the discussion for our Snapshot Case involving a 45 year old female complaining of chest pain.
Here is the 12 lead for review:
There is sinus rhythm at about 75 bpm, with a slightly leftward axis. Slight ST elevation in V2. Biphasic T wave inversion in V2, inverted T waves in aVL, V3-V5.
As we recall, the patient had complained of "off and on" chest pain radiating to her left arm. Concerning to be sure! In addition, the patient was "pain free" at about the time of this 12 lead ECG....
Source: EMS 12-Lead - February 6, 2014 Category: Cardiology Authors: David Baumrind Tags: ems-topics patient-management Training training-development 12-Lead ECG case study David Baumrind EMS 12-Lead ems12lead.com Paramedic Prehospital 12-Lead ECG blog snapshot case Wellens' Syndrome Source Type: research
All that wiggles isn’t Wellens’
This is the discussion for our Snapshot Case involving a 45 year old female complaining of chest pain.
Here is the 12 lead for review:
There is sinus rhythm at about 75 bpm, with a slightly leftward axis. Slight ST elevation in V2. Biphasic T wave inversion in V2, inverted T waves in aVL, V3-V5.
As we recall, the patient had complained of "off and on" chest pain radiating to her left arm. Concerning to be sure! In addition, the patient was "pain free" at about the time of this 12 lead ECG....
Source: EMS 12-Lead - February 6, 2014 Category: Cardiology Authors: David Baumrind Tags: ems-topics patient-management Training training-development 12-Lead ECG case study David Baumrind EMS 12-Lead ems12lead.com Paramedic Prehospital 12-Lead ECG blog snapshot case Wellens' Syndrome Source Type: research
Snapshot Case: 44 Year Old Male – Chest Tightness
Here's a new "Snapshot" case courtesy of Dr. Bojana Uzelac from Serbia…
A 44 year old male presents with a chief complaint of tightness in his chest x 1 hour. He was on his way to a conference when it started and states:
"It feels kind of like asthma. I've never been diagnosed but I imagine this is what it would feel like. Maybe I'm just nervous about speaking in front of everyone."
Vitals: HR 85 bpm, RR 20/min, SpO2 97% on room air, BP 157/84 mmHg, and temp 37.1 C.
The patient's skin is cool and dry and he appears mildly anxious. The following EKG is then captured.
Is this ...
Source: EMS 12-Lead - February 3, 2014 Category: Cardiology Authors: Vince DiGiulio Tags: ems-health-safety ems-topics patient-management Training training-development acute anterior STEMI vs. benign early repolarization case study concave up EMS 12-Lead ems12lead.com smile face ST-elevation smiley faced ST-elevation up Source Type: research
Snapshot Case: 44 Year Old Male – Chest Tightness
Here's a new "Snapshot" case courtesy of Dr. Bojana Uzelac from Serbia…
A 44 year old male presents with a chief complaint of tightness in his chest x 1 hour. He was on his way to a conference when it started and states:
"It feels kind of like asthma. I've never been diagnosed but I imagine this is what it would feel like. Maybe I'm just nervous about speaking in front of everyone."
Vitals: HR 85 bpm, RR 20/min, SpO2 97% on room air, BP 157/84 mmHg, and temp 37.1 C.
The patient's skin is cool and dry and he appears mildly anxious. The following EKG is then captured.
Is this pati...
Source: EMS 12-Lead - February 3, 2014 Category: Cardiology Authors: Vince DiGiulio Tags: ems-health-safety ems-topics patient-management Training training-development acute anterior STEMI vs. benign early repolarization case study concave up EMS 12-Lead ems12lead.com smile face ST-elevation smiley faced ST-elevation up Source Type: research
Conclusion: 87yom complaining of chest discomfort and dyspnea
Conclusion:
It was concluded that cardiac biomarkers were elevated secondary to Acute Renal Failure, which resulted in Acute Heart Failure. (Source: EMS 12-Lead)
Source: EMS 12-Lead - February 1, 2014 Category: Cardiology Authors: Ivan Rios Tags: 12 lead ecg CHF Heart Failure LBBB Uncategorized Dr. Smith's Modified Sgarbossa Rule IVAN RIOS Source Type: research
