68 Year Old Male: Chest Tightness – Part 1
A 68-year-old male presents with a chief complaint of chest tightness that started at rest approximately three hours prior and has been constant ever since. He desribes it as a vice-like sensation limited to the central portion of his chest. Nothing makes the pain better or worse and he rates it at about a 6 out of 10.
At a glance the patient appears pretty healthy. He is well-nourished and of normal weight, does not smoke, and feels alright aside from the nagging discomfort in his chest. His skin in warm, pink, and dry and his radial pulse is strong, fast, and irregular.
Vitals are as follows:
HR approx 125 bpm, ir...
Source: EMS 12-Lead - December 30, 2013 Category: Cardiology Authors: Vince DiGiulio Tags: ems-health-safety ems-topics patient-management Training training-development 12-Lead ECG atrial fibrillation case study EMS 12-Lead ems12lead.com ST-depression ST-elevation in lead aVR Vince DiGiulio Source Type: research
‘Twas the Night Before Christmas…
'Twas the night before Christmas and all through the lab,
Not a patient with chest pain, not even a stab…
The stockings were hung at the bedside with care,
And all of the cath lab technicians were there…
The patients were snuggled, our sheets were all clean,
As visions of a-fib danced over the screen…
Once in a while, my nurse would come by,
To say it was only a minor MI…
Soon I will go down the hall to a table,
Where if my cath lab surgeon is able,
To clear the blockage in a main artery,
The picture of health again I shall be…
He was all dressed in blue from his head to his toe,
Th...
Source: EMS 12-Lead - December 24, 2013 Category: Cardiology Authors: David Baumrind Tags: ems-topics holiday cheer Source Type: research
63 Year Old Female, CC: Neck and Arm Pain
Good morning. It's 7:45 am on a sunny winter Monday, and you are just finishing up your holiday shopping list– it is getting down to the wire after all!
The tones go off, and you are dispatched to the residence of a 63 year old female, "sick".
You arrive to a well kept two story suburban home. You are met by a well looking gentleman who directs you and your partner into the living room, where you find his wife sitting on the sofa looking slightly uncomfortable.
"How can we help you today?"
"Well, i'm having strange pain in my neck and both arms… feels like pins...
Source: EMS 12-Lead - December 16, 2013 Category: Cardiology Authors: David Baumrind Tags: ems-health-safety ems-topics patient-management Training training-development 12-Lead ECG case study David Baumrind ems12lead.com Paramedic Prehospital 12-Lead ECG blog Source Type: research
The 12 ECG’s of Christmas – Day 1
To get you in the holiday spirit, we're doing a series of 12 ECG's we feel like you just cannot miss!
On the first day of Christmas, my true love gave to me, this narrow complex rhythm:
So what rhythm did my true love give to me? (Source: EMS 12-Lead)
Source: EMS 12-Lead - December 13, 2013 Category: Cardiology Authors: Christopher Watford Tags: Uncategorized Source Type: research
Why do we send so many people to a cardiac arrest?
I did a fair amount of traveling and teaching in 2013 and I've been struck by the number of people who have been absolutely gobsmacked by the number of rescuers my fire department sends to a sudden cardiac arrest (1 ambulance, 2 engines, and a battalion chief).
I think there are several reasons for this. In the first place, most jurisdictions don't have the resources, or at least say they don't have the resources, to do what we we do. But I think the real issue is that people don't understand the benefit of sending 9 to 11 people to a sudden cardiac arrest. In fact, some have argued that sending that m...
Source: EMS 12-Lead - December 7, 2013 Category: Cardiology Authors: Tom Bouthillet Tags: ems-topics patient-management cardiac arrest checklist chain-of-survival Pit Crew CPR resuscitation Source Type: research
STEMI Mimics and STEMI Equivalents
Here’s my presentation from the VA EMS Symposium on 11/08/2013.
STEMI Equivalents and STEMI Mimics from Tom Bouthillet (Source: EMS 12-Lead)
Source: EMS 12-Lead - November 9, 2013 Category: Cardiology Authors: Tom Bouthillet Tags: ems-topics STEMI STEMI Equivalents STEMI mimics Tom Bouthillet Source Type: research
The Weekend Roundup: ECG Highlights from Around the Web…
*image credit
In case you missed it this week:
We had a great case discussion regarding an equivocally challenging ECG.. Was it pericarditis in the end?
Dr. Smith had a great case abou...
Source: EMS 12-Lead - November 8, 2013 Category: Cardiology Authors: David Baumrind Tags: ems-health-safety ems-topics news patient-management videos 12-Lead ECG David Baumrind ems12lead.com Paramedic weekend roundup Source Type: research
37 Year Old Male–CC: Chest Pain, Part II
This is part II to "37 year old male–CC: Chest Pain". You may wish to review the case.
So, while many of our cases are straightforward, this one is not.
But hey, our patients don't read the textbooks!
First, let's review the chief complaint:
Our 37 year old male had "chest tightness", but complained of lethargy and "chills" for at least a couple of days. While we must take the complaint of chest pain seriously, many of you pointed out that the history did not seem like typical ACS. We can't blow off chest tightness, but the history is no slam dunk.
Here...
Source: EMS 12-Lead - November 4, 2013 Category: Cardiology Authors: David Baumrind Tags: ems-health-safety patient-management Training training-development Source Type: research
37 Year Old Male- CC: Chest Pain
This excellent case comes to us from Jack Buckle. Thanks Jack!
You and your partner are in the middle of a busy shift, when you are dispatched to 37 year old male complaining of chest pain.
It's almost 2pm, and a balmy 78 degrees.
You arrive to a well kept house and find your patient sitting in his kitchen. He looks pale, but you don't notice any obvious distress.
"How can we help you today?"
"I just haven't felt well for a couple of days. No energy. Chills. And I've been nauseous."
"What made you call 911 today?"
"Well, to be honest, I started having some chest tigh...
Source: EMS 12-Lead - September 9, 2013 Category: Cardiology Authors: David Baumrind Tags: ems-health-safety ems-topics patient-management Training training-development 12-Lead ECG case study David Baumrind ems12lead.com Paramedic Prehospital 12-Lead ECG blog Source Type: research
“Treat the patient not the monitor?”- Redux
"For heaven's sake man, treat the patient not the monitor!"
Ahh, the angry cries appear every time we post a difficult case with a challenging ECG or treatment decision..
The attitude seems intractable, despite our best efforts.
Over a year ago, I wrote "Treat the Patient not the Monitor?", and not much has changes since!
So, I got to thinking. Where did this come from anyway? What were the intentions of the originators of "treat the patient not the monitor"?
In search of answers, I visited treatthepatientnotthemonitor.com, but surprisingly found nothing.
I am left only with m...
Source: EMS 12-Lead - August 6, 2013 Category: Cardiology Authors: David Baumrind Tags: ems-health-safety ems-topics patient-management Training training-development 12-Lead ECG David Baumrind ems12lead.com Paramedic Source Type: research
49 Year Old Male: Chest Pain
This excellent case comes to us from our friends in the UK. The author wishes to remain anonymous, but we thank him for his contribution.
It is about 8am on a gorgeous Wednesday morning, when your Paramedic unit is dispatched to a 49 year old male, "chest pain".
You arrive at the bungalow of a summer resort and are greeted by an elderly couple.
"They don't look too bad", you think, but you are not that lucky.
"Our son has been complaining of chest pain and vomiting for a couple of days".
You are led back to a room where you find your 49 year old patient lying in bed.
His parents say...
Source: EMS 12-Lead - July 22, 2013 Category: Cardiology Authors: David Baumrind Tags: ems-health-safety ems-topics patient-management Training training-development 12-Lead ECG case study David Baumrind ems12lead.com Paramedic Source Type: research
Editors’ Picks
Summer is in full swing, and we are often asked about the best resources out there to learn more about ECG.
We decided to put together a list of "Editors' Picks" for some of our favorite "go-to" educational ECG resources.
Of course, this list is not comprehensive, and there are many outstanding books and sites that are not mentioned here this time around.
However, you have to start somewhere!
Books:
"12 Lead ECG: The Art of Interpretation" (Garcia and Holtz)
"Chou's Electrocardiography in Clinical Practice" (6th edition is recommended)
&q...
Source: EMS 12-Lead - July 15, 2013 Category: Cardiology Authors: David Baumrind Tags: ems-health-safety ems-topics Training 12-Lead ECG Challenge app David Baumrind ECG Books ECG Websites Editors' Picks Source Type: research
RBBB Abnormalities Missed
The original presentation of this case appeared as "What's Wrong with Mr. Wilson?"… You can read the original post here.
Much has been written lately about RBBB abnormalities that were missed.
Dr. Smith has recently posted two cases here, and here discussing this.
First, let's review the 12 lead of a normal RBBB. When learning to recognize abnormalities, we must first be intimately familiar with what "normal" looks like:
&nbs...
Source: EMS 12-Lead - July 13, 2013 Category: Cardiology Authors: David Baumrind Tags: ems-health-safety ems-topics patient-management training-development 12-Lead ECG appropriate T-wave discordance David Baumrind ems12lead.com pathologic Q waves RBBB right bundle branch block STEMI Source Type: research
77 year old female CC: Abdominal Pain
It's a quiet Sunday afternoon when you're dispatched to a residence for a 77 year old female complaining of abdominal pain. Your dispatch notes indicates she was at the ED the day prior. Upon your arrival, you're met on the porch by the patient's son who directs you inside.
Your patient is sitting in a recliner, with mild respiratory distress, clutching her abdomen. Her skin appears a bit moist, and is warm when you touch her arm to feel for a radial pulse. When you ask her what is going on, she simply replies, "my belly won't stop hurting."
Your partner makes quick work of her vitals while yo...
Source: EMS 12-Lead - June 11, 2013 Category: Cardiology Authors: Christopher Watford Tags: ems-topics patient-management 12-Lead ECG case study Christopher Watford Paramedic Prehospital 12-Lead ECG blog Source Type: research
Survivor gives us a lens into regional systems of care for acute ischemic stroke in North Dakota
I just got back from the North Dakota Mission: Lifeline STEMI and Acute Stroke Conference in Bismark, ND. I had a great time and I learned a lot.
I often get asked to speak in various venues about acute STEMI and 12-lead ECG interpretation, but for this conference they wanted me to talk mostly about stroke. That turned out to be a good thing because it forced me to read the 2013 AHA / ASA Guildelines for the Early Management of Patients With Acute Ischemic Stroke to make sure I was asking intelligent questions during the panel discussion (which I moderated) and also giving accurate information for the class I taught about ...
Source: EMS 12-Lead - May 31, 2013 Category: Cardiology Authors: Tom Bouthillet Tags: ems-topics patient-management North Dakota Mission Lifeline Stroke Source Type: research
