From Precons to EMS 10 Awards and Nightwatch! #EMSToday2015
Wednesday, February 25, 2015
What an awesome day at EMS Today 2015! Kelly and I headed over to the Convention Center to get registered and ran into our very good friends Nick Nudell (@RunMedic), Chris Montera (@geekymedic), and Anne Robinson Montera (@CaringAnne).
Nick and I started the EKG Club many years ago as an email-based discussion group. It is now a thriving Facebook group that you should check out! We’ve also done some interesting consulting work together in the implantable medical device industry.
Chris and Anne are one of the “power couples” of EMS and are very influential in Community Paramed...
Source: EMS 12-Lead - February 26, 2015 Category: Cardiology Authors: Tom Bouthillet Tags: Uncategorized EMS Today 2015 Source Type: research
A visit to Johns Hopkins #EMSToday2015
Tuesday, February 24, 2015
We arrived a day early into Baltimore and decided it would be a good idea to visit what is arguably the nation’s best hospital. Johns Hopkins Hospital’s core values include Excellence & Discovery, Leadership & Integrity, Diversity & Inclusion, and Respect & Collegiality and you sense when you’re walking around that it’s more than just lip service.
I’ve written many times about Peter Pronovost and The Science of Safety (everyone in medicine should be required to watch the video). It’s not an accident that one of the world’s foremost expert...
Source: EMS 12-Lead - February 25, 2015 Category: Cardiology Authors: Tom Bouthillet Tags: Uncategorized EMS Today 2015 Source Type: research
The Calm Before the Storm! #EMSToday2015
In case you haven’t heard the good folks at PennWell and JEMS have selected yours truly as the Official Blogger of EMS Today 2015.
The #EMSToday2015 hashtag is already buzzing! My wife Kelly @barefootNurse24 and I @tbouthillet flew into Baltimore yesterday and it was fun to follow our international colleagues gearing up for the JEMS Games!
Here we have Hayden Drake @paramedickiwi from #TeamAUT (New Zealand) and a “stow away” which I choose to believe is the amazing kakapo (a critically endangered flightless parrot with a remarkable story).
Here we have Dan @Daniel_Barnwall, Dean, and Steve from th...
Source: EMS 12-Lead - February 24, 2015 Category: Cardiology Authors: Tom Bouthillet Tags: Uncategorized EMS Today 2015 Source Type: research
The 12 Leads of Christmas: V3
CONCLUSION: The real culprit
Getting to the heart of the matter, there are two main acute lesions we see that cause an isolated posterior STEMI pattern on the ECG:
Acute obstruction of a non-dominant LCx.
Acute obstruction of an obtuse marginal (OM) off the LCx, or similar artery.
The purple arrow points to an acute lesion in the LCx while the yellow territory is the ischemia downstream. You can see how it affect mainly the mid and basal portions of the lateral wall, perhaps also reaching a bit of the infero-basal wall. Image modified from Lippincott Williams & Wilkins “Atlas of Anatomy.” [2]
The pu...
Source: EMS 12-Lead - February 16, 2015 Category: Cardiology Authors: Vince DiGiulio Tags: 12-Leads of Christmas Original Articles Vince DiGiulio Source Type: research
Adenosine for sinus tachycardia: Try to avoid this!
This is the feedback I gave the student on this case. (Recall that this was a young adult male who presented with dyspnea, chest pain, as well as pre-syncope, whose initial ECG showed a brisk tachycardia which went up to the 170s at points):
At 150, about to speed up.
Bottom line:
“As you point out, this was sinus tachycardia. When you have sinus tachycardia, you have to look for causes and treat those. I encourage you to read David Baumrind’s excellent essay on this topic for a different explanation. Here’s mine.
Sinus Tachycardia
“Sinus tachycardia can be caused by hypovolemia, cardiogenic shock, hyp...
Source: EMS 12-Lead - January 15, 2015 Category: Cardiology Authors: Brooks Walsh MD Tags: Uncategorized Source Type: research
The first iPad mini goes to . . . #EMSToday2015
Well, apparently at least one of you registered for EMS Today 2015 using promo code EMS12LEAD during checkout.
How do I know this? Because I was recently notified by our friends at PennWell that the first drawing for an iPad Mini is complete!
The winner is . . . Steven Caho!
Congratulations, Steven! If you’re reading this please contact me at ems12lead@gmail.com.
It’s not over, folks! There is still time to register for EMS Today 2015 and there will be one more drawing for an iPad mini! But hurry! Early bird registration ends Monday, January 19th!
Click HERE to listen while A.J. Heightman explain all the rea...
Source: EMS 12-Lead - January 15, 2015 Category: Cardiology Authors: Tom Bouthillet Tags: Uncategorized emstoday2015 Source Type: research
Adenosine given for a narrow-complex tachycardia over 150
Conclusion
An echocardiogram and CT scan showed that the patient had a massive pulmonary embolus, blocking much of both pulmonary arteries. He had a history of PE and DVT, but was non-adherent with the anticoagulant medication.
Questions:
Was this rhythm a “SVT?”
Were the therapies (vagal maneuver and adenosine) helpful for diagnosis or treatment?
What is the “ACLS approach” to the arrhythmia in this patient?
What would your approach be?
(Source: EMS 12-Lead)
Source: EMS 12-Lead - January 13, 2015 Category: Cardiology Authors: Brooks Walsh MD Tags: Uncategorized Source Type: research
The 12 Leads of Christmas: V2
This article is the tenth in our latest series, The 12 Leads of Christmas, where each day we examine a new finding particular to an individual electrocardiographic lead.
Lead V2
I love V2.
It’s probably been my favorite lead to examine and ponder this past year. The cool thing is that it doesn’t seem all that special way at first. I mean, the precordial leads form what is essentially a smooth sigmoid curve across the chest; what could one lead tell us that’s so unique compared to its neighbors? As it turns out, in the right situation, V2 can hold some surprises when it comes to infarct localization.
I see...
Source: EMS 12-Lead - January 6, 2015 Category: Cardiology Authors: Vince DiGiulio Tags: 12-Leads of Christmas Original Articles Vince DiGiulio Source Type: research
The 12 Leads of Chistmas: V2
This article is the tenth in our latest series, The 12 Leads of Christmas, where each day we examine a new finding particular to an individual electrocardiographic lead.
Lead V2
I love V2.
It’s probably been my favorite lead to examine and ponder this past year. The cool thing is that it doesn’t seem all that special way at first. I mean, the precordial leads form what is essentially a smooth sigmoid curve across the chest; what could one lead tell us that’s so unique compared to its neighbors? As it turns out, in the right situation, V2 can hold some surprises when it comes to infarct localization.
I see...
Source: EMS 12-Lead - January 6, 2015 Category: Cardiology Authors: Vince DiGiulio Tags: 12-Leads of Christmas Original Articles Vince DiGiulio Source Type: research
The 12 Leads of Christmas: V5
This article is the ninth in our latest series, The 12 Leads of Christmas, where each day we examine a new finding particular to an individual electrocardiographic lead.
We’re getting into the home-stretch in our little series. I wasn’t entirely sure if we were going to make it through since a few of the leads, though they are useful, don’t bring much that is particularly unique to the table. V5 is one of those leads (like aVF and V4), and while there is still plenty to discuss, it’s not as exciting as lead III, aVL, or aVR.
Don’t lose faith, however, as I have saved three of my favorites—V2...
Source: EMS 12-Lead - January 3, 2015 Category: Cardiology Authors: Vince DiGiulio Tags: 12-Leads of Christmas Vince DiGiulio Source Type: research
The 12 Leads of Christmas: V4
This article is the eighth in our latest series, The 12 Leads of Christmas, where each day we examine a new finding particular to an individual electrocardiographic lead.
Like aVF, V4 is a tough lead to discuss on its own. It’s part of the natural flow of the complexes across the precordium and it is certainly nice to have, but because it’s so closely related to V3 and V5 there isn’t a whole lot that makes it unique. The two topics we’ll discuss today involve, but are not isolated, to V4.
First off, I can’t discuss V4 without mentioning the work of our blog’s good friend and mentor, Dr. ...
Source: EMS 12-Lead - January 2, 2015 Category: Cardiology Authors: Vince DiGiulio Tags: 12-Leads of Christmas Original Articles Vince DiGiulio Source Type: research
The 12 Leads of Christmas: V1
This article is the seventh in our latest series, The 12 Leads of Christmas, where each day we examine a new finding particular to an individual electrocardiographic lead.
Happy New Year everyone! Today’s post is going to be a bit of a hodge-podge as I recover from yesterday’s post on ST-elevation in aVR. Let’s talk about V1!
Brugada Syndrome
Like yesterday’s topic, we’ve reached the point where it seems like almost too many people are now aware of Brugada syndrome. It’s not an problem to have more people aware of a deadly disease but it does become an issue when the general understandin...
Source: EMS 12-Lead - January 1, 2015 Category: Cardiology Authors: Vince DiGiulio Tags: 12-Leads of Christmas Original Articles Uncategorized Vince DiGiulio Source Type: research
The 12 Leads of Christmas: aVR
Conclusion to 83 Year Old Male: Shortness of Breath (My earlier primer on diffuse subendocardial ischemia)
A Non STEMI That Needs the Cath Lab Now (Post by Dr. Smith that covers the management of emergent NSTEMI’s)
Five Primary Patterns of Ischemic ST depression, without ST elevation. (Amazing post by Dr. Smith on patterns of ST-depression)
Marked ST depression refractory to maximal medical therapy (More NSTEMI goodness from Dr. Smith)
ST elevation in aVR, with widespread ST depression (Another NSTEMI that needs the cath lab)
Deep and widespread ST depression signifies high risk coronary lesion (One final NSTEMI that...
Source: EMS 12-Lead - December 31, 2014 Category: Cardiology Authors: Vince DiGiulio Tags: 12-Leads of Christmas Original Articles Vince DiGiulio Source Type: research
The 12 Leads of Christmas: aVF
This article is the fifth in our latest series, The 12 Leads of Christmas, where each day we examine a new finding particular to an individual electrocardiographic lead.
I dug myself quite a hole on this one as there’s really not much to say about aVF. It’s located midway between leads II and III so any features you see here can usually be seen in one or both of those other leads. There is one trick that we can discuss pertinent to aVF, however…
In the second piece of this series examining lead II we discussed the lead II sign of right-arm/right-leg wire swap, why it displays the pattern that it does, and...
Source: EMS 12-Lead - December 30, 2014 Category: Cardiology Authors: Vince DiGiulio Tags: 12-Leads of Christmas Original Articles Vince DiGiulio Source Type: research
The 12 Leads of Christmas: aVL
This article is the fourth in our latest series, The 12 Leads of Christmas, where each day we examine a new finding particular to an individual electrocardiographic lead.
Lead aVL
Today’s review is going to be light (but heavy on EKG’s) on text to make room for tomorrow’s big post on aVR. It also helps that a lot of the principles that we discussed in yesterday’s post on lead III apply here as well. In summary: aVL is great for identifying STEMI’s (too!).
In addition to lead III and V3, aVL is the third lead I usually choose to monitor for my patients who present with signs and symptoms conc...
Source: EMS 12-Lead - December 29, 2014 Category: Cardiology Authors: Vince DiGiulio Tags: 12-Leads of Christmas 360 Degree Heart Original Articles Vince DiGiulio Source Type: research
