Archive for June2010

Paramedic Cardiac Examination Assessment

Here’s an interesting video brought to you by Pro EMS Center for MEDICS in Cambridge, MA. Clearly, this physical exam wasn’t gleaned from a paramedic textbook. I personally think paramedics need to do a much better job when it comes to performing a physical exam. Auscultating valve sounds in the field? Not realistic, IMHO. But […]

Evaluating the Pacemaker Patient

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A recent case over at Burned-Out Medic has reminded me how much I’ve benefited from the study of implantable medical devices. As I stated in my interview with EP Lab Digest: “As for the nuts and bolts of cardiac rhythm analysis, it’s the realization that the heart has two rhythms happening at the same time, one atrial […]

The missed STEMI

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Here is the history of present illness recorded by the physician at the time of the patient’s arrival in the emergency department. “This 67-year-old male presents via EMS for evaluation of weakness, dehydration and one episode of nausea/vomiting. The symptoms began after approximately one hour of jogging this morning. The patient did not eat breakfast […]

81 year old male CC: "Cold and shaky" – Conclusion

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This conclusion has been combined with Part 1.

Rhythm Challenge #4 – Discussion

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I’d like to thank everyone for the great comments on the most recent “rhythm challenge”. This turned out to be a more interesting rhythm strip that I thought! I’m going to break this down using some standardized steps that I follow for difficult rhythm strips. When I look at a strip, the first thing I ask […]

EMS Role in Reducing the Symptom to Reflow Interval for AMI – Closing Comments

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Here are my closing comments from the NAEMSP Dialog group discussion “EMS Role in Reducing the Symptom to Reflow Interval for AMI”. I think it’s important that we finish building regionalized STEMI systems in every state, and do our best to help ensure that our patients receive evidence based therapies, no matter where they live. […]

Patient presenting to fire station for BP check proves to be suffering acute STEMI

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An 81 year male presents to the fire station to have his blood pressure checked. He tells the paramedics he had just finished a round of golf and was sitting in the clubhouse when he felt “cold and shaky.” He states that he went out to his car, rolled up the windows in the warm […]

Rhythm Challenge #4

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How would you describe this heart rhythm? Lead II is on top and lead V1 is on bottom.