Author Archives: Brooks Walsh MD

Brooks Walsh is a board-certified emergency physician working in Connecticut. He studied the philosophy of physics in college (Bell's Theorem anyone?), and attempted a masters-degree program in pure mathematics. He found far more success in an EMT-B class, however, and hasn't looked back since. He spent eight years in EMS (five of those as a paramedic) working for private, volunteer, and hospital-based EMS agencies. He once led a traditional 5.10 route in New Hampshire (since downgraded to 5.9+...), has summited Denali, can often correctly use the subjunctive mood in Spanish, finished a marathon in 4:37, has a 2K erg time of 6:46, and is never, ever, sick at sea.

Anterior T wave inversions and PE.

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Last week, I described the case of a middle-aged male with a vague history of heart failure who had been having progressive shortness of breath for 4-5 days. On the day he called 911, he had been walking a short distance when he syncoped. EMS obtained an ECG: Compared with the prior ECG, the anterior […]

Not just S1Q3T3: Look at the other 10 leads!

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It was a slow morning in the ED, so I was able to catch the medic as she came in with the patient. “Hey Leigh, what do you have for us? Got an interesting ECG?” “Well, maybe,” she replied as she wheeled by with a comfortable looking middle-aged male, “here, take a look at it […]

68 y.o. male w/ weakness: conclusion – “Treat the monitor.”

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But perhaps not the computer… Recap of the case: A patient with CHF, COPD, and diabetes called after falling, apparently due to weakness. Their ECG was recorded by the paramedic: Interpretation: The underlying rhythm is unclear, due to artifact, but there are very wide QRS complexes. The computer measures the QRS as 158 ms, which […]

68 y.o. male with weakness: “Treat the monitor, not the patient?”

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A recent graduate of our hospital’s paramedic program brought this case to me. Leigh works for Stratford EMS, an excellent local service in Southwestern Connecticut. (A quick note on the specific details of the case: This patient did not necessarily come to my hospital. Additionally, several features of the case have been altered; some to […]

Conclusion: “And then I gave her a NTG…”

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Recap: From  Part 1: A 64 y.o. woman with typical symptoms of ACS was given nitroglycerin by the paramedic. Her ECG: ECG Interpretation: As noted by many of our astute readers, there is obvious ST-segment elevation (STE) in leads III and aVF. Lead II doesn’t show much STE, but relative to the small R wave […]

64 y.o. Female with CP – “And then I gave her a NTG…”

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My apologies for the faded ECGs. Turns out the medic (a recent grad from our hospital’s program) had been carrying them in his work pants for over a week, waiting to catch me in the ED. The  patient had been brought to another hospital, but he wanted to review the ECGs with me. They had […]

“Bad heartburn” – Conclusion

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Recap In “Bad Heartburn” – 82 y.o. female without chest pain, the paramedic had obtained an ECG on an elderly woman who only complained of mild “heartburn.” An initial ECG was obtained: ECG interpretation : The degree of ST elevation is significantly higher in lead II than lead II, which usually supports an RCA occlusion. […]

“Bad heartburn” – 82 y.o. female without chest pain.

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This case is courtesy of paramedic Jason Cameron, who works for Stratford EMS in Connecticut. The ALS unit had been dispatched for an older female with “chest pain.” Upon arrival, however, the 80 y.o. patient denied any pain or pressure, and only endorsed some mild “heartburn,” localized to the epigastrium, non-radiating, and rated it at […]

Conclusion: 38 Year Old Male – Chest Pain and Leg Paralysis.

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Recap In the post yesterday , the paramedic crew was evaluating a 38 y.o. male who had sudden, severe chest pain, as well as leg numbness and paralysis, and whose vital signs showed a mild bradycardia and pronounced hypertension. The ECG obtained by EMS appears to be junctional, with an unclear contribution from the SA […]

38 Year Old Male – Chest Pain and Leg Paralysis.

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You are called for severe chest pain. The patient is a 38 year old male who describes the abrupt onset of a severe pain in his chest about 30 minutes before his wife called EMS. While sweat streams off his face, he tells you that he has never felt pain this intense. He isn’t sure […]

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