Author Archives: Ivan Rios

Ivan is a Cardiology and Electrophysiology enthusiast from Orlando, Fl. He is a Critical Care Paramedic and Paramedic Instructor at First Response Training Group in Orlando Fl. He is an editor for the worldwide know sites, EMS12lead.com and its relate Facebook blogs and ECG & Cardiology blogspot. He has a great passion for Emergency Medicine and music, as an Acoustic Singer/Songwriter artist, know as Ivan J. Nash, by his local following.

Pulsus Paradoxus: Cardiovascular Function and Assessment

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Cardiovascular Assessment: Pulsus Paradoxus Assessing cardiac function, blood pressure and hemodynamic status play an important role during our overall patient assessment and treatment. Although 12 lead ECG evaluation is an essential part of patient assessment, especially cardiac etiology, understanding basic cardiac function plays a major role during treatment and overall patient status. During normal hemodynamic […]

Understanding Atropine

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As requested, during our previous Adenosine discussion, we will briefly review, Parasympathetic stimulation and Atropine pharmacodynamics on the heart. ACETYLCHOLINE (ACh) is one of the Neurotransmitters, a chemical signal, used by the Central Nervous System, which has many effects on the body, from stimulating muscle contraction, inducing peristalsis (digestion), Bile release by the liver, and […]

Understanding Adenosine (Adenocard)

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So, recently, I was involved in a conversation, where the topic of Adenosine administration came up. It seems like there is a misunderstanding regarding its use and mechanism of action. Although this is not our classic ECG interpretation topic, I believe its worth talking about for a bit. Adenosine, a Class V antiarrhythmic from the […]

76 year old male with chest pain and “peanut allergy” that turns out to be STEMI

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EMS is dispatched to the residence of a 76 year old white male with a chief complaint of chest pain. Upon patient contact the patient is found sitting on his couch, alert and oriented to person, place, time and event with GCS of 15. The patient appears to be in no distress, advising he believes […]

QRS AXIS DETERMINATION

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During ECG interpretation, cardiac axis, or direction of electrical impulses, may be normal (physiologic) or abnormal (pathologic), suggesting abnormal cardiac conductivity. Although every deflection obtained on the ECG will have an axis, we will focus on the ventricular axis. When we think of our cardiac monitoring lead placement, we have to understand cardiac Vectors, which is […]

Conclusion: 81 YOM with Chest Heaviness

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This is the recap and conclusion for the previous case: http://www.ems12lead.com/2014/03/11/81-yom-with-chest-heaviness/ Here’s the initial 12 lead ECG: What do we see? – Sinus rhythm with 1Left Atrial Abnormality or “Enlargement” – Wide complex QRS with a Right Ventricular Conduction Delay pattern or Right Bundle Branch Block (RBBB) morphology seen as rSR’ in V1 but abnormal […]

30 YOM with Chest Pressure: Reperfusion AIVR

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This the case of a 30 year old male, complaining of chest pressure 8/10 pain scale, for about a week. The patient was born with unknown cardiac complications, which led to multiple near death arrhythmias, which is why the patient has an on demand pacemaker/defibrillator in place. He also has a history of Hypertension (HTN), […]

81 YOM with Chest Heaviness

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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 […]

Magnesium and Cardiac Action Potential

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Magnesium (Mg++) is the second most abundant intracellular ion. Normal Serum Mg++ is 1.8 to 2.5 mg/dL or .8 to 1.5 mmol/L (millimoles per liter) (This values may vary depending on sources) Keep in mind, the Mg++ concentration in the average adult is approximately 25g, but most of our Mg++ is found in bones and […]

CONCLUSION: 87YOM COMPLAINING OF CHEST DISCOMFORT AND DYSPNEA

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This is the conclusion of the previous case: http://ems12lead.com/2014/01/87-yom-complaining-of-chest-pain-and-dyspnea/ So, as mentioned before, you obtain this 12 lead ECG: A few minutes later, the LIFEPAK 15 prints out another 12 lead ECG: Although the computer suggests Atrial fibrillation, this irregular tachycardia has a group beating pattern with presence of P waves prior the QRS complexes and […]

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