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54 year old male CC: Chest pain – Discussion

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This is the discussion for 54 year old male CC: Chest pain. Once again we see the importance of serial ECGs in the treatment of a suspected ACS patient. The difference between the first and second 12-lead ECG is the key to solving this case. As you can see, the T-waves become more pronounced in leads […]

54 year old male CC: Chest pain

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Here’s an interesting case submitted by Terry Weatherford, NREMT-P. EMS responds to a report of a 54 year old male complaining of chest discomfort. O—Sudden onset P—Nothing made the pain better or worse Q—Stabbing R—Radiated to left shoulder S—9/10 T—Less than 30 minutes Vital signs: B/P 110/78 HR—70 Resp—20/min. Pulse ox 100% with O2. S—Nausea […]

58 year old female CC: Chest pain – Conclusion

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Here’s the conclusion to the 58 year old female with chest pain and left bundle branch block. To refresh your memory here is the 12-lead ECG. And for those of you who requested lead V4R. This ECG meets all 3 of Sgarbossa’s criteria to identify acute STEMI in the presence of left bundle branch block. Keep […]

58 year old female CC: Chest pain

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Here’s a case study from a faithful reader who wishes to remain anonymous. Presenting Complaint – Chest Pain History of Present Complaint – 58 year old female, nil cardiac history, mild smoker, social drinker and overweight. Complaining of acute central chest pain @ rest. Awoken by pain. On Arrival – Sat upright on settee (Editor’s […]

69 year old male CC: "Indigestion"

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Here’s a case from a faithful reader who wishes to remain anonymous. In his own words: Presenting Complaint – Chest Pain History of Present Complaint – 69 year old male, nil cardiac history, none smoker, social drinker. Complaining of indigestion last 2-3 weeks with noticably increase in belching. This a.m acute onset of burning heavy […]

79 year old male CC: Shortness of breath

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Here’s another interesting case submitted by Geoff Dayne. 79 y/o male c/o non-provoked SOB without CP. Patient was found sitting upright, tripodding, 1 word dyspnea. Lung sounds: extremely decreased tidal volume. EMS crew was unable to tell if there was rales or wheezing. Past medical history: HTN, dyslipidemia, CHF, pacemaker (recently implanted within a week […]

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. http://www.ems12lead.com/2010/06/04/81-year-old-male-cc-cold-and-shaky/

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 […]

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 […]

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