This is the conclusion to 57 year old male: Chest Discomfort. We suggest you read the backstory first! We're now in the back of the ambulance with our stubborn 57 year old male with a rapid heart rate. He looks unwell, but is otherwise hemodynamically stable. Our partner is working on a line. Let's review the initial […]

This is part II to 59 year old male–"Lifting Boxes". You may wish to review the case. Let's review the ECG: There is sinus rhythm at about 90 bpm. Some of you saw a slight bit of ST elevation in the inferior leads, and maybe an abnormal aVL. Perhaps? Perhaps not? V1-V4 look possibly abnormal, […]

The following is a great case from Mordy E, and as always some details have been changed to protect patient privacy. You and your partner are refueling your ambulance at a gas station when a woman walks up and asks if you could, "come check out my husband." As you walk over to their car […]

This is the discussion for 88 year old female: Weakness. If you've not read the backstory, we suggest you check it out! When we last left off, our patient was in an exam room with an irregularly irregular rhythm. The ED physician had asked you if the patient had a history of atrial fibrillation. Let's […]

This great case was submitted by Vince DiGiulio, EMT-CC; we highly recommend you read his wonderful blog The Medial Approach to Emergency Medicine. As usual, the case has been altered to protect patient and provider privacy. You're working triage in a busy urban ED when an 88 year old female is brought in by her family. […]

This is part one of today's case study. As usual some information has been changed to protect patient confidentiality. EMS is called to the residence of a 59 year old male, who's chief complaint is chest discomfort.  As the crew enters the kitchen, they find the patient sitting in a chair surrounded by family members. […]

EMS 12-Lead podcast – Episode #9 – Thomas Concannon, ph.D. talks about the regionalization of STEMI care and the proliferation of PCI hospitals in the United States In this episode of the EMS 12-Lead podcast we're joined by Thomas Concannon, ph.D., Assistant Professor of Medicine at Tufts Medical Center and Tufts University School of Medicine. […]

Any paramedic who has studied the STEMI mimics has heard of the classic benign early repolarization pattern of a "fish-hooked" J-point with upwardly concave (smiley-faced) ST-segment, often best appreciated in lead V4. But, as the excellent work of Stephen Smith, M.D. demonstrates, not all cases of early repolarization present this way, and it can often […]

This is the discussion for "Snapshot: 64 Year Old Male–Chest Pain". First, let's talk about the patient presentation.What is concerning is the substernal chest pain, radiating to the shoulder and neck area. While this occurred about 30 minutes after exercise, it did not occur during exercise, so that is somewhat atypical. Still, enough red flags […]

This is the discussion for 77 year old female: Unresponsive, if you have not read the case report we recommend you start there! First, a hat tip to our readers who were unafraid to tackle this challenging scenario. Second, we were very impressed to see a number of readers correctly identify this challenging rhythm! When we […]