Identifying STEMI in the presence of LBBB – Sgarbossa’s Criteria Part 1

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This series has been updated and moved. Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 1 Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 2 Making Sense of Sgarbossa’s Criteria – Chest Pain and Left Bundle Branch Block – Part 3

Prehospital 12 lead ECG programs

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I posted this series of questions today at JEMS Connect. Please feel free to respond here or there. Does your service perform prehospital 12 lead ECGs? Does the prehospital 12 lead ECG help determine your transport destination? Is the cath lab activated based on the prehospital 12 lead ECG? Does your program rely on the […]

Who receives the most benefit from reperfusion therapy?

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Patients with new bundle branch block receive the highest benefit from reperfusion therapy, followed by patients with acute anterior STEMI, and then acute inferior STEMI. When fibrinolytic therapy is administered to patients with ST segment depression only, we kill an additional 14 patients per 1000 treated. When fibrinolytic therapy is administered to patients with a […]

Early repolarization or LAD occlusion?

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41 year old male complaining of chest discomfort. Past medical history: Asthma Medications: Inhaler (unknown type) EMS finds the patient sitting in a chair. The patient appears acutely ill. His skin is cool, pale, and diaphoretic. Breath sounds clear bilaterally. Onset: At rest Provoke: Nothing makes the pain better or worse Quality: “Heavy” and “unrelenting” […]

Man Dies at Home After Paramedics Diagnose Acid Reflux

Thanks to Dave Statter for turning me on to this story from the Washington Post. Apparently a 39 year old male died a few hours after paramedics diagnosed his chest pain and shortness of breath as acid reflux and prescribed him Pepto-Bismol. Here’s a quote from the story. “Lolitha Givens said the firefighters asked her son […]

Lifepak 15

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I was invited to the local hospital today to see a presentation on Physio-Control’s new STEMI Management Solution (a topic I will write about at a later date). In the process, I managed to get a look at the Lifepack 15. I was impressed!

Chest pain, bifascicular block, and de Winter T-waves

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EMS is called to a 82 year old male with a chief complaint of chest pain. Onset: 30 minutes prior to EMS arrival Provoke: Nothing makes the pain better or worse Quality: Severe pressure Radiate: The pain radiates to both arms Severity: 6/10 Time: No previous episodes Past medical history: Hypertension, including pulmonary hypertension Medications: Aspirin, […]

Agonal breathing predicts survival from cardiac arrest

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A recent by heartwire gives an overview of: Bobrow BJ, Zuercher M, Ewy GA, et al., Gasping during cardiac arrest in humans is frequent and associated with improved survival. Circulation. Published online before print November 24, 2008. Among the highlights: Someone stricken with out-of-hospital cardiac arrest might still be gasping for air, but that’s no […]

Advanced Airway Management – Should Paramedics Be Intubating?

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It’s a shame that so little attention was paid to the 2003 ACLS Reference Textbook and Experienced Provider Manual. Part of the problem was the delayed release. By the time it finally came out, everyone knew the 2005 update was around the corner. In my opinion, it was the best set of ACLS books the […]

Computerized interpretive statements and bundle branch blocks

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Here’s an ECG that I used for many years in the 12-lead ECG course for the Critical Care Transport (CCEMT-P) program. I would show it to students right after teaching them to differentiate between right and left bundle branch block. The patient is an 80 year old male who was out jogging when he experienced a syncopal […]

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