Transcutaneous Pacing (TCP): The Problem of False Capture

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Transcutaneous pacing (TCP) is perhaps the most underutilized and misunderstood intervention in all of ACLS. Why? Simple. Because it’s impossible to simulate during training. From the 2010 AHA ECC Guidelines – Part 8:3: Management of Symptomatic Bradycardia and Tachycardia “It is reasonable for healthcare providers to initiate TCP in unstable patients who do not respond […]

Large block method for heart rate calculation

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Some paramedics are not proficient at estimating the heart rate using the large block method for heart rate calculation. I realize that modern ECG machines calculate the heart rate, but I my attitude toward machines is similar to Ronald Reagan’s attitude toward the Soviet Union. “Trust but verify.” I created the following image using nothing […]

ACC/AHA 2008 Statement on Performance Measurement and Reperfusion Therapy

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The ACC/AHA 2008 Statement on Performance Measurement and Reperfusion Therapy was published on 11/10/08. Here are some highlights (from the prehospital perspective) with comments: “Acute reperfusion therapy, either with fibrinolytic therapy or percutaneous coronary intervention (PCI), is one of the most important treatments for patients with ST-segment elevation myocardial infarction (STEMI)…The timeliness of reperfusion therapy […]

Chest Pain and ST-Segment Elevation in Lead aVR

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EMS is dispatched to a 63 year old male complaining of chest pain. On arrival you find the patient lying supine in bed, alert and oriented to person, place, time and event. His general appearance is poor. He is pale, but not diaphoretic. Skin temp is normal. His chest pain is substernal 6/10 and non-radiating. […]

The Transition, R-Wave Progression, R/S Ratio in Leads V1-V2

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We covered the first 6 leads of the 12 lead ECG in the 6-part tutorial on axis determination, so it’s time to discuss the precordial leads (V1-V6). These are the unipolar leads that are placed directly on the patient’s chest. The heart is a 3-dimensional object, and calculating the heart’s electrical axis in the frontal […]

Fishin’ with Fuzzy

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I apologize for my absence, but I have a good excuse! Yesterday, my crew and I took advantage of a rare opportunity to fish with the legendary Captain Fuzzy Davis! The result? Lots of fish!

D2B times at Parma Community General Hospital

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Last week I was browsing around the D2B Alliance website and clicked on a section called Hospital D2B Stories. The very first listing was Parma Community General Hospital, Parma, OH – learn how PCGH achieved 85% of patients treated within the 90 minute goal. This caught my eye. It just so happens that I graduated […]

The honor formerly known as the Superior Scribbler Award

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Rogue Medic has bestowed upon Prehospital 12 Lead ECG the Superlative Hieroglyphicist Award (also known as the Superior Scribbler Award). Here’s what Rogue Medic had to say: “Prehospital 12 Lead ECG by Tom B. is a great blog about cardiology from a prehospital perspective. He understands 12 leads, how to teach them, and he is […]

October 18, 2008: Dr. Jacobs and Dr. Gibson Discuss Mission: Lifeline – The AHA STEMI Initiative

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Dr. Alice Jacobs and Dr. C. Michael Gibson discussed AHA Mission: Lifeline at TCT 2008. One part that I found interesting: 05:19 Dr. Jacobs: “In addition to the fact that only 50% of patients dial 9-1-1 and activate EMS, we know 10 to 15% of [EMS] vehicles have prehospital [12 lead] ECGs…although it’s said 70 […]

Weakness, nausea, and inferior-posterior-lateral STEMI

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You are dispatched to a report of a disoriented man on the beach. On arrival bystanders direct you to a 49 year old male who is sitting on a bench. An elderly couple states they were taking a walk and saw the man sitting on the bench and became worried about him due to his […]

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