Tag Archives: case study

65 year old male CC: Cardiac arrest on the tennis court

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65 year old male collapses while playing tennis. The scene is less than 1 minute from the fire station. On arrival, bystanders are providing rescue breaths but no chest compressions. Medical history is unknown. Initial rhythm: First shock: Return of spontaneous circulation (ROSC) noted. Rhythm strip: 12 lead ECG: The patient is still unconscious. LMA […]

81 year old female CC: ICD shocks x6

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EMS responds to a 81 year old female who was implanted with “a pacemaker” 2 weeks ago. She complains that the device has shocked her 6 times. On arrival the patient is found sitting in a chair. She is anxious but alert and oriented to person, place, time and event. Vital signs: Resp: 18 Pulse: […]

65 year old female CC: Chest pain

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EMS is called to a hotel for a 65 year old female complaining of chest pain. On arrival, the patient is found sitting on the edge of the bed in her hotel room. She is alert and oriented to person, place, and time. Her skin is pink, warm, and dry. Onset: 30 minutes ago while […]

Update to: 78 yom CC: "Chest heaviness"

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Lots of interesting comments on this case. Here is the update. I opted to treat this patient as a presumed monomorphic ventricular tachycardia which is hemodynamically stable. I placed an 18 ga catheter in his left AC at a TKO rate. At approximately 1005 I administered 130mg (1.5mg/kg) of Lidocaine slow IV push which had […]

12-Lead ECG Case Studies

My department is starting a 12-lead ECG “case of the month” as part of our continuing education. Each month, I will select an ECG that was transmitted from the field and resulted in a cath lab activation. Whenever possible, I will include the “before” and “after” angiograms so that the paramedics receive feedback about the […]

78 yom CC: "Chest heaviness"

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Here’s an interesting case submitted by Alex Kroeze. He is currently taking a sabbatical from blogging but was kind enough to share this interesting case with me. Here is the story in Alex’s own words. 78 year old male with a history of MI with cardiac arrest around 1975 as well as diabetes (metformin) and […]

Syncope, Chest Pain, and LAD Occlusion – Part 2

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This is the conclusion to Syncope, Chest Pain, and LAD Occlusion – Part 1. Let’s take another look at the 12-lead ECG. There is a regular rhythm at a rate of 60 (using the large block method there are 5 blocks between R-waves). The QRS complex is narrow at 86 ms. There are P-waves in […]

43 year old female CC: "Indigestion-like" chest discomfort

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Thanks to Jim Tarro for the following case study 43 year old female presents to EMS with “indigestion-like” chest discomfort. She states that it “feels like a previous heart attack.” Onset: Several hours ago Provoke: Antacids make the pain feel better Quality: “Indigestion-like” chest pain Radiate: The pain does not radiate Severity: She gives the […]

Syncope, Chest Pain, and LAD Occlusion – Part 1

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EMS is called to a community event for a patient who experienced a syncopal episode. On arrival, the patient is found slumped back in a chair with a cold, moist towel on his head. His eyes are closed, he is groaning, and appears acutely ill with pale and diaphoretic skin. Bystanders say that he passed […]

44 year old male CC: Palpitations

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Here is an absolutely fascinating case submitted by G.W. Lyster (who credits the case to J.C. Neetz). It's a patient who presented with a wide complex tachycardia who ended up receiving the kitchen sink! Here are the basics. 44 YOM C/O "palpitations". Denies CP, SOB, N/V, dizziness, weakness. Pt in NAD. Meds include Coreg, et […]

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