This is the conclusion to 65 year old male CC: Fall with injury. You may wish to review the history and clinical presentation. When we left off the patient was in severe heart failure with the following 12-lead ECG. As we have mentioned before on several occasions, the most important thing when treating a patient […]

Here's a very interesting case submitted by a faithful reader who wishes to remain anonymous. Some changes have been made to preserve patient confidentiality. EMS is called to a local breakfast restaurant for a 65 year old male who fell in the parking lot. He was reported to have suffered a head injury. On arrival […]

Here's a case submitted by a faithful reader who wishes to remain anonymous. He has submitted several cases before and they are always excellent so thank you, Mr. Anonymous!  EMS is called to the residence of a 69 year old female who is complaining of sudden onset of shortness of breath and weakness. Past medical […]

This is the conclusion to 88 year old male CC: Chest pain. You may wish to go back and review the history and clinical presentation. First, let's look at the rhythm strip. This shows an undetermined regular rhythm at a rate of about 60 with demand ventricular pacing.  This is an oversimplification but as long […]

Thanks go to Michael Herbert for this great case! As always, some details have been changed to protect patient privacy. It’s late into your shift when the tones go off for breathing problems at a local extended care facility. Enroute you’re advised it is a 64 year old female with a “low O2 sat,” and to, […]

Thanks to Ivan Rokos, M.D. for pointing out an important change in the 2011 ACCF/AHA/SCAI Guidelines for Percutaneous Coronary Intervention. Photo credit: Code STEMI Web Series at First Responders Network For years now many have complained about the AHA's official recommendation that primary PCI for acute STEMI be accomplished within 90 minutes of first medical […]

This is the conclusion to 90 year old male CC: "Possible stroke". You might want to go back and familiarize yourself with the details of the case. Let's take another look at the 12-lead ECG. Now with the computerized interpretive algorithm. On Facebook I had asked whether or not this ECG showed signs of ischemia. […]

EMS responds to a 90 year old male with a "possible stroke". On arrival the patient is found sitting on the toilet (lid down). His spouse states that he had walked outside to retrieve the newpaper when he lost his balance and skinned his knee. She helped him inside and sat him down on the […]

This is the conclusion to 83 year old male CC: "Cardiac patient in distress". You may wish to check out the previous post for details about the patient's clinical presentation. Let's take another look at the 12-lead ECG. This ECG shows a regular narrow complex tachycardia at a rate of 170. Could it be sinus […]

EMS is dispatched to a "cardiac patient in distress". On arrival paramedics are led to the bathroom where the patient is found sitting on a foot stool. He is conscious but appears acutely ill. Skin is pale and he is slumped over. He states that he feels weak. Past medical history: High blood pressure, high […]