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South Carolina has a state protocol that allows application of a ring magnet with online medical control. Just because "it's not in the protocols" doesn't mean it shouldn't be! :)

Yes for LP12 and ZOLL M-series. No for Philips MRx. Not sure about LP15. Tom

The GE-Marquette 12SL interpretive algorithm does a fairly decent job identifying conduction abnormalities like bundle branch blocks and has a fairly high specificity when it gives the ***ACUTE MI SUSPECTED*** or ***ACUTE MI*** message. However, it does not do particularly well at basic rhythm...

There is no reason to be doing a "study" or a "pilot" of therapeutic hypothermia at this point in time. The evidence is extremely robust. If you're going to do it make it the standard of care. It is absolutely untrue that it's "not good" to begin cooling prior to ROSC. In fact there's a slight...

A couple of other thoughts: 1.) Compare the morphology of the paced rhythm to the wide complex tachycardia. If the QRS complexes are essentially the same it's almost certainly a paced rhythm. 2.) This patient appears to be doing better with the tachycardia which lessens the likelihood that...

This is device specific so ask to see the patient's ID card. I wrote a 3-part tutorial on the application of magnets to ICDs here: http://ems12lead.com/2009/05/ineffective-or-inappropriate-icd-shocks-part-i/ In most cases tachy therapy is disabled while the magnet is applied and resumes...

Where paramedics get tripped up is foolishly calling a wide complex tachycardia SVT with aberrancy based on axis, lack of concordance, or QRS morphology. Wide and fast should be considered VT in the field absent strong evidence that it's something different.

Arrhythmia, ischemia, injury, infarction (especially early recognition of STEMI), conduction disorders (bundle branch blocks), prolonged QT, WPW pattern, Brugada pattern, Osborn waves (hypothermia), electrolyte derangement (especially hyperK), drug overdose (especially TCA), pacemaker capture...

It's not that lead II will look "normal" when the patient is in VT but it's possible that lead II will be isoelectric or the QRS complexes could appear to be narrow (as they often do in right bundle branch block because your eye is drawn to the tight R-wave and not the slurred S-wave) whereas...

The bradycardic, periarrest pediatric patient needs CPR, ventilation and a review of the Hs and Ts, not transcutaneous pacing.

Thanks for the clarification! That I would report as an unsafe practice. Tom

I did it just a couple of weeks ago to draw up a 20 ml flush for adenosine. Our prefilled saline syringes are only 3 ml. I'm surprised by the harsh reaction. We used the appropriate aseptic technique. Throughout my career I've seen it many times in many settings (in and out of the hospital...

Put down the rail on the gurney and take a knee along side the patient. Place your tourniquet and learn to apply it so that the ends point up toward the patient's head (not your work area). Hold the arm below the level of the patient's heart so the veins become distended. Hold the skin taut. If...

I think what you see is fragmentation of the QRS complex. It may indicate higher risk of future adverse events in patients with known coronary artery disease. I only recently learned about this (from Dr. John M.). http://www.theheart.org/article/822713.do Tom

Sustained monomorphic VT is a not-uncommon finding in a patient with an ICD. Often the patient presents with a wide complex tachycardia at a rate of < 150 with an ICD that is not firing. The oral antiarrhythmics (one presumes) keeps the rate of the VT slightly lower than the lower rate "shock"...