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I don't have a problem with transitioning to LUCAS for true refractory VF if there is a chance of saving them with ECMO (a patient with a very poor prognosis and nothing to lose). I am aware of some interesting cases from Minneapolis Heart where this was done. I would not, however, change my...

So you think that King County Medic One should take it's 62% survival rate for witnessed VF and trade it in for "LUCAS and run" so that the remaining 38% can have a chance at life. Is that a fair statement? I'm looking forward to reading all about your "highest in the world" survival rate thanks...

If you have poor outcomes for witnessed VF arrest the solution is to improve the chain-of-survival, not to "slap on a LUCAS and run like hell."

It's substandard care when you interrupt chest compressions during the "sweet spot" of the resuscitation (the 3rd shock should be delivered at minute 5) to apply the LUCAS device (no evidence of benefit) just so that you can (possibly) transition to ECMO or beat some arbitrary "soft" guideline...

In my department our goal is patient's side-to-first shock in less than 60 seconds (let's call it 1 minute). We deploy suction, assemble the BVM, attach to capnogrpahy and oxygen, and insert an appropriately sized OPA during the first 2-minute cycle after the first shock, then we shock again and...

Just remember that the maximum pacing rate of a LIFEPAK is 180 PPM. I worry about overdrive pacing simply because 90+% of the time when I review a transcutaneous pacing case it turns out to be false capture. I have not tried it but I would consider it for torsades de pointes refractory to...

I set mine for 300 mm Hg. Any higher than that and you end up snagging the inside of the patient's cheek. I frequently see the suction set in the red zone. It's something very few people pay attention to.

For any tachycardia I ask myself whether the symptoms are the result of the tachycardia or whether the tachycardia is the result of an underlying problem (a compensatory tachycardia). For example, if you have a patient in acute pulmonary edema and the monitor shows atrial fibrillation with rapid...

Start by framing the question the best way you possibly can. "What should I do when someone doesn't listen to me?" Step 1 is to do some soul searching and get your ego out of it. Yes, officers have formal authority in the fire service, but it's a sad officer who has to rely on it to get others...

Thank you!

Here's my question. EMS responds to a patient with difficulty breathing with trouble speaking between breaths. The patient has a cardiac history. S/he is hypertensive with adventitious breath sounds. Initial SpO2 in the high 70s. The patient gets a 12-lead ECG, nitroglycerin, and CPAP. By...

This is what happens in organizations that don't measure outcomes. There's nothing to prove that the system is underperforming. So now you have to show that a change in practice is warranted. It would be better if you knew your survival rate for witnessed VF was 15% or 20%. Then a reasonable...

Simultaneous left anterior and left posterior fascicular block would be indistinguishable from left bundle branch block. By convention bifascicular block is right bundle brach block plus either left anterior fascicular block (by far most common) or left posterior fascicular block.

If it's complete LBBB it's both because the block is above the bifurcation of the left bundle branch into the left anterior and posterior fascicles.

A normal QRS duration is in the 80-100 ms range. It is considered prolonged between 100-119 ms but not "wide" for the purposes of identifying complete bundle branch blocks and ventricular rhythms.

Pacemakers have been using impedance to measure respiratory rate and minute ventilation for a long time. http://www.ncbi.nlm.nih.gov/pubmed/3608595

There is more than one possible mechanism but some pacemakers monitor intrathoracic impedance between the lead and power plant (tip and can) to measure the respiratory rate. The device assumes that when you are breathing hard you need more cardiac output.

Could be atrial flutter with 3:1 pacing in the first strip and 2:1 pacing in the second. Slight variations in the flutter rate could place sensed atrial events barely inside or outside of the post ventricular atrial refractory period (PVARP) to make it switch back and forth from 2:1 to 3:1 but...

Do y'all transmit the EKG when you know you have a mimicker? * I don't transmit if I know I have a mimic (why would you?) but I tell my paramedics they are welcome to transmit for a consult if they have a concern. Do you activate the cath lab when your tracing meets Sgarbossas criteria? * Our...

+1 Tom