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"I want a whole lot more of an assessment, but just based on that information, lets try CPAP first and see if we can't get his rate down through bringing his sats up." Agree 100%. Don't forget the nitroglycerin!

Hyperkalemia, without a doubt. Even to the point of double-counting the QRS complexes which is often the case with the GE-Marquette 12SL interpretive algorithm. When the QRS duration is greater than 200 ms (one large block), the S and T waves merge together (sine wave or "Z-fold"), and the...

All cardiologists say that until they are called in at 0300 for a paced rhythm or because artifact triggered the ***ACUTE MI SUSPECTED*** message on the prehospital 12-lead ECG. Pericarditis is a special case because it's rare and widespread ST-elevation could also be a massive STEMI. Every...

I took the test again with the idea that: 1.) there was clinical correlation with typical signs/symptoms of ACS. 2.) that the standard was "do I think it's an occluded artery" with the understanding that the ECGs were taken from an academic paper on the topic. That's a different standard...

Sure. Transcutaneous Pacing (TCP) - The problem of false capture http://www.ems12lead.com/2008/11/15/transcutaneous-pacing-tcp-the-problem-of-false-capture/ Tom B.

Considering that TCP is one of the worst performed skills in the history of emergency medicine, and it would distract you from prioritizing airway and breathing, I'm delighted it's not in the pediatric bradycardia algorithm. It's also been downgraded in the adult algorithm (it used to be the...

Good Lord, Christopher! There's not a straight forward ECG in that entire test. Each was was difficult, IMHO. I would not feel comfortable calling any of them a STEMI without clinical correlation. My accuracy: 83% with 2 false positives and 4 false negatives (I answered conservatively). You...

A couple of points. TdP is polymorphic VT in the presence of an underlying prolonged QT interval. The dividing line between polymorphic VT and VF is a bit arbitrary. Some might say that polymorphic VT should have a cyclic rate less than 300. However, I've seen TdP with a cyclic rate...

I can't disagree. It must be correlated to the history and clinical presentation but I've seen very similar ECGs with ROSC patients who ended up with 3-5 vessel bypasses (after cath showed severe multi-vessel disease).

Thank you! Here is Part 1 of the Wake County EMS episode of Code STEMI. https://www.reelhouse.org/setla/codestemi/wakecountyepisodeone Tom

The only one that isn't truly a block is 1st degree AV block which is why some cardiologists refer to it simply as PR prolongation. I personally use the term AV dissociation only when the ventricular rate is higher than the atrial rate.

Here's the teaser for Part 1 of the Wake County episode of the Code STEMI Web Series. https://www.reelhouse.org/setla/codestemi Feedback welcome. Tom

Re-read what I wrote. Resolving ST-depression, all by itself, is sufficient reason to perform a 12-lead ECG with the first set of vital signs, and before MONA. When the blood work comes back negative, the prehospital 12-lead ECG may be the only solid evidence that the patient's chest pain was...

There is enough reason to believe that it will erase ischemia in general. Don't forget about ST-depression. NTG is a potent coronary vasodilator. It can absolutely reverse ST-elevation when coronary vasospasm is involved (happens in the cath lab all the time when given intracoronary). "Hasn't...

Back in 2008 David Hildebrandt (Hennepin at the time) presented a poster presentation and abstract to NAEMSP showing 7% of STEMIs normalized by arrival in the ED. All patients who normalized had positive troponins and PCI was not delayed because the ST-elevation had normalized. They speculated...

That's why dispatchers should be specifically trained to consider any adult who suddenly collapses a cardiac arrest until proven otherwise (only exception is the patient who is reported to be breathing NORMALLY). This will result in a lot of over-triage but will catch many of the sudden...

A potentially viable patient and awesome CPR? Or, respiratory induced asystole with lots of CO2 build up? There's a big difference between 20 and 50.

No, but I've checked a BGL that read "high" and gave calcium because I suspected a potassium shift. It was an unwitnessed asystolic arrest and we did get ROSC. Turned out the patient was hypothermic (we figured that out en route to the hospital) and when the labs came back in the ED it did turn...

Because I prefer a wide complex rhythm at a rate of 100 to asystole. I'm actually breaking one of my own rules here. I normally don't theorize about an ECG I haven't laid eyes on. But, there's no way I would give amiodarone in this set of circumstances. Consider the Hs and Ts. I would only...

I would not.