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I would continue CPR and give 1 mg Epinephrine and 1g/10 ml calcium gluconate. I would certainly not give an antiarrhythmic like amiodarone.

It's definitely not my intent to be argumentative, and medicsb's last comment nails it IMHO, but consider this. I agree that LBBB with s/s of ACS is AMI until proven otherwise, but the issue at hand is whether or not it's STEMI until proven otherwise. That's an important distinction because...

Can you post the ECG?

By this logic knowing how to intubate means you like to play mini-anesthesiologist. But you'd never say that, right? Because you know how to intubate?

Normally I make it a point to not comment on an ECG I haven't laid eyes on, but assuming this is true it may have been a STEMI. Typically LBBB has an upright QRS in lead aVL and negative QRS in leads III and aVF. So, ST-elevation in lead aVL would be concordant ST-elevation and ST-depression in...

ROC PRIMED showed no significant difference between shocking right away versus shocking after a prescribed interval of CPR. However, compressions were almost certainly being performed while setting up the defib and charging the capacitor. From...

I wouldn't call an MI that presented with nausea, vomiting, and diaphoresis "silent". I'm not trying to nitpick but this is an important point.

Sinus bradycardia in a patient with some kind of nerve stimulator.

R-wave progression is one of the best tools to help distinguish early repolarization from LAD occlusion but, as others have indicated, absence of reciprocal changes is also important. Other indicators include a QTc on the short side of normal, well developed R-wave in lead V4, fish-hooked...

Yes, if the pre-shock coronary perfusion pressure is less than 15 mm Hg you will almost always shock the rhythm into asystole. This is why it's extremely important to perform comrpessions while the capacitor is charging and minimize the peri-shock pause. The pre-shock pause is more important...

As a paramedic do I have any business knowing how to read a chest x-ray? The question itself smacks of arrogance, turf protection, and an attitude that learning isn't for everyone. It's not part of the EMT scope of practice to read electrocardiograms. But it's everyone's duty to be a life-long...

"I'd be fine with you talking to the person who makes decisions for the patient and having them refuse backboarding." Five stars for this comment. In the U.S. I've noticed that a lot of EMTs and paramedics have an attitude that an EMS call must be short and that we can't wait on scene for...

STEMI patients are not "just like any chest pain or cardiac patient" and that's the point. Things like triaging to the most appropriate medical facility or preactivating the cardiac cath lab are ultimately our most important interventions.

So what it a STEMI? It sucks when you're not given the tools to do your job as well as you'd like to.

It sounds right to me. I would just mention that increased vagal tone is very common with acute inferior/posterior STEMI and atropine is likely to help in this circumstance. By "help" I mean reversing the rate and vascular tone changes associated with increased vagal tone (the exact term used is...

The blood supply to the SA node is very high up in the RCA so it would require a proximal occlusion to cause direct ischemia of the SA node. I first read about the Bezold-Jarisch reflex and it's association with acute inferior STEMI in Braunwald's Heart Disease, Fifth Edition (1997)...

Thanks for the feedback! Glad you enjoyed all the episodes!

"Normal" has been called the hardest diagnosis in electrocardiography! Indeed, in all of medicine! It's hard to say, isn't it?

Sounds interesting to me!

It's definitely being discussed in addition to Wake County.