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Thank you my brother!

The full episode is now available online! Comments welcome. First Responders Network: http://firstrespondersnetwork.com/codestemi/videos/london-ambulance-service/ YouTube: http://www.youtube.com/watch?v=Vv7-GDyQcfU http://www.youtube.com/watch?v=PJv28uzV21k Blip.tv...

Thanks for sharing! You guys will enjoy the solution. Tom

Good one, Christopher!

Yes, will not make that mistake again! Tom

I have, actually, set demand pacing for 40 PPM with a patient who was in AF with slow ventricular response and an occasionally somewhat scary asystolic pause. Here's a tip when you do that: turn the pacer off before the nurses disconnect your 3-lead in the emergency department...

It's almost like being in kindergarten! Thanks, n7lxi.

Thanks for posting the link, Hunter! That's the first time I've taught a class over a telephone with no students in front of me to interact with. It was very strange. But, I hope it was useful! :) Tom

Good luck with that wager.

Yes, they were the largest enroller in ER-TIMI-19. http://www.ncbi.nlm.nih.gov/pubmed/12103258 Tom

Have you ever noticed how often the ACLS algorithms say, "consider expert consultation"? There are thousands upon thousands of health care providers walking around with an ACLS card that can barely distinguish VT from VF let alone distinguish between AF/WPW and Torsades. Knowing what the...

The ACLS Resource Text for Instructors and Experienced Providers. http://shop.aha.channing-bete.com/onlinestore/storeitem.html?iid=176477 ACLS is only "easy" because it's a video-driven cake walk. To become an expert at advanced cardiac life support is difficult and rarely accomplished.

What is the patient's blood pressure? I say leave it! Here's hoping that the AHA gets rid of all antiarrythmics in 2015 unless the Hs and Ts indicate a specific antidote!

I think they do, yes. But their training is completely different from a paramedic's education. Paramedics want all of the respect of being "clinicians" without any of the appropriate education and training. You can't have it both ways.

Generally speaking (and I know this view isn't popular) I do not believe that paramedics diagnose. We treat a "field diagnosis" at best. You could argue that every diagnosis is a "working diagnosis" subject to change based on new information but the reality is that a paramedic's education is not...

The SpO2 waveform does not look contemporaneous with the ECG which seems odd.

I agree with you. ST-elevation is present and with the ST-depression in the inferior leads it must be explained. Hopefully they were able to compare with an old ECG. Things tend to move slower with old ladies from the nursing home.

It looked like 2:1 flutter to me at first but the premature beat in the first rhythm strip was a happy coincidence that proves it is not. You would see the 'hidden' flutter wave after the QRS.

Asystole/PEA arrest is very common in the in-hospital setting compared to primary VF/VT arrest. I saw it many times when I worked in the hospital on a stepdown unit and the link you provided indicates that asystole/PEA is the first pulseless rhythm 76% of the time. Tom

Discordance. But not too much (in LBBB and paced rhythm). http://ems12lead.com/2010/12/excessive-discordance-as-a-marker-of-acute-stemi-in-lbbb/