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You couldn't find a lot of resources about it? The search term "EMTALA" yields over 55,000 results. Front page hits include Wikipedia, CMS, ACEP, etc. So astonish me. Where did you look?

Interesting point. Dr. Smith and Dr. Weingart talked about that in a podcast last year and both recommended routing administration of calcium prior to pacing because hyperkalemia can be "the great imitator" and calcium is cheap and benign. When you've been burned with an atypical hyperkalemia...

If you're suggesting that in all other circumstances you can activate without transmission that's actually pretty cool and probably a best practice! I would take issue with "early repolarization" being on the list because differentiating between BER and LAD occlusion is extremely difficult...

This is the best kind of false positive! A really good STEMI mimic. It wasn't a false activation based on poor data quality, a confounded computerized interpretive algorithm, a simple LBBB, paced rhythm, obvious BER, or typical strain pattern from LVH. It has a pseudo-reciprocal change! It seems...

This would be a reasonable cath lab activation (assuming signs and symptoms of ACS). I say that because the T-wave is inverted in lead aVL. Since you're asking I'm assuming this was a "false positive" cath lab activation. I've seen something similar before. See this case for an example (it is...

Even better! So what did you do after the experiment proved it was flutter? Tom

Cool strips! Thanks for sharing. Tom

1:1 VA conduction does not necessarily make it junctional. It could just as easily be ventricular but I agree it's not AF. Tom

I found this to be a bit confusing. In the first place, we weren't discussing how well the human animal tolerates high heart rates (which extremely variable) but rather how high a rate atrial fibrillation is capable of achieving. I was simply pointing out that it depends on whether or not an...

Without an accessory pathway as high as 250 but that is unusual. Most un-medicated AF is in the 120-140 range. Above 250 and you should suspect an accessory pathway. That's why most cases of new onset atrial flutter are right around 150 with 2:1 conduction. The AV node should not allow 1:1...

Exactly. It's contraindicated.

That's not true. AF with RVR should not be in the 250-300 range and if it is you should strongly suspect an accessory pathway, particularly when the shortest R-R interval is 240 ms or less. In that case you could harm the patient with antiarrhythmics (including amiodarone). The only "safe" drug...

@46Young @systemet Thanks, guys! Online learning is powerful and it's best when we can learn from each other!

Your strips do not show an SpO2 reading (pulse or oxygenation). I looked for it!

Here's a picture-perfect ECG of TCP with capture (although the patient did not survive). http://ems12lead.com/2011/02/transcutaneous-pacing-tcp-for-asystole/

This blog post explains why there is often an increase in BP, improvement in LOC, and even a detectable arterial waveform with false capture: http://ems12lead.com/2008/11/transcutaneous-pacing-tcp-the-problem-of-false-capture/ Just keep in mind that you cannot have mechanical capture...

Definitely not capture. The second "phantom" paced cardiac cycle shows the intrinsic rhythm in the absolute refractory period which is impossible. 50 mA generally will not achieve capture on a LP12. At least, not in my experience. I've seen one case where capture was achieved at 80 mA. All...

This happened to me and it really freaked me out! http://ems12lead.com/2010/02/transcutaneous-pacing-tcp-with-a-lifepak-12/ I'm not sure what I would have seen had I selected paddles view. I couldn't turn the Lifepak off fast enough because I wasn't expecting it to start pacing when the...

The problem with this line of reasoning is that most paramedics "don't know what they don't know" with regard to 12-lead ECG interpretation so they end up treating a patient who presents with a panic attack and a right ventricular strain pattern with nitroglycerin because they see ST-depression...

Atrial abnormalities are like axis deviation. You can "get by" without knowing it but it can lend support to a diagnosis. For example, let's say you have a 12-lead ECG that barely meets the voltage criteria for LVH. You look at the P-wave in lead II is close to 120 ms in duration and the...