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I'm sorry to hear it.

I'm not sure what there is to debate here. Bifascicular block and LAD occlusion. I hope that was the cardiologist's opinion (for the patient's sake). Tom

My department does 30:2 and we have excellent outcomes. You can also perform what the Seattle group calls "BLS Continuous" which is continuous chest compressions with a small breath interposed every 10th compression. It has been studied and there was no difference in outcomes...

Maybe this could be moved to the EMS Lounge or Children With Nothing Better To Do forum.

I would not personally decompress without signs of significant air hunger and hypoxia. On both occasions I have witnessed an actual developing tension pneumothorax there was jugular venous engorgement, asymmetrical chest (best viewed from the feet looking toward the head), absent breath sounds...

How I wish I had access to this information when I was in Paramedic school. Good luck! How To Master Tracheal Intubation Airway Management With Rich Levitan

"Because of their favorable effect on morbidity and mortality in patients with systolic HF, beta-adrenergic blockers are the preferred agents for achieving rate control unless otherwise contraindicated. Digoxin may be an effective adjunct to a beta blocker. The nondihydropyridine calcium...

What was the benefit in this case? Looks to me like a clear-cut case of heart failure (it doesn't get any clearer based on the history that was provided). The patient's pressure bottomed out to 70/40. Let the ED attending and cardiologist decide how rate control is best achieved in a patient...

If your criterion for diltiazem is symptomatic but hemodynamically stable AF/RVR with symptom onset < 48 hours (as it should be) then it can wait. Let the docs decide whether or not they want to perform an echo or give heparin prior to conversion. There's simply no rush. If the patient's in...

Shouldn't we all be cardioverting "malignant" tachydysrhythmias?

In my opinion you should always start with NTG and CPAP with decompensated heart failure. The rate typically comes down on its own with increased SpO2 and decreased work of breathing. In fact this is one of the reasons we removed diltiazem from the trucks.

I wrote a 2-part series on WPW. Part 1 looks at delta waves and Part 2 looks at the arrhythmias of WPW. Part 1: https://www.ecgmedicaltraining.com/wolff-parkinson-white-wpw-syndrome-part-1/ Part 1: https://www.ecgmedicaltraining.com/wolff-parkinson-white-syndrome-part-2/ Realistically...

"The man called 911 complaining of chest pain, but he appeared in no significant distress. He was alert, oriented, and ambulatory on scene. His rate was 220, with a BP of about 85/50. I know this meets every indicator to move straight to electrical therapy, but given how non-symptomatic he...

I'm 0 for 3 with modified Valsalva. Converted with adenosine in all 3 cases. https://www.ecgmedicaltraining.com/svt-adenosine-revert-trial/ Tom

Good for him. There is a lot of narrative fallacy in medicine. "He was purple from the nipple line up so he must have had a massive PE." I respect people who say they don't know unless they actually know.

We used to but now we don't. At the time we didn't have waveform capnography and every time an ED doc pulled one of our tubes the paramedic would say "it must have become dislodged between the back of the ambulance and the ED bed." A cervical collar may increase intracranial pressure. It's not...

You're welcome, guys. Would you mind posting the complete computerized interpretive statement? @Smellypaddler

This is a great case. One that Stephen Smith, M.D. would find interesting. This is almost certainly LAD occlusion. First, you have clinical correlation (always a good idea to consider pre-test probability). The T-waves in leads V1-V4 are hyperacute because they are disproportionate to the size...

It was Palm Beach County Fire Rescue. To say the least, I worry about application time. http://www.emsworld.com/article/12078215/heads-up-cpr

We use "obeying commands" rather than "purposeful movement". Too much gray area for the latter. Is grabbing for a tube purposeful? Perhaps, but it's primitive. We've withheld cooling for these patients and they ended up trying to shave with the TV remote (borderline CPC 3 -- long term care...