the 100% directionless thread

Howdy!
 
Two of my coworkers ran a STEMI the other day that turned into an absolutely awesome call. They were ~1 hour from a PCI center and happened to be close to this call (and an extra power unit!).

Dispatched as a Charlie level "seizure" (low priority, seizure ended at time of call, no seizure history). They arrived to find a patient adamantly refusing care with no symptoms. He looked "terrible" per their report and they did a 12 lead EKG. First two EKGs showed an insane STEMI and they managed to convince the patient to consent to transport. Mid transport, the patient decided to go full mega code mode on them and variously exhibited v tach with pulses, pulseless VT, torsades, and some variety of bradycardia in the 30s.

At various times in this transport, they activated a STEMI alert early on a holiday weekend, gave ASA, NTG, an amiodarone drip, a magnesium drip, and versed. They cardioverted the patient 5x, defibrillated him 2x, did some chest compressions, and ended up successfully initiating transcutaneous pacing all the way to the cath lab.

I'm not sure what kind of occlusion the patient had, but he underwent PCI and is recovering in a cardiac step down unit now with completely normal neurological function. To me, it is really cool to hear about a call where well performed prehospital ALS made a true and quantifiable difference in the outcome.
 
60fa01ae8d7f265019007538978a1804.jpg


Also, here's the first EKG from that call if anyone wants to provide some input.
 
Achilles said:
Hello?
Click to expand...

Woah, back from the dead?

chaz90 said:
Two of my coworkers ran a STEMI the other day that turned into an absolutely awesome call. They were ~1 hour from a PCI center and happened to be close to this call (and an extra power unit!).

Dispatched as a Charlie level "seizure" (low priority, seizure ended at time of call, no seizure history). They arrived to find a patient adamantly refusing care with no symptoms. He looked "terrible" per their report and they did a 12 lead EKG. First two EKGs showed an insane STEMI and they managed to convince the patient to consent to transport. Mid transport, the patient decided to go full mega code mode on them and variously exhibited v tach with pulses, pulseless VT, torsades, and some variety of bradycardia in the 30s.

At various times in this transport, they activated a STEMI alert early on a holiday weekend, gave ASA, NTG, an amiodarone drip, a magnesium drip, and versed. They cardioverted the patient 5x, defibrillated him 2x, did some chest compressions, and ended up successfully initiating transcutaneous pacing all the way to the cath lab.

I'm not sure what kind of occlusion the patient had, but he underwent PCI and is recovering in a cardiac step down unit now with completely normal neurological function. To me, it is really cool to hear about a call where well performed prehospital ALS made a true and quantifiable difference in the outcome.
Click to expand...

That is badass man, its cool to hear about those types of calls with a good outcome.
 
chaz90 said:
60fa01ae8d7f265019007538978a1804.jpg


Also, here's the first EKG from that call if anyone wants to provide some input.
Click to expand...
All I can say is "wow" while I pick my jaw up off the floor. Septal, anterior, inferior, lateral... Perhaps the only way to tell if there WASN'T a part of the heart that wasn't ischemic might have been to do a 15 lead with V4R... That's one very lucky dude to have survived that, neurologically intact, to boot!
 
So it's bad when some of the leads could be mistaken for an etCO2 waveform?
 
Looks like very early onset of a wraparound LAD occlusion to me.

Edit: @trigger I think when the ST elevation makes it look like sharkfins like that, it has to do with how early the onset of the MI is rather than how profound it is. It'll begin to look more like the typical ST elevation we normally see in STEMIs as time goes on. Dr. Smith shared something about this morphology a couple of months ago. I'll try to find the link.

Edit: It's a lot more dramatic in the link, but I think it still applies.

http://hqmeded-ecg.blogspot.com/2015/07/giant-r-waves-what-are-they.html
 
Last edited:
Aprz said:
Looks like very early onset of a wraparound LAD occlusion to me.

Edit: @trigger I think when the ST elevation makes it look like sharkfins like that, it has to do with how early the onset of the MI is rather than how profound it is. It'll begin to look more like the typical ST elevation we normally see in STEMIs as time goes on. Dr. Smith shared something about this morphology a couple of months ago. I'll try to find the link.

Edit: It's a lot more dramatic in the link, but I think it still applies.

http://hqmeded-ecg.blogspot.com/2015/07/giant-r-waves-what-are-they.html
Click to expand...
More of a joke but I appreciate the link. My EKG knowledge is minimal, but I know that don't look right...
 
Jim37F said:
Ok computer literate people, I'm shopping for a new laptop, primary use Internet, Office, and some PC games. I was about to pick up a $400 laptop when the sales guy said the i3 core wouldn't do.....So what should I be looking for in terms of processor and all that should I be looking for?
Click to expand...


It depends on what you want to spend. Core i7 is the best. I recommend Lenovo, might be around $700. Costco sells them online. Mine is a 17". 15" might be cheaper.

Also the Dell XPS13 is good. It's small. Alienware 17 is good.
*This info is coming from my ex who is an IT Tech, btw.

If you want to do extreme gaming, you'll have to spend more bucks. The ones I listed are not as pricey, but they are all good machines.
 
Yeah I got an Acer with an i5 core with a dedicated graphics card so that should help
ViolynEMT said:
It depends on what you want to spend. Core i7 is the best. I recommend Lenovo, might be around $700. Costco sells them online. Mine is a 17". 15" might be cheaper.

Also the Dell XPS13 is good. It's small. Alienware 17 is good.
*This info is coming from my ex who is an IT Tech, btw.

If you want to do extreme gaming, you'll have to spend more bucks. The ones I listed are not as pricey, but they are all good machines.
Click to expand...

And in other news, plane tickets to Hawaii are officially bought (Of course I have to buy a new laptop at the same time as airfare....fortunately I got my paycheck from my Annual Training at the same time, that's pretty much gone straight to those two expenses haha)
 
Tigger said:
More of a joke but I appreciate the link. My EKG knowledge is minimal, but I know that don't look right...
Click to expand...
I know you were joking, but I think you nailed it with the EtCO2 comment. I remember seeing a similar 12-lead awhile ago. I recall thinking is it metabolic like hyperkalemia or STEMI? I've always associated wide complex and bizarre looking with hyperkalemia and sodium channel blocker overdose. I don't feel like that morphology (especially when it is more like the examples Dr. Smith has) is something you see commonly.

A wraparound LAD occlusion I feel like is another thing you don't see that commonly. I saw this once before on the EKG Club, but the ST elevation was less excessive and sharkfin looking. A bunch of people kept calling it pericarditis because there was global ST elevation pretty much (with the exception of ST depression in I think I and aVL like in Chaz example, which made me think wraparound occlusion rather than pericarditis). I was looking for that ECG because I remember commenting on it, but I think it was deleted when they added the rule that patient's name and the date of the ECG has to be removed.
 
Jim37F said:
Yeah I got an Acer with an i5 core with a dedicated graphics card so that should help


And in other news, plane tickets to Hawaii are officially bought (Of course I have to buy a new laptop at the same time as airfare....fortunately I got my paycheck from my Annual Training at the same time, that's pretty much gone straight to those two expenses haha)
Click to expand...


Yeah. I read that after I posted. lol. I haven't been keeping up with the thread lately. Have fun in Hawaii.
 
You must log in or register to reply here.
Back
Top