Mechanical Complications of STEMI

Unfortunately not every patient that suffers a STEMI makes a complete recovery, even if treated with primary PCI. Patients that present late into their infarct have a higher risk of developing a complication. Here are two cases that illustrate the spectrum of mechanical complications that can occur in the aftermath of an infarct. Case 1 […]

April 5, 2016

Myths and Cognitive Biases in Interpretation of Wide Complex Tachycardias

“Today, the vogue seems to be an irresistible urge to call VT supraventricular with aberration…” Marriott A middle-aged male with a complex arrhythmia history contacts EMS after several hours of palpitations. He has an implantable cardioverter defibrillator (ICD) but denies feeling any activations. He also denies any significant symptoms of dyspnea or discomfort. Medications: Flecainide, […]

March 7, 2016

55 year old male with altered mental status, hypothermia, and Osborn waves

A 55 year old man is brought in by EMS for altered mental status. It is the middle of February and he was found sleeping outside. He smells of alcohol, is moaning on the gurney, and responds to painful stimuli. Vital signs are assessed. RR: 13 HR: 38 BP: 110/90 Temp: Cold to touch SpO2: […]

March 1, 2016

Prehospital Use of 10% Dextrose for Management of Severe Hypoglycemia

Diabetic emergencies constitute a substantial percentage of ‘9-1-1’ calls and emergency department visits, with occurrences expected to rise as the percentage of the population diagnosed with diabetes mellitus (DM) increases.1 Severe hypoglycemia, or “diabetic shock”, is generally thought to be a true medical emergency, and treatment has been made widely available for prehospital professionals to […]

February 23, 2016

Cardiac Cath Lab Activation for Subtle Acute Inferior STEMI

EMS responds to a 78 year old male complaining of chest pain. On initial observation the patient is pale, cool, and diaphoretic. He says to the treating paramedic, “I think I’m having a heart attack.” He states that he was watching TV when he felt a crushing pain that radiated to his arm and jaw. […]

February 11, 2016