Way to go Ivan! http://www.latimes.com/features/health/la-me-heartattack27mar27,1,4554508.story Victims treated by paramedics obtain life-saving treatment...
Yeah but now EVERYBODY who gets a little chest pain will be calling 911 and overload the system. Last night EMS brought me a chest pain patient with IV, EKG,...
I am surprised by their numbers. 90% of MI patients who called 911 had "necessary procedures" performed within 90 minutes. Does that mean D2B time was < 90...
That 5-county region of Southern California is doing great. Ivan Rokos, MD is the EM representative to the D2B Alliance. Tom ... From: Andrew J Bowman...
All that says to me is that the paramedics are inadequately trained in your area. The citizen did the right thing. GG ... ************** Planning your summer...
My book, The ECG in Acute MI, has a chapter on each of: normal variants, cocaine chest pain, LVH, pericarditis, ventricular aneurysm, hyperkalemia. I wrote it...
Am cleaning out my "star-ed" messages and came across this case which is very similar to one I had about a week ago. Responded on BLS unit to a call for an...
Hey Bill, At what point were they bradycardic? The object of a stress test is to get the HR up... was it an exercise or drug study? Did they give you a copy of...
Hi Nick, According to the staff when I arrived the patient began to look/feel sick a couple minutes into the test and started to brady down. They gave me...
You need to know if the bradycardia occured at peak or during cool down. Patients do brady down if they stop abruptly, sometimes even if they don't. I have had...
Nick, Often when I give dobutamine for a stress test, especially in women and younger men, I will get a vagal response-I usually dread it, because then the...
Thanks Chris, Had we been able to get any legitimate history from the staff instead of blank stares and inappropriate remarks it would have helped. ...
For info go to the website: http://tylenol.com/page.jhtml?id=tylenol/news/subptyschol.inc&s_kwcid=ContentNetwork|1522742753 We know that dedicating yourself to...
The following is from a 28 year old male with a hx of aortic root valve replacement in 2003. No med or allergies. (cadaver valve) Presented with diplopia,...
Hi Sam, Are you saying that file JMB is all from III or was there a lead change in the middle of the strip? The Uwaves in aVR, aVF, V2-6 are interesting. Is...
Hi guys, excellent case and strips, first I would say that you must be sure you are really seeing increased amplitude at peak inspiration which generally goes...
I appreciate your responses. We were able to time the change with inspiration, I had him take a slow inspiratoy phase and hold for a few seconds and the QRS...
I appreciate your responses. We were able to time the change with inspiration, I had him take a slow inspiratoy phase and hold for a few seconds and the QRS...
Nick, This was sent from my partner at work. He is on a flight right now. We took the ecg from our PIC 50 12 lead monitor, its in lead III. On a slow deep insp...
Hi Guys Am on call tonight for STEMI's. Had a call from the ambulance service earlier on this evening they were en route with a 40 year old female with chest...
Galpert Jacob (St Mar...
Jacob.galpert@...
Apr 9, 2008 11:10 pm
10126
Are you treating her for pericarditis??What was the rate prior to the bradycardia? Did the bradycardia resolve on its own? Was the LBBB persistent? Did it show...
Hi Tom Now that we have ruled out CAD we will treat the Pericarditis. The rate prior to the bradycardia was about 85. The bradycardia resolved on its own. The...
JJ Galpert
Jacob.galpert@...
Apr 10, 2008 6:07 am
10128
Sgarbossa criteria came out of the GUSTO-1 study as a method of diagnosing AMI in the presence of LBBB. Indicators: (1) ST-segment elevation of 1 mm or more...
Thanks James the answer is she definitely did not meet this criteria. BTW what does the list think about canberra's sign JJ Galpert Senior Cardiac Physiologist...
JJ Galpert
Jacob.galpert@...
Apr 10, 2008 7:58 am
10130
Was the onset of bradycardia sudden? Was 1:1 AV conduction maintained throughout? Was the PR interval constant? Did P wave morphology change? Did the ECG show...
I always confirm LBBB by looking at lead I which should show a monophasic QRS complex. It will rarely show a small Q wave from old MI, but it should not show...
I have seen this phenomenon 3 times in my career. I asked Tim Phalen a long time ago (his dad does the same thing) where on deep inspiration his lead III only...
Hi Paul, What is telling about the strips (especially the two longer ones in the separate file) is that the Twaves did not change. The Pwave, QRS, and Jpoints...
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