Jim37F
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Howdy!
the 100% directionless thread
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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.
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.
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Also, here's the first EKG from that call if anyone wants to provide some input.
CALEMT
The Other Guy/ Paramaybe?
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Woah, back from the dead?
That is badass man, its cool to hear about those types of calls with a good outcome.
TransportJockey
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Looks just fine
Also, here's the first EKG from that call if anyone wants to provide some input.
PotatoMedic
Has no idea what I'm doing.
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CALEMT
The Other Guy/ Paramaybe?
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Also, here's the first EKG from that call if anyone wants to provide some input.
I had to haha.
cruiseforever
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All depends on how long it takes you to do one call.
CALEMT
The Other Guy/ Paramaybe?
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The typical 45 minutes to a hour. Nothing to outrageous.
NomadicMedic
I know a guy who knows a guy.
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Wow. That's a great call! 105 land?
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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!
Also, here's the first EKG from that call if anyone wants to provide some input.
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Kinda. Ran the call on the 103 side of the 88 district. Transport time increased because AGH would have been a poor destination choice...
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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
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
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More of a joke but I appreciate the link. My EKG knowledge is minimal, but I know that don't look right...
Gurby
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Normal sinus right?
Well, it's a sinus rhythm anyways... Not so sure about the "normal" part!
ViolynEMT
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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.
Jim37F
Forum Deputy Chief
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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)
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)
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.
ViolynEMT
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Yeah. I read that after I posted. lol. I haven't been keeping up with the thread lately. Have fun in Hawaii.