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Anaphylaxis presenting as cardiac ischemia

​EMS is called to a single family residence for a 84 year old female who was reportedly experiencing difficulty breathing. On EMS arrival the patient is found sitting in a

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Usefulness of the QRS/T angle when diagnosing acute STEMI

A reader asks, “Have you ever seen a patient with a QRS/T angle of greater than 100 degrees who was experiencing acute STEMI?” To give you some background, I often

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Should you activate the cardiac cath lab?

EMS is called to a walk-in medical clinical for a 52 year old male with a chief complaint of palpitations. The nurse advises the treating paramedic that the patient underwent

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Importance of Lead aVL in STEMI Recognition

In 2013 an article was published in Prehospital Emergency Care that measured the ability of paramedics to identify acute STEMI on the 12-lead ECG. The results showed that paramedic accuracy

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Sinus Node Dysfunction

Sinus Node Dysfunction Refers to problems with sinus node impulse formation and propagation May include sinus bradycarda, sinus pauses or arrest, chronotropic incompetence, and sino-atrial exit block When accompanied by

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The Basics of Paced Rhythms

Objectives Review the indications for permanent pacing Appreciate pacemaker timing cycles Develop awareness of the revised NASPE/BPEG Generic (NGB) Pacemaker Code Understand the basics of single chamber and dual chamber

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Sudden Cardiac Death in Firefighters

Overview Sudden cardiac death is the number one cause of line of duty death (LODD) for firefighters Firefighting is stressful, physically demanding, and dangerous! Many firefighters die during routine training or annual

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Large Block Method to Calculate Heart Rate

Objective Understand and learn to use the large block method to estimate heart rate on the electrocardiogram Graphic Large Block Method The fastest and easiest method to calculate the heart

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De Winter ST/T-Waves

Objective Understand and identify de Winter ST/T-waves as a STEMI equivalent De Winter ST/T-Waves ECG abnormality described by de Winter et al. in 1998 Characterized by 1-3 mm of ST-depression with

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Wolff-Parkinson-White Syndrome – Part 2

This is Part 2 in our series on Wolff-Parkinson-White (WPW) Syndrome. In Part 1 we went over the history of WPW and the pre-excitation syndromes and reviewed normal cardiac conduction