As in Incident command...

IC established!
We'll have several different sections reporting in - recent research, local topics, or highlighting areas of the Sponsor Hospital Council of Greater Bridgeport protocols.

*** Keep in mind - this website does not replace your protocols, and these posts do not reflect SHCGB or Bridgeport Hospital policies. This is a place to discuss research, controversies, or discuss possible future protocols. When in doubt, check your current protocols through the official source.

Thursday, October 4, 2012

Two interesting recent EMS calls.

I don't have a deep analysis of a recent study, or a recent change to the protocols, or even my thoughts on some EMS controversy

I do, however, have a gross picture and an interesting EKG! Both of these come from patients brought in by the same long-time medic at American Medical Response in Bridgeport.

First, the EKG.

The patient was an elderly lady, brought in from an nursing home, with a low blood pressure, but not looking "shocky," or at least not yet. Although there was no chest pain or other obvious cardiac complaints, and no arrhythmias, the medic nonetheless (wisely) obtained a 12-lead.

Of course, shooting an EKG, like any other  data point you obtain in the field, has been compared to picking your nose in public - namely, what do you do with the results?


So what would you do with this booger? Extra points if you find the occult STEMI.

The medic, correctly, did not call for cath lab activation.

Now the picture!

Same medic, bringing in a 80-ish year-old women who, because of dementia and multiple strokes, has had her diet restricted to pureed & thickened foods. Unfortunately, her husband, while preparing dinner, turned his back for just a moment while preparing himself a meal. When he turned back she wasn't breathing so well, and was starting to look a little blue-ish.

Not quite this bad.
By the time the patient showed up at the ED, however, she had a mild dry cough, but had her reassuringly pink skin color back!

The paramedic, not sure if we fully appreciated what had happened, held aloft with his MacGill forceps the spoils of the hunt:


Gross.

Nonetheless, a nice save! I have no idea how this lady managed to stuff a piece of meat that size into her mouth, let alone get it down into her epiglottal zone. Definitely a case that required on-scene, definitive, airway management.

Okay, that's it - no deep topics today.

But the next post will be more "meaty," I promise.



4 comments:

  1. The computer thinks the QRS width is a whopping .024. Nice. Looking at V2, the actual width is around .100-.110.

    So the computer is likely measuring the tail end of the QRS as the ST segment. Looking at that, it thinks there is STE in III, aVF, V1-V3. Although I'm not sure why it says there is STE in the lateral leads also, unless it is just confused by the low voltage in V4-V6.

    You can also tell it is looking at just the beginning of the QRS by measuring the QT interval. Computer says .332. I'm just eyeballing and spitballing, but I get about .240 most easily measured in V1-V2. .330-.240=.90. There's the missing .90 from the QRS duration.

    ReplyDelete
  2. Hey, nice catch!

    I didn't think to look at the QRS measurement. Generally it's pretty accurate. I wonder why the short QRS didn't get flagged.

    Then again, there's no "short QRS syndrome," so there wouldn't have been a reason to program that message into the algorithm.

    ReplyDelete
  3. Actually, ignore that last paragraph. I wasn't thinking, and was measuring the QT starting at the end of the QRS instead of the beginning.

    With the ridiculously low voltage in V4-V6, I was also thinking about dextrocardia but don't see any other signs of it.

    ReplyDelete
  4. Yeah, that voltage is odd. Cards thought so too!

    ReplyDelete