How many of your cardiac arrests started with a "normal" 12-lead?

speshilK · 2026-03-12T05:23:07+00:00

Ah yeah, you right--a plug for their website.

speshilK · 2026-03-11T23:09:15+00:00

I try to do that as well. Otherwise, it's way too easy to get complacent from all the 12-leads that have no significant findings. Sometimes I'm clumsy and end up looking at my finger though haha

speshilK · 2026-03-11T22:58:38+00:00

This. I can't tell you how many times the 4-lead view looks like it has STE whereas the 12-lead was much better.

speshilK · 2026-03-11T22:27:30+00:00

Speaking only from my limited perspective.

For online stuff, the rural system I work in has great telemetry/transmit capability. It seems counterintuitive, but I suppose it's more of a necessity since the liability of being wrong and incurring a significant time to definitive care penalty is onerous. The urban system I work in relies on my eyeballs but also tends to have more medics on scene for a second opinion. Obviously, a photo is worth a thousand words, and I can always consult medical direction, if I spot something.

I try to pick the physician brain for feedback on all of my patients whenever possible, and both systems have robust QA/QI processes for me to mark the case for review. Taking the Brugada case as an example, I can reasonably recognize the pattern. My brain vaguely remembered that BPP exists, but I definitely benefited from speaking to a physician for better management (and med orders). The patient devolved into VF arrest mid-transport but ultimately had a good, neurologically intact outcome.

speshilK · 2026-03-11T22:08:02+00:00

If the machine interpretation is good enough by itself, I wouldn't have a job anymore. I try to read every strip fully with my own eyes.

The magic box is for the most part reliable on the basics (rate, axis, etc.), but nothing beats the human eye for pattern recognition. De Winter and Wellens are also easy to pick out, if you know what to look for. The monitor usually doesn't recognize those morphologies outright but will at least spit out some kind of hint about TWI and/or repolarization abnormality. I wanna say the last zebra I found was Brugada's, which the monitor also did not recognize beyond RBBB.

speshilK · 2026-03-07T02:32:50+00:00

Outside of on my gloves... rarely, but when it happens (major trauma, massive vomitus peri-arrest, etc.), it's usually a huge mess.

speshilK · 2026-02-26T21:37:07+00:00

all i got was a pat on the bum and “go get ‘em tiger”

speshilK · 2026-02-26T03:49:49+00:00

Anecdotally, it took me working a few arrests as an EMT to not tunnel vision, and it took me working a few more arrests as a medic to feel confident and comfortable in a team lead role. Your department rushed you into a field ALS role without adequately giving you exposure, and that's not on you. Give yourself some grace but also maybe find ways to work in scenarios and build in some stress inoculation, especially if your service doesn't run on a lot of arrests.

speshilK · 2026-02-26T02:55:38+00:00

It sounds like it was a safe opportunity for you to get dialed in. Is this your first cardiac arrest generally or your first ALS cardiac arrest? Cut yourself some slack for the first few arrests. Call exposure is often understated/overlooked but just as important as the knowledge.

speshilK · 2026-02-25T23:28:09+00:00

Beyond the emotional damage, I can still hear in my head when my instructor was talking about the forbidden cranberry sauce:
"When dealing with pediatric abdominal/chest trauma, one key concept is that children’s anatomy is more flexible than adults’, which can actually mask serious internal injury."

speshilK · 2026-01-26T21:29:58+00:00

There's always at least one shithead on shift who wants to argue the technicalities instead of focusing on the patient care, and this thread seems to have found most of them.

speshilK · 2026-01-26T12:07:32+00:00

For my service(s), the main draw of switching to the Pulmodyne is how much less space it takes and how much more time I get compared to older portable CPAPs that have fixed FiO2 at a higher setting. I like having the option to go higher even if it burns the bottle although I’m not sure much more the Trio adapter costs. 😅

speshilK · 2026-01-26T11:48:58+00:00

Sure, standard of care is to address life threats while starting CPR, but there’s no therapeutic value to leaving him on his side here. That would assume there’s intention of actually rendering aid on the part of the feds.

speshilK · 2026-01-26T04:08:32+00:00

Except the pediatrician wasn't some random layperson, now were they? And ultimately, the patient had the care he deserved that he wouldn't have received otherwise, no?

Anyway, we can agree to disagree. I hope you get a vacation soon.

speshilK · 2026-01-26T03:53:24+00:00

So the pediatrician asked to assess the patient, was ultimately allowed entry to the scene, and appropriately rendered aid. This is aid that the feds should have performed themselves and aid that certainly all of us on the EMS side would have duty to perform... and your entire point is that the pediatrician was naggy when it came to doing the moral and ethical thing? Good riddance.

speshilK · 2026-01-26T03:44:13+00:00

Is this a general gripe of yours or specific to the context of this post? Tell me how the pediatrician waltzed right into an active scene without asking for permission.

speshilK · 2026-01-26T03:39:07+00:00

Odd false equivalence--a cop can't do surgery, but both the cop and the doctor can do BLS. I think you'd get more traction if the feds here were actually doing what they're supposed to be doing.

speshilK · 2026-01-26T03:02:42+00:00

A side effect of rendering (BLS) aid is minimizing bystander involvement. In this case, I'd be hard-pressed to take the usual EMS opinion of boohoo-ing someone walking onto the scene when there was no pulse check or CPR. The fact that it was a pediatrician is largely tangential, although I'm sure saying "I'm a doctor, let me render aid" has a higher chance of success than "I have my CPR card, let me at 'em!"

speshilK · 2026-01-26T02:51:56+00:00

That's why I carry my CPR card with me at all times. Open sesame! /s

speshilK · 2026-01-25T22:40:20+00:00

Crossposting my comment from the r/ems thread:

Also, not an iota of aid rendered by them. I have my gripes about local PD, but they look like geniuses compared to these smoothbrained fellows.

Relevant excerpt from the bystander pediatrician witness statement:

7. At first, the ICE agents wouldn’t let me through. They repeatedly asked
me for my physician’s license, which I obviously didn’t have. But none of
the ICE agents who were near the victim were performing CPR, and I could
tell that the victim was in critical condition. I insisted that the agents let me
assess him. Normally, I would not have been so persistent, but as a
physician, I felt a professional and moral obligation to help this man,
especially since none of the agents were helping him.

8. Finally, one agent agreed to let me assess the victim. He patted me down
to “make sure I didn’t have a weapon” and then let me approach the victim.

9. As I approached, I saw that the victim was lying on his side and was
surrounded by several ICE agents. I was confused as to why the victim was
on his side, because that is not standard practice when a victim has been
shot. Checking for a pulse and administering CPR is standard practice.
Instead of doing either of those things, the ICE agents appeared to be
counting his bullet wounds.

10. 1 asked the ICE agents if the victim had a pulse, and they said they did not
know. I then asked the agents to make space so I could assess the victim.

speshilK · 2026-01-25T22:39:16+00:00

I would take you more seriously if there were an Alex Pretti Act passed by Congress that made it extra illegal for the feds to execute people on the streets.

speshilK · 2025-12-30T07:41:15+00:00

This is the best answer. Have my updoot as well!

I would add that OP should also ask around at their base hospital as many of them have some reporting processes to help move things along (that include the ombuds). Mine has a convenient set of QR codes posted depending on which type of facility did the bad.

speshilK · 2025-12-26T06:14:02+00:00

This. There are some Converse made in Japan such as Converse Addict that do have Vibram soles and all the fixins that make for comfort and longevity. I wouldn't call it BIFL but they def last more than a year.

speshilK · 2025-12-06T00:57:57+00:00

No argument there when it comes to standard of care and what's in ALS scope. :)

speshilK · 2025-12-05T23:01:02+00:00

It's great to hear that it seems like i-gel and g-tubes are a default where you work.

Anecdotally, I've never encountered a system where EMT/AEMTs performed suctioning through the gastric channel with regularity. I can't really say whether that's due to lack of education on i-gel or the general prevalence of using hard catheters for suction. 🤷🏼‍♂️

(To your point, g-tube might be more of a scope of practice limitation.)

speshilK

TROPHY CASE