ctmedic09

Kim, If you are still seeking help I would first suggest to you Dale Dubins book. It is the simplest read on cardiology that breaks everything down to an understandable level. The next step is just start going through sample EKGs and case studies. The most important thing I teach my students about 12 leads is to est a method of interpreting them. I start with lead II and assess for rate and rhythm. Next I start at Lead I and work my way down strictly analyzing the ST segment and T-Wave changes. After I have identified if I have ST changes I group them in contiguous groups i.e II,III,avF. I want to apologize if I simplify this too much I am not meaning to question intelligence, From that point I determine if I have two or more anatomically contiguous leads with ST elevation and determine if I have a STEMI on my hands. That process is about 20 seconds at looking at the EKG. I hope this helps if you have anymore questions or are in need of some sample EKGs I would be more than happy to forward some along. Chris

To begin with this is a bad scenario, you have this patient that is 97 years old that more than likely has CAD and other coronary disease in a dangerous rhythm. My personal approach would be to contact medical control, depending on your service area and the meds that you carry, and request an alternate treatment plan that may include a calcium channel blocker ( Diltiazem, or Verapamil) , benzodiazepine (Lorazepam) , or beta-blocker (Metoprolol), at least with a CCB you have calcium chloride / gluconate to reverse the effects and it is a slow push that you can stop pushing if you notice undesired effects. I am not sure I am comfortable pushing adenosine as a first line drug in someone over the age of 85 or so. This is only my take on avoiding the cardiac arrest situation, now to the question of the DNR, it is what it is. Say you are called to the scene of an auto accident, the patient is a 20 year old male that is a terminal cancer patient that is unresponsive, has a pulse, with a respiratory rate of 6, do we intubate even though the DNR is second to the CA, the answer is no, it does not matter the situation of the arrest the DNR is a legal document and the family has the right to seek legal help and sue if the DNR is violated. I hope this helps and would like to get the opinion of other EMS professionals on the use of CCB, benzos, and beta blockers prior to adenosine in the high risk patient.