EMS 20/20 Please Don't Take Me There
Apr 10, 2024
A tense prehospital cardiac arrest scenario with third-degree heart block and STEMI. Field pacing, sedation, and emergency airway decisions under short-transport pressure. A clash over hospital choice and bedside systems failures when a nearby ED struggles with pacing and 12-lead interpretation. Ethical, protocol, and monitoring-filter debates about treatment, documentation, and system-level fixes.
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Longtime Partners Spot Sudden Third Degree Block
- Raph and Mikey, longtime partners on Pizza Ambulance, respond to a 60s female with nausea and vomiting who rapidly deteriorates into hypotension and severe bradycardia.
- Their teamwork and routine (jump bag, monitor, ETCO2 cannula) let them quickly identify a third-degree heart block and start interventions before calling for extra ALS help.
Stabilize Symptomatic Complete Heart Block With Pacer And Push Epi
- Do start pacing and give push‑dose epinephrine for symptomatic third‑degree heart block with hypotension immediately to restore perfusion.
- Raph started 500 mL NS, gave 20 mcg push‑dose epi, placed transcutaneous pads and achieved capture at 90 mA with palpable pulse of 80.
Use Lowest Effective Sedation Dose For Pacing
- Try low initial sedative dosing when pacing to avoid worsening hypotension or respiratory depression.
- Their protocol allowed 2–5 mg midazolam for pacing; Raph gave 5 mg which likely contributed to respiratory depression requiring BVM and later intubation.