Part One: ECG Case Studies for Practice & Reflection
When the Loudest Voice in the Room Is the One in Your Head
SECTION 1: Chest Pain Spectrum
From “non-specific” to time-critical cardiac events
1A. Mild Chest Pain / Anxiety vs Cardiac Origin
NSR, borderline tachycardia, normal ECG → safety-netting, GP referral
Focus: HX, risk factors, ruling in/out via context not just ECG
1B. Silent MI / Vague Symptoms
Elderly diabetic woman with SOB and fatigue → posterior or NSTEMI changes
Focus: atypical presentations, reciprocal changes, clinical gestalt
1C. Clear-cut STEMI
Young-ish male, crushing central pain, anterior elevation
Focus: pre-alert criteria, pain relief, don’t delay on scene
SECTION 2: PE / Peri-Arrest States
When the ECG whispers but the patient screams
2A. Sudden SOB in Young Fit Female
ECG: sinus tachy, LAD, incomplete RBBB → suspected PE
Focus: risk factors, scene-time justification, HAC vs ED
2B. Decompensated PE → Peri-Arrest
Central cyanosis, pulsus paradoxus, ECG shows RBBB + S1Q3T3
Focus: don’t wait for V/Q scan to act, prepare for deterioration
SECTION 3: Shockable Rhythms & ROSC
The moment your LP15 becomes the loudest voice in the room
3A. Narrow Complex Tachy — NOT SVT
V1–V3 stress signs, LAD, and borderline width
Focus: differential between atrial arrhythmia vs VT
3B. 3rd Degree Heart Block + Wide Complex + Collapse
Transcutaneous pacing unavailable — pack + go
Focus: scope awareness, critical extrication strategy
3C. VF / Pulseless VT → ROSC
ECG: coarse VF, delivered shock, ROSC achieved
Focus: post-ROSC care, ongoing rhythms, destination choice
SECTION 4: Non-Shockable Arrests
When it’s not about electricity, it’s about everything else
4A. PEA with RBBB (your case)
ECG not screaming MI, but pt is dying
Focus: oxygenation, reversible causes, realistic crew limits
4B. Asystole
ECG confirms flatline after efforts
Focus: team communication, early consideration of ROLE
SECTION 5: Dignity, Debrief & After Care
Because the job isn’t over when the ECG is blank
5A. Role of the Tech Crew at EoL Events
Scenario: Family present during resus or ROSC
Focus: dignity in care, calm explanation, presence
5B. Multi-Agency Situations (Care Homes, MPS, GPs)
Complex DNRs, LPA documents, or uncertain decisions
Focus: assertive compassion, communication clarity
5C. Internal Debrief and Crew Wellbeing
Prompt: “What do we wish we’d said? What went well?”
Focus: peer support, reflective practice, load-sharing
This structure
Allows cases to be tackled in isolation or thematically
Builds confidence while reinforcing complexity
Respects the limits of EMT/Tech scope without flattening urgency
Makes room for human, ethical, and operational reflections — not just ECG geekery