In this episode of Good Reads, we conclude our series on left bundle branch block (LBBB) by exploring Criteria C using the Smith Modified Criteria. We delve into how the ST segment elevation must be 25% or greater in relation to the preceding R wave depth and replace the outdated 5 mm rule. The video includes a step-by-step example to make this criterion clear. Learn how to identify positive indications for LBBB, especially in challenging environments like an ambulance. Additionally, we touch upon recognizing reciprocal changes and how other criteria (A and B) intertwine. 00:00 Introduction and Welcome 00:03 Overview of Criteria C 00:40 Example of the 25 Percent Rule 01:09 Detailed Calculation Steps 02:01 Application in Real Scenarios 02:43 Conclusion

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The integration of point-of-care ultrasound (POCUS) is transforming emergency medical services (EMS) by enhancing diagnostic capabilities and improving accuracy in answering important clinical questions. Recently, I had the opportunity to discuss this topic extensively with Allen Wolfe, the Senior Director of Education at Life Link III. A significant challenge in incorporating ultrasound technology within EMS has been overcoming initial barriers to adoption. Many programs, burdened by cost concerns and technological intimidation, have historically relegated ultrasound units to the back shelves. However, as Allen outlined, strategic changes in accessibility and training can dramatically alter this landscape. Accessibility First: If the ultrasound device is tucked away, it's as good as non-existent. Moving the equipment to a more accessible location, like the primary medical bag, encourages routine use. This minor logistical tweak signals a significant shift in operational culture from "available when necessary" to "essential and ready." Education and quality control are the pillars of successful ultrasound integration. Allen emphasized the transformative role of continuous education and a robust quality assurance (QA) framework in cultivating proficiency among EMS providers. Baseline Proficiency Matters: Establishing baseline proficiency through regular assessments and feedback ensures that EMS personnel are equipped with ultrasound technology and adept at using it effectively. Regular workshops, simulation sessions, and competency evaluations form the backbone of a sustainable ultrasound program. Quality Over Quantity: It's not just about having the equipment; it's about ensuring that each scan contributes to better clinical outcomes. Implementing a rigorous QA process where scans are regularly reviewed and critiqued helps maintain high standards of care and reduces the risk of diagnostic errors. Discussing the clinical impact of ultrasound, it's evident that POCUS is not just a diagnostic tool but a pivotal component in decision-making processes that can save lives. Ultrasound facilitates immediate and accurate assessments of conditions like pneumothoraces, pericardial effusions, and cardiac activity, to name a few. From Reactive to Proactive Use: Shifting from a reactive to a proactive use of ultrasound involves training EMS providers to integrate scanning as a fundamental part of the initial assessment, not just a secondary thought. This shift ensures that ultrasound examination becomes as routine as checking vital signs, embedding it deeply into the extension of the physical assessment. Integrating artificial intelligence (AI) in ultrasound technology presents an exciting frontier. AI can assist providers by enhancing image interpretation, suggesting potential diagnoses, and even guiding probe placement. This technology does not replace the clinician's judgment but augments it, providing a safety net for less experienced users. Moreover, expanding educational opportunities beyond internal training to include collaborations with academic institutions and specialized workshops can enhance the skills and confidence of EMS providers in using ultrasound.

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