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🎙️ CARDIOCast – 5th Monday Bonus Episode: BLS Cardiology Interventions

Welcome to CARDIOCast, part of the Pre-Hospital Paradigm Podcast!
This special 5th Monday bonus episode kicks off our 2025 mini-series exploring foundational cardiology topics, starting with what BLS providers can do in the field to impact cardiac outcomes. Whether you're a new EMT or a seasoned provider, this is the episode to reinforce your basics and elevate your care.

🔍 Episode Overview

In this episode, we explore:

• ✅ The evolving role of BLS in cardiology care
  
  

• ⚡️ EMT use of AEDs, 4-leads, and 12-lead EKGs (Ohio-specific scope discussed)
  
  

• 📡 Why transmitting EKGs matters — even if you can’t interpret them
  
  

• 💊 The power of BLS medications: aspirin and nitro — when and how to use them
  
  

• 🫁 Oxygen: more is not always better
  
  

• 🩺 Primary assessments, vital signs, and the value of the story
  
  

• 🎯 Scene management and reducing time-to-cath-lab
  
  

• 🫀 The importance of proper pad placement, EKG skin prep, and troubleshooting interference
  
  

• 💡 Recognizing red flags for aortic dissection
  
  

• ⚕️ STEMI case reviews, best practices, and lessons learned
  
  

💡 Key Takeaways

• EMTs Can Do More Than You Think
  In Ohio, EMTs can acquire and transmit 12-leads — even if they can’t interpret them. These transmissions give emergency physicians a head start, enabling faster diagnoses and better outcomes.
  
  

• The Story Tells All
  Good assessments and patient narratives often point to the diagnosis before any monitor does. Always include symptoms, appearance, and context with your EKGs.
  
  

• Aspirin Saves Lives
  EMTs should give aspirin (324mg) ASAP in suspected ACS — unless red flags suggest aortic dissection.
  
  

• Nitro is About Pain, Not Mortality
  Nitroglycerin can relieve pain and reduce oxygen demand, but its effect on outcomes is minimal. Use it under proper indications, and always screen for contraindications (BP, ED meds).
  
  

• Oxygen Isn’t Always Needed
  If the patient is above 94% SpO2 and not in distress, skip the O2 — too much can cause vasoconstriction and worsen ischemia.
  
  

• Defibrillation Requires Good Contact
  Pad adhesion, hair removal, dry skin, and avoiding artifacts are critical for effective AED use and accurate monitoring.
  
  

• Good EKGs Start with Good Prep
  Cheap or dried-out electrodes, poor skin prep, interference from LED lights or devices — all can sabotage a diagnostic tracing.
  
  

• Be Scene-Time Smart
  Don’t wait for the medic if it delays transport. Early 12-lead, aspirin, and decision-making can start with BLS. Go toward the STEMI center when appropriate.
  
  

📚 Pro Tips for BLS Providers

• Bring the monitor into the scene — don’t rely on dispatch info alone.
  
  

• Always prep skin for EKG electrodes: wipe off oils, rough up skin, avoid bony surfaces.
  
  

• Limb leads go on the limbs — not the shoulders or stomach.
  
  

• Count intercostal spaces for proper precordial lead placement.
  
  

• Transmit a name and DOB with your 12-lead — it helps the ED access prior EKGs.
  
  

• If in doubt: document, transmit, communicate!
  
  

📈 Real-World Win

An all-EMT crew quickly identified a STEMI, transmitted the EKG, bypassed waiting for ALS, and delivered the patient straight to a cath lab. The outcome? A door-to-balloon time of under 15 minutes and a patient who lived — because the basics were done right.

🔁 Upcoming Episodes

Stay tuned as we move deeper into ALS cardiology, pharmacology, and electrophysiology in future bonus episodes. We'll keep bridging the gap between BLS and ALS — 1 rhythm strip at a time.

👇 Join the Conversation

Are you a BLS provider in another state or country? We’d love to hear how your scope compares. Comment or message us with your insights!

The Protocols

From The Episode