ACS Coronary Paramedic 
EMS 12-Lead
APRIL 14, 2022
Madden, Paramedic. It should be emphasized here that this is a presentation of high-pretest probability for Acute Coronary Syndrome (ACS). An interesting comment provided by Paramedic Madden is that a few team members initially interpreted the T wave presentation as hyperkalemia, as opposed to occlusive hyperacuity.
The Skeptics' Guide to EM
SEPTEMBER 11, 2021
The paramedics achieve return of spontaneous circulation (ROSC) after CPR, advanced cardiac life support (ALCS), and Intubation. Acute coronary syndrome (ACS) is responsible for the majority (60%) of all OHCAs in patients. EMS arrives and finds the patient in monomorphic ventricular tachycardic (VT) cardiac arrest.
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EMS 12-Lead
JUNE 20, 2022
David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review provided by Dr. Steve Smith @SmithECGblog I was conducting QA/QI on two very recent cases and was struck by the uniqueness of both. It’s important to stress the presence of a normal QRS (i.e., This ECG immediately struck me as an LAD occlusion.
EMS 12-Lead
JULY 24, 2023
David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic (ret) @DidlakeDW Expert commentary and peer review by Dr. Steve Smith [link] @smithECGBlog A 57 y/o Female with PMHx HTN, HLD, DM, and current use of tobacco products, presented to the ED with chest discomfort. It’s judicious, then, to arrange for coronary angiogram.
EMS 12-Lead
JULY 30, 2023
She was known to have a history of poorly controlled COPD, AFib, and multivessel coronary disease. This should prompt immediate investigation into supply-demand mismatching, or ACS. Pharmacology Review Digoxin is probably one of those medications vaguely recalled from paramedic school. A 12 Lead ECG was captured.
Dr. Smith's ECG Blog
AUGUST 11, 2024
Below is the first ECG recorded by paramedics after 2 hours of chest pain, interpreted by the machine as “possible inferior ischemia”. In isolation this ECG does not show OMI, but following the paramedic ECGs this indicates spontaneous LAD reperfusion. It’s unclear if the paramedic ECGs were seen or missed in the ED.
Dr. Smith's ECG Blog
APRIL 18, 2024
Paramedics provided another 3 sprays of nitro, and 6mg of morphine, which reduced but did not resolve the pain. Similarly, if a patient with known CAD presents with refractory ischemic chest pain, the ECG barely matters: the pre-test likelihood of acute coronary occlusion is so high that they need an emergent angiogram. Alencar et al.
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