ACS, E-9-1-1 and STEMI - Paramedicine Now

TIMI Risk Score for STEMI, NSTEMI and unstable Angina

ECG & Echo Learning

MARCH 8, 2023

All patients with NSTE-ACS ( NSTEMI or unstable angina) are treated similarly with respect to anti-ischemic and anti-thrombotic drugs. Guidelines recommend the use of validated risk models to estimate the risk of acute myocardial infarction , 30-days and 1-year mortality in patients with NSTE-ACS. Circulation.

STEMI

STEMI E-9-1-1 ACS Coronary

Occlusion myocardial infarction is a clinical diagnosis

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." Case continued She was loaded with aspirin 325 mg, and repeat troponin drawn around the time of EKG 1 resulted at 267 ng/L. At midnight.

E-9-1-1

E-9-1-1 ACS Coronary STEMI

Judge for yourself the management of this patient with "NSTEMI, multivessel disease"

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

Post Cath ECG: Obviously completing MI with LVA morphology, and STE that meets STEMI criteria (but pt is still diagnosed as "NSTEMI"). Day 12 ECG: FINAL DIAGNOSIS: "NSTEMI" Despite the fact that his day 4 ECG easily meets STEMI criteria, the patient is diagnosed as NSTEMI. No TIMI flow was listed in the report. Am Heart J.

E-9-1-1

E-9-1-1 ACS STEMI Coronary

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. for those of you who do not do Emergency Medicine, ECGs are handed to us without any clinical context) The ECG was read simply as "No STEMI." found normal ECGs in only 3 of 50 patients with massive PE, and 9 of 40 with submassive PE.

E-9-1-1

E-9-1-1 ACS Emergency Department Coronary

Concerning EKG with a Non-obstructive angiogram. What happened?

Dr. Smith's ECG Blog

DECEMBER 19, 2023

link] A 62 year old man with a history of hypertension, type 2 diabetes mellitus, and carotid artery stenosis called 911 at 9:30 in the morning with complaint of chest pain. Challenge QUESTION: The relative change in T-QRS-D is not the only thing that changes during period of time that passed between recording of the 2 ECGs shown in Figure-1.

E-9-1-1

E-9-1-1 Coronary ACS BLS

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. IMPRESSION: 1. hours T-wave are getting larger again The patient went for an angiogram at about 7 hours after arrival. Stroke-volume:50 ml.

Coronary

Coronary E-9-1-1 STEMI ACS

Anaphylaxis, chest pain, and ST elevation in aVR

Dr. Smith's ECG Blog

MARCH 1, 2023

This pattern occurs regardless of whether the cause is ACS (decreased supply) or any other cause of decreased supply or increased demand. A "STEMI alert" was called and soon cancelled. You must understand that this pattern does not differentiate ACS from other causes of supply/demand mismatch.

Allergic Reaction

Allergic Reaction E-9-1-1 Epinephrine Coronary

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

The fire department, who operate at an EMT level in this municipality, arrived before us and administered 324 mg of baby aspirin to the patient due to concern for ACS. mm of ST segment elevation, V2 and V3 have 1 mm of elevation, v4 has 2 mm of elevation and v5 around 1.5 Learning Points: 1. What do you think? V1 has 0.5

Emergency Department

Emergency Department E-9-1-1 Coronary STEMI

Is this a STEMI? No, not by definition! Why not? Why is this Important?

Dr. Smith's ECG Blog

OCTOBER 24, 2018

A 40-something male presented with dyspnea and left arm numbness, and perhaps some chest tightness, for 1 1/2 hours. This is all but diagnostic of STEMI, probably due to wraparound LAD The cath lab was activated. Here is his triage ECG: There is massive STE in V3-V6, and also STE in II, III, aVF. Why is this important?

E-9-1-1

E-9-1-1 STEMI ACS Coronary

A woman in her 50s with chest pain and lightheadedness and "anterior subendocardial ischemia"

Dr. Smith's ECG Blog

JULY 30, 2023

It does not meet STEMI criteria. Obvious STEMI(+) OMI of inferior, posterior, and lateral walls, now with likely 2nd degree heart block type 1 (Wenckebach). Learning Points: We can find OMI on ECG much sooner than STEMI criteria in many cases, and of course many OMIs never meet STEMI criteria at all.

E-9-1-1

E-9-1-1 STEMI OR ED

"Pericarditis" strikes again

Dr. Smith's ECG Blog

DECEMBER 13, 2019

Written by Pendell Meyers A man in his late 40s with several ACS risk factors presented with a chief complaint of chest pain. On review of systems the patient reported back pain for approximately 1 week which he was treating with NSAIDs with minimal relief. 15-9/6/2017 ). His first troponin T then resulted elevated at 0.19

E-9-1-1

E-9-1-1 ACS Coronary CAD

Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Here they are: Learning Points: 1. 7 These 3 studies, as well as 1 smaller meta-analysis, 6 and another small study, 8 make it clear that troponin is associated with increased severity and mortality in COVID when adjusted for multiple other variables. 12 All STEMI patients had very high cTn typical of STEMI (cTnT > 1.0

E-9-1-1

E-9-1-1 STEMI Coronary ALS

Right precordial ST depression in a patient with chest pain

Dr. Smith's ECG Blog

AUGUST 3, 2017

There are two main etiologies of ischemic ST-depression: 1) subendocardial ischemia 2) reciprocal to ST-elevation in an opposite wall Here there are distinct R-waves with marked ST-depression throughout most of the precordium. But if there is none - then you are looking at least at an Isolated Posterior STEMI until proven otherwise.

STEMI

STEMI E-9-1-1 Coronary ALS

AHA/NCS Statement on Critical Care Management of Post ROSC Patients

EMDocs

JANUARY 11, 2024

The neurologic section was divided into (1) brain oxygenation, perfusion, edema, and intracranial pressure (ICP); (2) seizures and the ictal-interictal continuum (IIC); and (3) sedation and analgesia. Authors state early cath may be of benefit in those with no STEMI, but much of the more recent literature suggests this is more controversial.

Critical Care

Critical Care E-9-1-1 OR ICU

Paramedicine Now

TIMI Risk Score for STEMI, NSTEMI and unstable Angina

Occlusion myocardial infarction is a clinical diagnosis

Trending Sources

Judge for yourself the management of this patient with "NSTEMI, multivessel disease"

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Concerning EKG with a Non-obstructive angiogram. What happened?

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Anaphylaxis, chest pain, and ST elevation in aVR

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Is this a STEMI? No, not by definition! Why not? Why is this Important?

A woman in her 50s with chest pain and lightheadedness and "anterior subendocardial ischemia"

"Pericarditis" strikes again

Extreme shock and cardiac arrest in COVID patient

Right precordial ST depression in a patient with chest pain

AHA/NCS Statement on Critical Care Management of Post ROSC Patients

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