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.

STEMI 100

STEMI Paramedic Coronary EMS 100

FOAMfrat

APRIL 22, 2024

In one of my classes, I ask everyone what happens if you give nitro in a paramedic school scenario without obtaining a 12 lead first.? I can remember TCP simulations in paramedic school where you would turn the mA up until you get a complex after every pacer spike and then palpate the femoral artery to make sure you have mechanical capture.

E-9-1-1 78

E-9-1-1 ACS Paramedic Critical Care 78

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. This results in Type I MI.

Coronary 130

Coronary ACS CAD ED 130

EMS 12-Lead

APRIL 8, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review by Dr. Stephen Smith @smithECGblog I was reviewing ECG’s in our LifeNet database and happened upon this one without any knowledge of clinical circumstances.

STEMI 130

STEMI ALS Coronary CAD 130

Dr. Smith's ECG Blog

SEPTEMBER 12, 2024

Because the most severe LAD OMIs can cause ischemic failure of the RBB and LAF, any patient with ACS symptoms and new RBBB and LAFB with any concordant STE has LAD OMI until proven otherwise. In EMS2 ECG, the T waves in V5 is possibly hyperacute.

STEMI 121

STEMI EMS ACS ED 121

EMS 12-Lead

JUNE 1, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review provided by Dr. Steve Smith [link] @SmithECGblog A 72 y/o Male experiences a syncopal episode while seated. This is important because we must rely on the ECG to further elucidate the story when the patient cannot.

Coronary 130

Coronary ALS ED ACS 130

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. Non-STEMI guidelines call for “urgent/immediate invasive strategy is indicated in patients with NSTE-ACS who have refractory angina or hemodynamic or electrical instability,” regardless of ECG findings.[1] But only 6.4%

STEMI 121

STEMI Coronary ALS CAD 121

ECG Medical Training

AUGUST 21, 2016

Assuming the patient has signs and symptoms of ACS, this should be an easy diagnosis. If you’re a paramedic, by obtaining a 12-lead ECG with the first set of vital signs , and not waiting until the patient is in the back of the ambulance, it gives you “another bite at the apple” before you leave the scene.

STEMI 52

STEMI ACS Ambulance Paramedic 52

Dr. Smith's ECG Blog

MARCH 13, 2023

This is acute ACS, but it almost always seen in a pain free state. Smith — in the setting of a patient with new chest pain — the initial ECG in today's case ( = ECG #1 — obtained by the EMS team prior to ED arrival ) — is diagnostic of ACS ( A cute C oronary S yndrome ) until proven otherwise.

ED 52

ED ACS Coronary Paramedic 52

EMS 12-Lead

APRIL 2, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Expert commentary provided by Dr. Ken Grauer CASE 1 An 82 y/o Male called 911 for sudden onset dizziness while at rest. Anecdotally, had there been symptoms unequivocally consistent with ACS then one could justifiably make the case for a potential D1 occlusion.

ALS 130

ALS STEMI Coronary OR 130

Dr. Smith's ECG Blog

DECEMBER 27, 2014

The paramedic instead gave adenosine , which is not contraindicated, and will not harm a patient in VT. ACS is of course possible. Here is the 12-lead: By any analysis, it is most likely VT: There is slow depolarization of the initial deflections of the QRS. However, this is a very fast VT. It is now part of the ACLS protocol.

ACS 52

ACS Paramedic OR 52

Don't Forget the Bubbles

JUNE 30, 2023

T – He’s got a single grey cannula in situ, and we’ve given him a 5 mg bolus of IiV morphine on the way in The primary survey Thanking the paramedic team, you ask the T&O SHO to proceed with a primary survey. Temperature 36.8C. Trauma Surg Acute Care Open.

E-9-1-1 139

E-9-1-1 FFP Plasma Emergency Department 139

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. Look at the aortic outflow tract. What do you see? Answer below in the still shot.

Coronary 40

Coronary ACS ALS STEMI 40

EMDocs

SEPTEMBER 25, 2023

Medications: FI has a long history of use in the prehospital world, as many agencies were/are reluctant to provide paralytics to paramedics. References: Heffner AC et al. The utilization of midazolam as a pharmacologic adjunct to endotracheal intubation by paramedics. Resuscitation 2013; 84(11): 1500 – 4. Prehosp Emerg Care.

ED 92

ED Emergency Department ALS Paramedic 92

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. Learning Points: 1. Learn to Recognize Hyperacute T-waves 2. References: 1.

Emergency Department 52

Emergency Department E-9-1-1 Coronary STEMI 52

Dr. Smith's ECG Blog

OCTOBER 3, 2018

This was shown to me by a very astute Hennepin paramedic. Although this comes from a Hennepin paramedic, the patient was not brought to Hennepin County Medical Center. It is important for cardiologists to realize that a paramedic may see something they do not. of this post. This is my reponse. This is not tribalism.

Coronary 52

Coronary STEMI Paramedic ALS 52

Paramedic Nat

APRIL 10, 2020

Just time, an empty road and a playlist of AC/DC, ABBA, Queen and … Bubbles from Trailer Park Boys (don’t ask ). I normally wouldn’t have let Adam stay awake so late – but now I could. The highway would not have been so goosebumpingly empty – but tonight it sure was. We had no plans.

ACS 40

ACS 40

NCOAE

DECEMBER 11, 2023

The Eastern Association for the Surgery of Trauma (EAST) , the National Association of EMS Physicians (NAEMSP) , and the American College of Surgeons Committee on Trauma (ACS-COT) all support the recommendation against the use of spinal immobilization in patients with isolated penetrating injuries.

OR 52

OR Emergency Medical Technician Emergency Department Emergency Medical Services 52

Dr. Smith's ECG Blog

JUNE 8, 2023

Here’s the paramedic ECG (digitized by PMcardio). According to the STEMI paradigm, the patient doesn’t have an acute coronary occlusion and doesn't need emergent reperfusion, so the paramedics can bring them to the ED for assessment, without involving cardiologists. paramedic transportation to the ED as “chest pain, STEMI negative” 2.

STEMI 86

STEMI Coronary Paramedic ALS 86

Dr. Smith's ECG Blog

APRIL 2, 2025

Here is a case that shows how Wellens' pattern evolves from a subtle OMI (Case 3): Paramedics make a great call A middle-aged male called 911 for chest pain. Serial ECGs demonstrated dynamic changes diagnostic of ACS (transient STEMI) 4. Here was the first prehospital ECG with pain at 5/10: Computerized QTc is 418 ms.

STEMI 76

STEMI Coronary ED ACS 76

Dr. Smith's ECG Blog

MARCH 3, 2025

She was found by paramedics with an oxygen saturation of 64%, but could not tolerate BiPAP during transport due to claustrophobia. This presentation clearly indicates more than simple ACS ( A cute C oronary S yndrome ). She awoke in the morning with sharp chest pain which worsened throughout the morning.

E-9-1-1 74

E-9-1-1 Coronary STEMI Emergency Department 74

Dr. Smith's ECG Blog

JANUARY 15, 2025

Pretty impressive for someone who has not yet attended med school, or even been a nurse or paramedic yet. html ) Despite an undetectable troponin and three normal EKGs, the nature of the patients symptoms and his positive cardiac history warranted concern for ACS. This interpretation was confirmed by the overreading physician.

Coronary 68

Coronary ED CAD Paramedic 68