ALS Ambulance Coronary 
Dr. Smith's ECG Blog
NOVEMBER 15, 2023
She was brought in by ambulance and received aspirin and nitroglycerin en route. Angiogram No obstructive epicardial coronary artery disease Cannot exclude non-ACS causes of troponin elevation including coronary vasospasm, stress cardiomyopathy, microvascular disease, etc. Detailed coronary artery evaluation not performed.
Dr. Smith's ECG Blog
DECEMBER 19, 2023
The ambulance report says "BP continued to drop during transport and pt remained cold and clammy." Frick — an all-too-common misconception is that the absence of obstructive coronary disease on cardiac catheterization rules out acute coronary occlusion as the cause of the patient's acute event. This is not the case.
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Dr. Smith's ECG Blog
JUNE 5, 2023
A 40-something male presented by ambulance with one hour of chest pain that was improving after sublingual nitroglycerine and 325 mg of aspirin, chewed. Or had not had a prehospital ECG on the ambulance. Aside on ECG Research: 20% of Definite diagnostic STEMI (Cox et al.) have perfect coronary flow by the time of angiogram.
Dr. Smith's ECG Blog
APRIL 20, 2018
The nitro she took in the ambulance did not help. If she had no risk factors, it is doubtful that she would have developed such extensive coronary artery disease as we see on the angiogram. Her first EKG in isolation has no hard findings that are diagnostic for an acute coronary occlusion.
Dr. Smith's ECG Blog
MARCH 6, 2023
I am sure that I posted it, but don't know when or where: This patient arrived to the ED by ambulance with chest pain that had resolved. Reference: • Writing Committee, Kontos MC, de Lemos JA, et al. Is the ability to diagnose posterior reperfusion a useful skill? Here is a case from a while back. They did, but had not recognized it.
EMS 12-Lead
JUNE 1, 2022
Such findings would normally suggest primary ischemia with concomitant surveillance of coronary occlusion, but these ST/T changes might very well be secondary to the Escape mechanism at hand. Evaluation of T-wave morphology in patients with left bundle branch block and suspected acute coronary syndrome. 3] Meyers, H. 4] Dodd, K.
REBEL EM
SEPTEMBER 28, 2023
Paper: Van de Werf, F et al. STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. References: Van de Werf, F et al. PMID: 37439219 Armstrong P et al. Primary PCI: 95.7% Primary PCI: 95.7%
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