ALS, Ambulance and STEMI - Paramedicine Now

STREAM-2: Half-Dose Tenecteplase vs Primary PCI in Older Patients with STEMI?

REBEL EM

SEPTEMBER 28, 2023

Background: Primary PCI is the recommended reperfusion strategy in patients with STEMI and should be initiated within 2 hours after first medical contact. Paper: Van de Werf, F et al. In non-PCI-capable hospitals this goal is not always achievable due to delays in transfer. Primary PCI: 95.7% Primary PCI: 95.7% Primary PCI: 78.4%

STEMI

STEMI Allergic Reaction Coronary Ambulance

How unreliable are computer algorithms in the Diagnosis of STEMI?

Dr. Smith's ECG Blog

MARCH 10, 2017

A 61 year-old with chest pain arrived to the ED by ambulance with resolving chest pain. link] Hughes KE et al. However, when I saw this patient, I knew that he had come by ambulance, so I knew there must be a prehospital ECG recorded somewhere and went to look for it. This ECG is NOT normal. There is low QRS amplitude.

STEMI

STEMI Ambulance ED ALS

A 40-something male with resolving chest pain and a "Normal ECG" by computer and cardiology overread

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. Here it is: Obvious Inferior Posterior STEMI (+) OMI. Or had not had a prehospital ECG on the ambulance. Aside on ECG Research: 20% of Definite diagnostic STEMI (Cox et al.)

STEMI

STEMI Coronary ED Ambulance

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

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

She was brought in by ambulance and received aspirin and nitroglycerin en route. Lindahl et al. From Gue at al. STEMI MINOCA versus NSTEMI MINOCA STEMI occurs in the presence of transmural ischaemia due to transient or persistent complete occlusion of the infarct-related coronary artery.

Coronary

Coronary E-9-1-1 STEMI ACS

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

Written by Bobby Nicholson, MD 67 year old male with history of hypertension and hyperlipidemia presented to the Emergency Department via ambulance with midsternal nonradiating chest pain and dyspnea on exertion. In fact, Kosuge et al. Stein et al. This is a paper worth reading : Marchik et al. Kosuge et al.

E-9-1-1

E-9-1-1 ACS Emergency Department Coronary

REBEL Cast Ep114: High Flow O2, Suspected ACS, and Mortality?

REBEL EM

MARCH 2, 2023

Based on recent studies, current guidelines recommend that O2 should not be given to non-hypoxemic patients with STEMI or NSTEMI [2,3]. Click here for Direct Download of the Podcast Paper: Stewart, RAH et al. 4159 patients (10% of total population) had STEMI 30d Mortality: High O2 protocol: 8.8% PMID: 25260718 Ibanez B et al.

ACS

ACS Coronary STEMI Ambulance

Paramedics make a great call

Dr. Smith's ECG Blog

NOVEMBER 2, 2015

Serial ECGs demonstrated dynamic changes diagnostic of ACS (transient STEMI) 4. Finally, Transient STEMI should be taken emergently to the cath lab. Normalization of Diagnostic For STEMI Prehospital ECG with Nitroglycerin Therapy. If the initial ECG was diagnostic for STEMI the paramedic called to mobilize the reperfusion team.

Paramedic

Paramedic STEMI ACS Ambulance

Management of STEMI (ST-Elevation Acute Myocardial Infarction)

ECG & Echo Learning

JANUARY 18, 2023

STEMI , ST-segment elevation acute myocardial infarction ). 1 Initial diagnosis of STEMI ECG Management Recommendation Level of evidence A 12-lead ECG should be interpreted immediately (within 10 minutes) at first medical contact. I B Designated PCI centres should provide angiography and reperfusion 24/7 without delay.

STEMI

STEMI Coronary OR Defibrillator

Another Inadequate Paper Published on Triage ECGs, whose Conclusions Need Scrutiny.

Dr. Smith's ECG Blog

OCTOBER 9, 2018

link] In this paper, in a department in which they state they have only 50 STEMI per year, they looked at only 8 days worth of triage ECGs for a total of 538. They did not find one STEMI on their triage ECGs (no surprise! We at HCMC have 30 walk-in STEMIs per year; the rest come by ambulance. October 2018. Fair enough.

STEMI

STEMI ED OR Ambulance

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

Dr. Smith's ECG Blog

DECEMBER 19, 2023

The ambulance report says "BP continued to drop during transport and pt remained cold and clammy." Figure-2: Classification of Underlying Diagnoses in Patients with MINOCA ( Adapted from Table-1 in Sykes et al: Interventional Cardiology Review: 16:e10, 2021 ).

E-9-1-1

E-9-1-1 Coronary ACS BLS

The Latest Research in Neurologic Emergencies

ACEP Now

SEPTEMBER 6, 2024

You may have mastered all the latest changes affecting management of sepsis, STEMI, and opiate-use disorder, but there’s no stopping the relentless revisions to our approach to neurologic emergencies. It should sound familiar from its use in the early days for STEMI. References Li G, Lin Y, Yang J, et al. N Engl J Med.

ALS

ALS STEMI Ambulance Critical Care

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Dr. Smith's ECG Blog

OCTOBER 7, 2019

There is an obvious inferior STEMI, but what else? Besides the obvious inferior STEMI, there is across the precordial leads also, especially in V1. This STE is diagnostic of Right Ventricular STEMI (RV MI). In fact, the STE is widespread, mimicking an anterior STEMI. See this paper by Smith et al.

STEMI

STEMI EMS Coronary ALS

Cardiac Care Show – Episode 2: Post-Resuscitation Care

ECG Medical Training

MAY 25, 2017

If it was a shockable rhythm, and the ECG is showing clear-cut STEMI, we want to activate the cardiac cath lab. In my system, we announce CODE-STEMI over the radio and get a time stamp, and we follow up with ECG transmission. References Callaway C, Donnino M, Fink E et al. All of your practice has just paid off. Circulation.

CPR

CPR STEMI EMS Ambulance

What do you think of this ECG?? Is this during pain, or after pain resolution? Also, see the CT image of the heart.

Dr. Smith's ECG Blog

MARCH 6, 2023

Here is the repeat ECG at 52 minutes after arrival to triage: Obvious posterolateral STEMI Angiographic findings: 1. 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.

OR

OR STEMI ED Critical Care

OMI Can be Diagnosed by "Pseudonormalization of ST Segments"

Dr. Smith's ECG Blog

APRIL 20, 2018

The nitro she took in the ambulance did not help. Patients like her are the reason we are advocating for a change in the ACS paradigm from STEMI to OMI. Armstrong et al attempted to study it but may have included too many 'obvious' cases - the criteria from that paper would certainly have missed this case.

Coronary

Coronary STEMI EMS ACS

Another MUST know ECG, and why its notoriety annoys Dr. Smith

Dr. Smith's ECG Blog

JANUARY 31, 2025

The patient contacted the ambulance service after he experienced sudden onset chest pain and diaphoresis that had started 20 minutes prior. al in 2008, and is eponymously named after the main author. This ECG pattern is my favorite example of how the STEMI criteria are fundamentally flawed. How will you manage this patient?

STEMI

STEMI Coronary ALS Ambulance

Which patient needs a CT scan?

Dr. Smith's ECG Blog

DECEMBER 16, 2024

She had this ECG recorded: Obvious massive anterior STEMI She was quickly brought to the critical care area and the cath lab was activated. Here is the ECG at 25 minutes: Terrible LAD STEMI (+) OMI So a CT scan was done which of course showed a normal aorta. This time the Queen of Hearts interpreted: No STEMI or Equivalent.

STEMI

STEMI Coronary Critical Care ED

Prehospital activation: De-activated on ED arrival by Cardiologist because "It's not a STEMI"

Dr. Smith's ECG Blog

OCTOBER 27, 2024

The cath lab was deactivated by cardiologist on arrival at ED because it was "not a STEMI". It was in his central and left chest, radiated to his left arm, and he experienced some cold sweats and nausea prompting him to call 911 and he was brought to ED via ambulance. Lupu et al. Pain was decreased to 2/10.

STEMI

STEMI ED Coronary EMS

Paramedicine Now

STREAM-2: Half-Dose Tenecteplase vs Primary PCI in Older Patients with STEMI?

How unreliable are computer algorithms in the Diagnosis of STEMI?

Trending Sources

A 40-something male with resolving chest pain and a "Normal ECG" by computer and cardiology overread

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

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

REBEL Cast Ep114: High Flow O2, Suspected ACS, and Mortality?

Paramedics make a great call

Management of STEMI (ST-Elevation Acute Myocardial Infarction)

Another Inadequate Paper Published on Triage ECGs, whose Conclusions Need Scrutiny.

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

The Latest Research in Neurologic Emergencies

A 40-Something male with a "Seizure," Hypotension, and Bradycardia

Cardiac Care Show – Episode 2: Post-Resuscitation Care

What do you think of this ECG?? Is this during pain, or after pain resolution? Also, see the CT image of the heart.

OMI Can be Diagnosed by "Pseudonormalization of ST Segments"

Another MUST know ECG, and why its notoriety annoys Dr. Smith

Which patient needs a CT scan?

Prehospital activation: De-activated on ED arrival by Cardiologist because "It's not a STEMI"

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