ACEP Now

OCTOBER 3, 2023

This document is an update of guidelines first published in 2000, and then updated in 2007. Confounders to the GCS such as seizure and post-ictal phase, ingestions and drug overdose, as well as medications administered in the prehospital setting that impact GCS score should be documented. References Lulla A, et al.

Emergency Medical Services 98

Emergency Medical Services EMS OR Overdose 98

Dr. Smith's ECG Blog

AUGUST 9, 2024

He had no previously documented medical problems except polysubstance use. The receiving emergency physician consulted with interventional cardiology who stated there was no STEMI. Bigger et al. Is there STEMI? Sadowski ZP, Alexander JH, Skrabucha B, et al. The patient continued having chest pain. Leave it alone.

STEMI 86

STEMI Coronary Heart Attack ACS 86

Dr. Smith's ECG Blog

NOVEMBER 15, 2013

You've read in my previous posts that I have a lot of evidence that Wellens' represents spontaneously reperfused STEMI in which the STEMI went unrecorded. New ST elevation diagnostic of STEMI [equation value = 25.3 It is well documented with continuous 12-lead monitoring that acute re-occlusion is frequently asymptomatic.

Coronary 52

Coronary STEMI ALS Emergency Department 52

Dr. Smith's ECG Blog

DECEMBER 29, 2023

But because there was no new ST elevation, the ECG was signed off as “STEMI negative” and the patient waited to be seen. But the ECG still doesn’t meet STEMI criteria. It was therefore interpreted as “no STEMI” and the patient was treated with dual anti-platelets and referred to cardiology as “NSTEMI.” the cardiologist 5.

STEMI 74

STEMI Coronary OR ALS 74

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 C If possible, patients should bypass non-PCI centres to a PCI-capable centre.

STEMI 40

STEMI Coronary OR Defibrillator 40

Dr. Smith's ECG Blog

JULY 21, 2024

The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. In both tracings — an exceedingly fast PMVT is documented. In this study — Procainamide was superior to Amiodarone for terminating monomorphic VT, as well as having fewer adverse effects than Amiodarone ( Ortiz et al — Eur Heart J 1;38 (17): 1329-1335, 2017 ).

Defibrillator 113

Defibrillator Coronary ALS STEMI 113

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 52

ACS Coronary STEMI Ambulance 52

NAEMSP

MARCH 5, 2024

Article Summary by Sarah Fabiano, MD, FACEP, FAAEM Lyng JW, Braithwaite S, Abraham H, et al. Appropriate air medical services utilization and recommendations for integration of air medical services resources into the EMS system of care: a joint position statement and resource document of NAEMSP, ACEP, and AMPA.

Critical Care 52

Critical Care Medical Transportation CPR EMS 52

Dr. Smith's ECG Blog

APRIL 17, 2023

The Queen of Hearts correctly says: Smith : Why is this ECG which manifests so much ST Elevation NOT a STEMI (even if it were a 60 year old with chest pain)? His HEAR score (before troponin resulted) was documented at 3, with documentation stating "low suspicion for ACS." Physician interpretation: "No STEMI."

OR 52

OR STEMI ACS Emergency Department 52

ACEP Now

JULY 6, 2023

4 Formerly, chest pain patients without an S-T Elevation Acute Myocardial Infarction (STEMI), whose pain was suspected to be cardiac in nature, became inpatients for sequential monitoring of their lactate dehydrogenase and creatine kinase isozyme profiles. Gulati M, et al. Stiell IG, et al. Stiell IG, et al. Postgrad Med.

ALS 52

ALS Emergency Department STEMI ED 52

Dr. Smith's ECG Blog

OCTOBER 6, 2018

He wrote in his note that "The EKG showed early repolarization in I, V2-V3 but no clear STEMI pattern." See far below for data on 24 troponin T in STEMI and NSTEMI, and correlation with infarct size. This difficulty results in high lateral OMI being the most commonly missed OMIs by the misguided STEMI criteria. From AM et al.

STEMI 40

STEMI Coronary ALS OR 40

Dr. Smith's ECG Blog

JULY 11, 2018

This is of course diagnostic of an acute coronary occlusion MI (OMI) that also meets STEMI criteria. Comment by KEN GRAUER, MD ( 7/11/2018 ): = Insightful blog post by Dr. Smith regarding ECG criteria for recognizing acute RV involvement in patients with inferior STEMI. But which myocardial walls are affected?

Coronary 52

Coronary STEMI ED ALS 52

Dr. Smith's ECG Blog

JULY 22, 2023

A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. Our patient had a Brugada Type 1 pattern elicited by an elevated core temperature, which is also a documented phenomenon. So maybe she is better than I am. There was a 0.9%

E-9-1-1 67

E-9-1-1 CAD OR STEMI 67

Dr. Smith's ECG Blog

JANUARY 30, 2019

2) The STE in V1 and V2 has an R'-wave and downsloping ST segments, very atypical for STEMI. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab. In the largest study looking at this topic by Mizusawa et al., Bicarb 20, Lactate 4.2, Ammonia 100.

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

EMDocs

JANUARY 11, 2024

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. These conversations should occur frequently and be clearly documented for other health care professionals who are not present during the conversations (96%, 22/23).

Critical Care 76

Critical Care E-9-1-1 OR ICU 76

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

Document in the patient's chart that rapid infusion is intentional in response to life-threatening hypokalemia." the associated loss is double, at 200-400 mEq.* [ Sterns RH, et al. to greatly decrease risk (although in STEMI, the optimal level is about 4.0-4.5 If cardiac arrest from hypokalemia is imminent (i.e.,

Plasma 40

Plasma STEMI Defibrillator Overdose 40

Dr. Smith's ECG Blog

JUNE 8, 2023

STEMI negative : the EMS automated interpretation read, “STEMI negative. 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. Inferior infarct, age undetermined.

STEMI 61

STEMI Coronary Paramedic ALS 61

Dr. Smith's ECG Blog

DECEMBER 5, 2019

Thus, Brugada is the likely diagnosis _ A very nice explanation of this is given in the document quoted below on current ECG criteria for Brugada pattern. Bayes de Luna, A et al. This is based on the Sieira et al, 2017, risk calculator , which gives a borderline risk score (2). J Electrocardiology 45 (2012):433-442.

ALS 52

ALS OR Defibrillator STEMI 52