Remove ALS Remove EMR Remove STEMI
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SGEM#344: We Will…We Will Cath You – But should We After An OHCA Without ST Elevations?

The Skeptics' Guide to EM

Date: September 8th, 2021 Reference: Desch et al. Date: September 8th, 2021 Reference: Desch et al. He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP).

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OMI-NOMI paradigm established as better than STEMI-NSTEMI with new article

Dr. Smith's ECG Blog

Their OMI Manifesto details how use of standard STEMI criteria results in an unacceptable level of inaccuracy, in which an estimated 25-30% of acute coronary occlusions are missed! The article by Aslanger, Smith et al that is featured above in today’s post has just been published.

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Dynamic OMI ECG. Negative trops and negative angiogram does not rule out coronary ischemia or ACS.

Dr. Smith's ECG Blog

By Smith, peer-reviewed by Interventional Cardiologist Emre Aslanger Submitted by anonymous A 53 y.o. Here is his ED ECG at triage: Obvious high lateral OMI that does not quite meet STEMI criteria. male presents to the ED at 6:45 AM with left sided chest dull pressure that woke him up from sleep at 3am. He was started on nitro gtt.

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

Dr. Smith's ECG Blog

Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. 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.

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Physical Examination as a Helpful Aid in Decision-Making in Challenging ECGs

Dr. Smith's ECG Blog

This was contributed by Co-editor Emre Aslanger, an interventional cardiologist in Turkey. As per Dr. Aslanger — a number of medical providers were initial confused by what initially appears as marked ST elevation with reciprocal ST depression, indicative of an acute STEMI. That was also my initial concern.

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LBBB: Using the (Smith) Modified Sgarbossa Criteria would have saved this man's life

Dr. Smith's ECG Blog

The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. Accordingly, in the algorithm by Cai et al for patients with LBBB and ischemic symptoms ( See below ) — the first indication for PCI is clinical: patients with hemodynamic instability or acute heart failure. Which was the culprit lesion?

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A young patient with diminishing pain with a subtle but diagnostic ECG.

Dr. Smith's ECG Blog

Written by Emre Aslanger (Emre is our newest editor. As per Dr. Aslanger and his citation of the J Am Heart Assoc article by Meyers, Smith et al — posterior leads are not needed for the diagnosis of acute posterior OMI! Here are his publications.) He says that the pain intensity was 10/10 at home but now about 4/10.

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