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. have perfect coronary flow by the time of angiogram. Here is his initial ED ECG: What do you think?

STEMI 96

STEMI Coronary ED Ambulance 96

REBEL EM

MARCH 2, 2023

Background: Historically, we have treated acute coronary syndrome with supplemental oxygen regardless of the patient ’ s oxygen saturation. More recent evidence, however, demonstrates that too much oxygen could be harmful ( AVOID Trial ) by causing coronary vasoconstriction and increasing oxidative stress. Low O2 protocol: 3.1%

ACS 52

ACS Coronary STEMI Ambulance 52

Dr. Smith's ECG Blog

AUGUST 9, 2018

Ambulated to ambulance for eval. The coronaries were clean (this is not the gold standard, however, as some patients with ischemic ST elevation may have clean coronaries). ACTUAL CORONARY ANATOMY: Dominance: Right LM: A 5 mm vessel which bifurcates into the LAD and LCx coronary artery.

E-9-1-1 52

E-9-1-1 STEMI Coronary Ambulance 52

Dr. Smith's ECG Blog

JULY 12, 2023

Turns out that it was a 50-something patient with no previous cardiac history who had called 911 for chest pain and had presented 75 minutes earlier by ambulance to triage (as the entire ED was overloaded). So I looked on the computer. After the ECG was recorded, he was placed in the waiting room where he had been for over an hour.

ED 94

ED Coronary Ambulance OR 94

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

Acute coronary occlusion is the most common and most treatable cause of this pattern, but it is not the only cause. Takotsubo, spasm, low flow with a preexisting stable coronary lesion, etc. In the ambulance during transport, the patient suddenly suffered VF arrest.

STEMI 52

STEMI Coronary ACS Defibrillator 52

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.

Coronary 40

Coronary STEMI EMS ACS 40

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

It was a constant ache on the left side of his chest that forced him to stop cycling and call for an ambulance. He was taken emergently to the cardiac catheterization lab and found to have multi-vessel coronary artery disease with a near-occlusive culprit lesion in the RCA, possibly reperfused.

E-9-1-1 52

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

ECG & Echo Learning

JANUARY 18, 2023

This page summarises the most current recommendations for the management of acute coronary syndromes with persistent ST-segment elevations (i.e I B Ambulance personnel must be trained and equipped to identify STEMI and administer fibrinolysis if necessary. STEMI , ST-segment elevation acute myocardial infarction ).

STEMI 40

STEMI Coronary OR Defibrillator 40

Dr. Smith's ECG Blog

OCTOBER 10, 2022

He reportedly told his family "I think I'm having a heart attack", then they immediately drove him to the ED, and he was able to ambulate into the triage area before he collapsed and became unresponsive. CPR was initiated immediately. It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. (The

ACS 52

ACS CPR CAD Heart Attack 52

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. page 1932 • “The application of STEMI ECG criteria on a standard 12-lead ECG alone will miss a significant minority of patients who have acute coronary occlusion. (21) 2022.08.750 Section 5.2.2,

OR 52

OR STEMI ED Critical Care 52

Dr. Smith's ECG Blog

JUNE 20, 2020

He rehydrated and had no orthostatic symptoms prior to discharge, ambulated well. - Discussion Thus, no further ECGs were recorded and there was no angiogram or stress test or CT coronary angiogram. No previous study for comparison. Clinical Course: - He had no events on cardiac monitoring overnight. -

STEMI 52

STEMI CAD OR Coronary 52

Dr. Smith's ECG Blog

OCTOBER 7, 2019

They did not have an ultrasound on the ambulance (some local crews are starting to utilize POC limited US in our service areas). Smith pointed out that while atropine may may result in slightly more oxygen demand, the increase in cardiac output and in blood pressure would increase overall coronary perfusion and decrease ischemia.

STEMI 40

STEMI EMS Coronary ALS 40

ACEP Now

JUNE 14, 2024

Some of the critical differentials include pulmonary embolism, acute decompensated heart failure, pneumonia, pneumothorax, and acute coronary syndrome. Anginal chest pain, chest heaviness, or evidence of fluid overload suggest acute coronary syndrome or acute decompensated heart failure. Signs and symptoms of systemic infection (e.g.,

ALS 52

ALS Coronary OR ED 52

Dr. Smith's ECG Blog

DECEMBER 16, 2024

Cardiology wanted a CT of the aorta to rule out dissection, presumably partly due to the very high blood pressure readings, but also because it is hard for people to believe that a 20-something woman could have acute thrombotic coronary artery. Coronary malperfusion due to type A aortic dissection: mechanism and surgical management.

STEMI 105

STEMI Coronary Critical Care ED 105

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. This typically occurs in the setting of a rapidly reperfused coronary artery following a myocardial infarction. The ECG below ECG was recorded on the scene. How will you manage this patient?

STEMI 114

STEMI Coronary ALS Ambulance 114

Dr. Smith's ECG Blog

DECEMBER 27, 2024

The patient was then sent to the ED for evaluation not by ambulance but driven to the ED by his wife. In this case report the 69-year old woman ( who incidently had a history of both coronary disease and cardiomyopathy ) remained in sustained VT for 5 days without hemodynamic deterioration.

Coronary 121

Coronary Defibrillator ACS ED 121

International Journal of Paramedicine

JANUARY 15, 2025

Ambulance Tasmania recently implemented prehospital thrombolysis (PHT) as part of a pharmacoinvasive strategy. Methods: This was a descriptive, retrospective cohort study of the first 30 consecutive patient encounters involving PHT for STEMI at Ambulance Tasmania from August 2021 to October 2022. minutes shorter than pre-PHT.

STEMI 52

STEMI Paramedic Ambulance Coronary 52

Dr. Smith's ECG Blog

JANUARY 15, 2025

As such, the patient was placed on a heparin drip and transferred by ambulance to a cardiac cath-capable facility. Whereas the ST-T wave changes that have occurred between the time that these 2 tracings were done are subtle in this older man with known coronary diseae and new CP Aren't there real differences in leads aVL , V2 , V3?

Coronary 68

Coronary ED CAD Paramedic 68

Dr. Smith's ECG Blog

JANUARY 5, 2025

On Sunday, the patient complained of dyspnea and angina while ambulating. If interested, you can review the angiography in detail on my coronary angiography guide where you will find a lot more information about coronary angiography generally. Echocardiogram showed inferior wall hypokinesis. Repeat ECG is shown.

E-9-1-1 77

E-9-1-1 Coronary OR Ambulance 77

Dr. Smith's ECG Blog

OCTOBER 27, 2024

Initial 4th generation troponin I was 10 ng/mL is consistent with large MI due to acute coronary occlusion (OMI). 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. Pain was decreased to 2/10.

STEMI 121

STEMI ED Coronary EMS 121