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). All triage ECGs are immediately shown to triage ED faculty.

ED 94

ED Coronary Ambulance OR 94

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

APRIL 20, 2018

This is her pre-hospital ECG: This is her first ECG in the ED: What do you think? The nitro she took in the ambulance did not help. She also received an additional nitro in the ED after receiving aspirin and nitro via EMS. 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

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. The value of Stat Echo in the ED for confirming clinical and ECG suspicion of acute PE cannot be overstated!

ACS 52

ACS CPR CAD Heart Attack 52

Dr. Smith's ECG Blog

MARCH 6, 2023

Study idea: We should look at all OMIs who had a chest CT and compare to all patients with Non-OMI pathology who had a contrast chest CT and have radiologists blindly interpret the perfusion of the myocardium The cardiology fellow came down to the ED and said: "What are you worried about? This ST depression?" 2022.08.750 Section 5.2.2,

OR 52

OR STEMI ED Critical Care 52

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

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). Also, the RV appears large and hypokinetic The patient kept having recurrent syncopal episodes in the ED and was subsequently intubated for stabilization and airway protecting prior to going to the cath lab.

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. They also recommended a NTG drip, after which she reported complete resolution of pain.

STEMI 105

STEMI Coronary Critical Care ED 105

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

Dr. Smith's ECG Blog

JANUARY 15, 2025

He was worked up non-emergently in the ED with pain recurring and resolving multiple times during his stay. As such, the patient was placed on a heparin drip and transferred by ambulance to a cardiac cath-capable facility. Three years later, the patient presented again to the ED with chest pain. Another EKG was eventually taken.

Coronary 68

Coronary ED CAD Paramedic 68

Dr. Smith's ECG Blog

APRIL 6, 2025

This case was a 69 year old male, brought in by ambulance, after being found unresponsive in bed by family earlier that day. On arrival to the ED, he was breathing spontaneously, had faint pulses, and was cool to the touch. He received an additional 300 mg rectal aspirin and 5000 unit heparin bolus in the ED.

OR 90

OR Epinephrine CPR ED 90

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". Initial 4th generation troponin I was 10 ng/mL is consistent with large MI due to acute coronary occlusion (OMI). He presented to the ED for evaluation chest pain. There are moderate coronary artery calcifications.

STEMI 121

STEMI ED Coronary EMS 121