AmboFOAM

MAY 7, 2017

We have a large number of graduate paramedics starting with Ambulance Victoria this year, so it’s probably a good time to revisit a topic that seems to receive surprisingly little attention in an industry that relies so heavily upon it. This means that wherever possible the closest ambulance is sent to high priority cases.

Ambulance 40

Ambulance CPR Paramedicine Paramedicine 40

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. Reteplase is not “new” by any stretch of the imagination.

ALS 49

ALS STEMI Ambulance Critical Care 49

Dr. Smith's ECG Blog

JUNE 20, 2020

The medics were worried about STEMI, as it meets STEMI criteria. He rehydrated and had no orthostatic symptoms prior to discharge, ambulated well. - The troponins are NOT consistent with STEMI (OMI), which typically has a troponin I of at least 5 ng/mL. There was no prodrome and no associated symptoms such as SOB or CP.

STEMI 52

STEMI CAD OR Coronary 52

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. Our receiving hospital is a PCI hospital so we don’t need to consider bypassing the local non-PCI hospital.

CPR 52

CPR STEMI EMS Ambulance 52

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. After return from CT, the patient's pain was severe again. 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. The chest pain started about one hour prior to arrival while bike riding. It was radiating to his bilateral upper arms. It was associated with nausea but he denied dyspnea, dizziness, and headache.

E-9-1-1 52

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

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. While she was in her bed at home, she had sudden onset of left sided chest pain that radiated to her shoulder. The pain was pleuritic, without nausea or diaphoresis.

Coronary 40

Coronary STEMI EMS ACS 40

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. In non-PCI-capable hospitals this goal is not always achievable due to delays in transfer. In these cases, thrombolysis is recommended to improve morbidity and mortality. Primary PCI: 95.7%

STEMI 138

STEMI Allergic Reaction Coronary Ambulance 138

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. 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. The cath lab was activated, as it should be with transient STEMI. I found it.

STEMI 52

STEMI Ambulance ED ALS 52

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 40

STEMI Coronary OR Defibrillator 40

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 52

Paramedic STEMI ACS Ambulance 52

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]. 4159 patients (10% of total population) had STEMI 30d Mortality: High O2 protocol: 8.8% 4159 patients (10% of total population) had STEMI 30d Mortality: High O2 protocol: 8.8%

ACS 52

ACS Coronary STEMI Ambulance 52

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 52

STEMI ED OR Ambulance 52

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. EKG is pictured below: What do you think?

STEMI 40

STEMI EMS Coronary ALS 40

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. Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. What do you think?

E-9-1-1 139

E-9-1-1 ACS Emergency Department Coronary 139

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

There is a very small amount of STE in some of the anterior, lateral, and inferior leads which do NOT meet STEMI criteria. The case was reviewed by all parties, and it was stated correctly that the ECG does not meet the STEMI criteria. In the ambulance during transport, the patient suddenly suffered VF arrest.

STEMI 52

STEMI Coronary ACS Defibrillator 52

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.

ACS 52

ACS CPR CAD Heart Attack 52

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 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 ECG pattern is my favorite example of how the STEMI criteria are fundamentally flawed. We have a series of 20 TIMI-0 LAD Occlusions that do meet STEMI criteria. 17 have HATW.

STEMI 113

STEMI Coronary ALS Ambulance 113

International Journal of Paramedicine

JANUARY 15, 2025

Background: Patients with ST-elevation myocardial infarction (STEMI) in regional Tasmania frequently encounter reperfusion delays. Ambulance Tasmania recently implemented prehospital thrombolysis (PHT) as part of a pharmacoinvasive strategy. minutes shorter than pre-PHT.

STEMI 52

STEMI Paramedic Ambulance Coronary 52

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. Pt received 324 ASA and 2 sprays of nitro with improvement.

STEMI 121

STEMI ED Coronary EMS 121

The Good, The Bad & The Ugly Paramedic

OCTOBER 31, 2020

We feel the warm glow, they feel cared for, the paramedic profession remains valued as a whole and ambulance service bills are paid without protest. An increasing number of patients now know that clinical competence comes included with the package, rather than balk at a cost comparison between ambulances and Ubers as a method of transport.

Paramedic 52

Paramedic Ambulance First Responder CPR 52