Peter Canning
JANUARY 27, 2025
When I started as a paramedic in Hartford in January of 1995, I was given a 100-page protocol book to memorize. There were fewer than 50 protocols in the book, along with pages for 24 medications and 8 procedures. The book was approved by the two largest hospitals in Hartford. Paramedics didnt do 12-lead ECGs then.
Dr. Smith's ECG Blog
AUGUST 2, 2024
This was a machine read STEMI positive OMI. The meaning of this quote is that at times, something as obvious as the dramatic anterior lead ST elevation that we see in today's tracing is not the result of an acute LAD STEMI. His ECG is shown below. Pretty obvious anterior current of injury. What would you guess is the culprit artery?
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EMS 12-Lead
APRIL 2, 2022
Figure 1-1 My colleague, a faithful student of ECG interpretation, handed me the tracing and said that it warranted STEMI activation because of apparent terminal QRS distortion (TQRSD) in V2. ASA 324mg was administered while a STEMI activation was simultaneously transmitted to the nearest PCI center. Attached is the first ECG.
Dr. Smith's ECG Blog
DECEMBER 29, 2015
would require the ST/S ratio to be 25% for diagnosis of STEMI in LVH. The physician was concerned about STEMI, but also worried that she was overreacting, with the potential that LVH was producing a "STEMI-mimic." Can you diagnose an ACO (STEMI) when you also have LVH? The criteria of Armstrong et al. References 1.
Dr. Smith's ECG Blog
SEPTEMBER 7, 2024
Smith : there is some minimal ST elevation in V2-V6, but does not meet STEMI criteria. Transient STEMI has been studied and many of these patients will re-occlude in the middle of the night. Is it normal STE? The computer thinks so, and the physician thinks that is quite possible. However , there is terminal QRS distortion in lead V3.
Dr. Smith's ECG Blog
APRIL 26, 2017
Note 2 other similar cases at the bottom that come from my book, The ECG in Acute MI. This meets "STEMI criteria" However, there is very high voltage, with a very deep S-wave in V2 and tall R-wave in V4. The morphology is not right for STEMI. This is very good evidence that the ST elevation is not due to STEMI.
Dr. Smith's ECG Blog
SEPTEMBER 17, 2023
Troponin T peaked at 2074 ng/L (very high, typical of OMI/STEMI). Here is an example of isolated RV infarction, from Dr. Smith's book : Learning points: 1) OMI can be very subtle and RV infarction may manifest poorly on the standard ECG. Post PCI the patient became gravely hypotensive and "shocky". The LV EF was 57% at formal echo.
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