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Something Winter This Way Comes

EMS 12-Lead

David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic @DidlakeDW A 50 y/o Male was taking his dog for a leisurely stroll through the park when he suddenly experienced new onset chest discomfort. Otherwise, no admission of CAD, HLD, or family history of sudden cardiac death. However, when the Troponin I returned 8.4

MICU 130
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Critical Left Main

EMS 12-Lead

David Didlake Acute Care Nurse Practitioner Firefighter / Paramedic (ret) @DidlakeDW Expert commentary and peer review by Dr. Steve Smith [link] @smithECGBlog A 57 y/o Female with PMHx HTN, HLD, DM, and current use of tobacco products, presented to the ED with chest discomfort. A 12 Lead ECG was captured on her arrival.

Coronary 130
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Formula Utilization

EMS 12-Lead

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review provided by Dr. Steve Smith @SmithECGblog I was conducting QA/QI on two very recent cases and was struck by the uniqueness of both. Moreover, he had no pertinent medical history to report in terms of CAD, HTN, HLD, or DM, for example.

ACS 130
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Dark Side of the Moon

EMS 12-Lead

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review by Dr. Stephen Smith @smithECGblog I was reviewing ECG’s in our LifeNet database and happened upon this one without any knowledge of clinical circumstances. Furthermore, there was no family history of early CAD, MI, or sudden cardiac death.

STEMI 130
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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

This case was provided by Spencer Schwartz, an outstanding paramedic at Hennepin EMS who is on Hennepin EMS's specialized "P3" team, a team that receives extra training in advanced procedures such as RSI, thoracostomy, vasopressors, and prehospital ultrasound. I could have told you this (and did tell you this) without an MRI.

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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. The patient was brought directly to the cardiac catheterization lab for PCI, bypassing the ED. 2 The astute paramedic recognized this possibility and announced a CODE STEMI.

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Normal ECG by many measures. Is it normal?

Dr. Smith's ECG Blog

Case A 68 year old man with a medical history of hypertension, hyperlipidemia, and CAD with stent deployment in the RCA presented to the emergency department with chest pain. Pretty impressive for someone who has not yet attended med school, or even been a nurse or paramedic yet. He had an EKG recorded right away.