EMS 12-Lead

APRIL 14, 2022

Madden, Paramedic. It should be emphasized here that this is a presentation of high-pretest probability for Acute Coronary Syndrome (ACS). An interesting comment provided by Paramedic Madden is that a few team members initially interpreted the T wave presentation as hyperkalemia, as opposed to occlusive hyperacuity. Physiology.

ACS 130

ACS Paramedic Coronary ALS 130

EMS 12-Lead

JUNE 1, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review provided by Dr. Steve Smith [link] @SmithECGblog A 72 y/o Male experiences a syncopal episode while seated. Pertinent medical history includes HTN, HLD, and DM – all of which are optimally controlled with medication.

Coronary 130

Coronary ALS ED ACS 130

EMS 12-Lead

AUGUST 14, 2022

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. A second 12 Lead ECG was recorded: This is a testament to the dynamic nature of coronary thrombosis and thrombolysis.

MICU 130

MICU STEMI CAD Coronary 130

EMS 12-Lead

JUNE 20, 2022

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. Here is the final ECG just prior to ED transfer. It’s important to stress the presence of a normal QRS (i.e.,

ACS 130

ACS Coronary STEMI CAD 130

EMS 12-Lead

MAY 8, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review provided by Dr. Steve Smith [link] @SmithECGBlog An adult female called 911 for chest discomfort and difficulty breathing. The following ECG was captured upon arrival at the receiving ED. The ED resulted an 8.7 The serum K returned 8.7,

STEMI 130

STEMI ED EMS Firefighter 130

Dr. Smith's ECG Blog

MAY 23, 2023

But the paramedic and the ED physician in this case did not subscribe to this idea. It is far too premature to say that paramedics and physicians should not be bothered to interpret ECGs labelled as "normal" or "otherwise normal" by the computer algorithm. Thus, this is obvious STEMI(+) OMI until proven otherwise.

STEMI 98

STEMI Coronary Paramedic OR 98

EMS 12-Lead

APRIL 8, 2022

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. 1] Here is the admitting ED ECG after cancellation of Code STEMI. 1] Driver, B.

STEMI 130

STEMI ALS Coronary CAD 130

EMS 12-Lead

AUGUST 22, 2022

The coronary angiogram revealed no critical stenosis, or acute plaque ulceration. Takotsubo should be a diagnosis of exclusion after angiography reveals no obstructive coronary disease, and repeat Echo displays left ventricular recovery. Chou’s Electrocardiography in Clinical Practice (6th ed). Surawicz, B. & Knilans, T.

E-9-1-1 130

E-9-1-1 Coronary ALS ICU 130

Dr. Smith's ECG Blog

MARCH 13, 2023

An ED ECG, if recorded with pain, should show LAD OMI. Smith — in the setting of a patient with new chest pain — the initial ECG in today's case ( = ECG #1 — obtained by the EMS team prior to ED arrival ) — is diagnostic of ACS ( A cute C oronary S yndrome ) until proven otherwise.

ED 52

ED ACS Coronary Paramedic 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

Written by Jesse McLaren Two patients in their 70s presented to the ED with chest pain and RBBB. Patient 1 : a 75 year old called paramedics with one day of left shoulder pain which migrated to the central chest, which was worse with deep breaths. Coronaries were normal, as was serial troponin. Vitals were normal.

STEMI 73

STEMI Paramedic Coronary ED 73

Dr. Smith's ECG Blog

DECEMBER 9, 2023

[link] Case continued The conventional algorithm diagnosed STEMI and so did the paramedics. On arrival in the ED, the patient denied any symptoms at all. No chest pain, no shortness of breath, no back pain, no numbness, weakness, tingling, no seizures or history of seizures, First ED ECG This still shows apparent inferior OMI.

STEMI 115

STEMI Coronary ED Paramedic 115

EMS 12-Lead

APRIL 2, 2022

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Expert commentary provided by Dr. Ken Grauer CASE 1 An 82 y/o Male called 911 for sudden onset dizziness while at rest. Chou’s Electrocardiography in Clinical Practice, 6th ed. Goldberger’s Clinical Electrocardiography: A Simplified Approach, 9th ed.

ALS 130

ALS STEMI Coronary OR 130

Dr. Smith's ECG Blog

JULY 7, 2024

They arrived in the ED 30 minutes later to meet the cardiology team, where an ECG was repeated: Again no STEMI criteria, and there has been improvement in the deWinter and swirl pattern. First trop was 7,000ng/L (normal 25% of ‘Non-STEMI’ patients with delayed angiography have the exact same pathology of acute coronary occlusion.

STEMI 66

STEMI Coronary ALS OR 66

Dr. Smith's ECG Blog

JANUARY 8, 2024

She went to angio and had normal coronaries. Paramedics found her semi-conscious, pale, cool, diaphoretic, tachypneic, very hypotensive. No d-dimer or CT pulmonary angiogram was done when they discovered that she had normal coronary arteries. I discussed the case with Cardiology will admit to their service."

Coronary 71

Coronary STEMI EMS Paramedic 71

Dr. Smith's ECG Blog

OCTOBER 3, 2018

This was shown to me by a very astute Hennepin paramedic. Although this comes from a Hennepin paramedic, the patient was not brought to Hennepin County Medical Center. It is important for cardiologists to realize that a paramedic may see something they do not. For some reason unknown to me, the interventionalist was in the ED.

Coronary 52

Coronary STEMI Paramedic ALS 52

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

Written by Jesse McLaren Two 70 year olds had acute chest pain with nausea and shortness of breath, and called paramedics. But these ECGs were from the same patient: #1 on paramedic arrival and #2 thirty minutes later. Thankfully this patient’s second ECG met STEMI criteria, so paramedics brought them as a code STEMI.

STEMI 52

STEMI Paramedic Coronary ALS 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

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. One need not have obstructive coronary disease to have occlusive thrombus!

Emergency Department 52

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

Dr. Smith's ECG Blog

JUNE 24, 2016

The paramedic recorded a series of ECGs; the initial ECG is representative here: Computer read: “ Normal ECG ” What do you think? He was almost asymptomatic when he arrived in the ED. The paramedic interpreted this as a STEMI. An ECG was obtained in the ED: There is ST elevation in V2-V4. The ED ECG is more equivocal.

STEMI 40

STEMI Coronary Paramedic ED 40

Dr. Smith's ECG Blog

DECEMBER 19, 2018

The symptoms improved somewhat after the paramedic gave her nitroglycerin. The pain had almost resolved by the time an ECG was obtained in the ED: Here is the computer diagnosis What do you think? Despite the computer interpretation, the ED physician was concerned about the ECG, and planned for serial troponins.

Coronary 52

Coronary ED OR Paramedic 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2016

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.

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

AUGUST 9, 2018

This case was sent by Lou B, a paramedic and RN. 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

JUNE 11, 2021

The paramedics found the patient with ROSC and a GCS 7, and an ECG showing LBBB with possible lateral ST elevation. The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. Below is the first ED ECG, labeled LBBB by the machine. Vitals were HR 58 BP 167/70 R20 sat 96%.

EMR 52

EMR STEMI CPR ED 52

Dr. Smith's ECG Blog

JUNE 17, 2016

Pretest probability: Especially when there is no Chest pain, or there are very atypical symptoms, one should be very suspicious of the diagnosis of coronary occlusion unless the ECG is crystal clear. Outcome "I later found out that this is a patient who regularly calls paramedics to c/o chest pains and he had fooled many of them.

STEMI 52

STEMI OR Coronary EMS 52

Dr. Smith's ECG Blog

SEPTEMBER 17, 2020

Her initial 12-lead ECG that was obtained by paramedics in the field is shown in Figure-1. Figure-1: The initial ECG in todays case, obtained by paramedics in the field. ( NOTE: Because LBBB changes the sequence of LV repolarization it may be more difficult to recognize acute coronary occlusion on ECG. See text ). ( See text ).

STEMI 52

STEMI Paramedic ED OR 52

Dr. Smith's ECG Blog

FEBRUARY 4, 2023

Pretest probability: Especially when there is no Chest pain, or there are very atypical symptoms, one should be very suspicious of the diagnosis of coronary occlusion unless the ECG is crystal clear. Outcome "I later found out that this is a patient who regularly calls paramedics to c/o chest pains and he had fooled many of them.

STEMI 52

STEMI Coronary EMS Paramedic 52

Dr. Smith's ECG Blog

OCTOBER 7, 2019

When the paramedics arrived, they obtained a 12 lead ECG and confirmed the unstable vital signs. 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. Why is the patient in shock?

STEMI 40

STEMI EMS Coronary ALS 40

Dr. Smith's ECG Blog

JUNE 8, 2023

Here’s the paramedic ECG (digitized by PMcardio). According to the STEMI paradigm, the patient doesn’t have an acute coronary occlusion and doesn't need emergent reperfusion, so the paramedics can bring them to the ED for assessment, without involving cardiologists. HR 40, BP 135/70, RR16, O2 100%. What do you think?

STEMI 86

STEMI Coronary Paramedic ALS 86

Dr. Smith's ECG Blog

NOVEMBER 14, 2024

This was texted to me by a paramedic while I was out running one day: "54 yo male chest pain started at 1pm. I found out that the interventionalist had just finished a case and came to the ED to see about the de-activated case. He saw the ECG and ordered an ED ECG." History of diabetes type II and stent placement in 2018.

ED 126

ED Coronary Paramedic OR 126

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

This is what the providers in the ED understood on patient arrival: Patient called 911 for syncope, then had witnessed PEA arrest after medics arrived. Here is the written paramedic report available after all the events were over: Patient was seen by witnesses to become unresponsive. The coronaries were clean. From this site.

STEMI 89

STEMI Paramedic E-9-1-1 Epinephrine 89

Dr. Smith's ECG Blog

MARCH 3, 2025

She was found by paramedics with an oxygen saturation of 64%, but could not tolerate BiPAP during transport due to claustrophobia. She arrived to the ED with a nonrebreather mask. The ED physician noted Once her respiratory status improved, her EKG looks much improved with no evidence of STEMI. An EKG was immediately recorded.

E-9-1-1 74

E-9-1-1 Coronary STEMI Emergency Department 74

Dr. Smith's ECG Blog

MARCH 19, 2025

Case submitted by Andrew Grimes, Advanced Care paramedic, with additions from Jesse McLaren and Smith An 84-year-old male with a notable cardiac history (CABG, multiple stents) woke at 0500hrs with pressure in his chest, diaphoresis, and light-headedness. He presented to a rural ED at approximately 0630hrs.

STEMI 116

STEMI Coronary ED Paramedic 116

Dr. Smith's ECG Blog

JANUARY 15, 2025

Pretty impressive for someone who has not yet attended med school, or even been a nurse or paramedic yet. He was worked up non-emergently in the ED with pain recurring and resolving multiple times during his stay. En route to the next hospital, the paramedics recorded another 12-lead tracing. Another EKG was eventually taken.

Coronary 68

Coronary ED CAD Paramedic 68

Dr. Smith's ECG Blog

OCTOBER 27, 2024

This was submitted by a paramedic, Hailey Kennedy A late 50s male called 911 following 2 hours of chest pain that started while working at his desk. The paramedic thought it was LAD OMI, but wasn't certain. The cath lab was deactivated by cardiologist on arrival at ED because it was "not a STEMI". Pain was decreased to 2/10.

STEMI 121

STEMI ED Coronary EMS 121