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

ECG Medical Training

SEPTEMBER 4, 2016

The ECG is determined to be non-diagnostic by the treating paramedic. The treating paramedic withholds aspirin. At the hospital a 12-lead ECG is recorded within 10 minutes and read by the attending physician, who activates the “Code STEMI” protocol. The paramedic, feeling a bit sheepish, asked me to review the case.

STEMI 52

STEMI Paramedic Coronary Emergency Department 52

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. A prehospital STEMI activation was transmitted to the closest PCI center, and 324mg ASA was administered.

ACS 130

ACS Coronary STEMI CAD 130

Dr. Smith's ECG Blog

MAY 23, 2023

Notice on the right side of the image how the algorithm correctly measures STE sufficient in V1 and V2 to meet STEMI criteria in a man older than age 40. As most would agree, this ECG shows highly specific findings of anterolateral OMI, even with STEMI criteria in this case. Thus, this is obvious STEMI(+) OMI until proven otherwise.

STEMI 98

STEMI Coronary Paramedic OR 98

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. There’s inferior ST depression which is reciprocal to subtle lateral convex ST elevation, and the precordial T waves are subtly hyperacute – all concerning for STEMI(-)OMI of proximal LAD. Who needs the cath lab?

STEMI 52

STEMI Paramedic Coronary ALS 52

Dr. Smith's ECG Blog

OCTOBER 17, 2024

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. The prehospital and ED computer interpretation was inferior STEMI: There’s normal sinus rhythm, first degree AV block and RBBB, normal axis and normal voltages. Vitals were normal.

STEMI 73

STEMI Paramedic Coronary ED 73

Dr. Smith's ECG Blog

JUNE 17, 2016

Jason was very skeptical of STEMI. 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. This also argues against STEMI. He complained of 3 days of diarrhea and abdominal pain.

STEMI 52

STEMI OR Coronary EMS 52

Dr. Smith's ECG Blog

DECEMBER 9, 2023

He has a history of STEMI and heart failure. link] Case continued The conventional algorithm diagnosed STEMI and so did the paramedics. A Coronary angiogram from 8 years prior revealed that he had had an inferior posterior STEMI at the time due to 100% occlusion of the proximal RCA. He had a prehospital ECG.

STEMI 115

STEMI Coronary ED Paramedic 115

Dr. Smith's ECG Blog

JANUARY 8, 2024

She was diagnosed with a Non-STEMI and kept overnight for a next day angiogram. She went to angio and had normal coronaries. Paramedics found her semi-conscious, pale, cool, diaphoretic, tachypneic, very hypotensive. Medics recorded the above ECG and called a STEMI alert. Her troponin I returned at 900 ng/L.

Coronary 71

Coronary STEMI EMS OR 71

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. ASA 324mg was administered while a STEMI activation was simultaneously transmitted to the nearest PCI center. Attached is the first ECG.

ALS 130

ALS STEMI Coronary OR 130

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

AUGUST 9, 2018

This case was sent by Lou B, a paramedic and RN. Here it is: The computer reads STEMI What do you think? More from the medic: "LifePak 15 interpretation was STEMI. My response: "I think it is very worrisome for STEMI." It meets STEMI criteria even for a male under age 40, with STE 2.84 Pattern looked to be BER.

E-9-1-1 52

E-9-1-1 STEMI Coronary Ambulance 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? The paramedic interpreted this as a STEMI. Can you employ the Subtle Anterior STEMI calculator ? It is not yet available, but this is your way to get on the list. or LAD occlusion?

STEMI 40

STEMI Coronary Paramedic ED 40

Dr. Smith's ECG Blog

FEBRUARY 4, 2023

Jason was very skeptical of STEMI. 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. This also argues against STEMI. He complained of 3 days of diarrhea and abdominal pain.

STEMI 52

STEMI Coronary EMS ED 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 diagnostic coronary angiogram identified only minimal coronary artery disease, but there was a severely calcified, ‘immobile’ aortic valve. Look at the aortic outflow tract.

Coronary 40

Coronary ACS ALS STEMI 40

Dr. Smith's ECG Blog

MARCH 30, 2014

My most talented blog readers are paramedics because they have to put themselves on the line every time they activate the cath lab. Trop T now very high, well into the range one sees with a STEMI; very unusual in type II MI. In any case, these further support the diagnosis of coronary occlusion or near occlusion.

STEMI 52

STEMI Coronary Paramedic OR 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 OR ED 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. This ALONE is very strong evidence of acute coronary occlusion. Any indications for cath lab activation?

EMR 52

EMR STEMI CPR ED 52

Dr. Smith's ECG Blog

JUNE 8, 2023

Here’s the paramedic ECG (digitized by PMcardio). STEMI negative : the EMS automated interpretation read, “STEMI negative. But the latest ACC consensus on the evaluation of chest pain in the ED warns that “STEMI criteria will miss a significant minority of patients with acute coronary occlusion.”[1]

STEMI 85

STEMI Coronary Paramedic ALS 85

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 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

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. Cardiology was consulted, who advised to surveil a metabolic process as this did not strike them as acute coronary syndrome.

STEMI 130

STEMI ED EMS Firefighter 130

Dr. Smith's ECG Blog

OCTOBER 7, 2019

When the paramedics arrived, they obtained a 12 lead ECG and confirmed the unstable vital signs. 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).

STEMI 40

STEMI EMS Coronary ALS 40

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. of this post. This is my reponse. This is not tribalism.

Coronary 52

Coronary STEMI Paramedic ALS 52

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. STEMI criteria are only 43% sensitive for OMI.

STEMI 116

STEMI Coronary ED Paramedic 116

International Journal of Paramedicine

JANUARY 15, 2025

Background: Patients with ST-elevation myocardial infarction (STEMI) in regional Tasmania frequently encounter reperfusion delays. This study aimed to describe a cohort of the first patient encounters involving STEMI treated under the new guideline to review the implications of the PHT initiative and inform ongoing implementation.

STEMI 52

STEMI Paramedic Ambulance Coronary 52

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. Supply-demand mismatch can cause ST Elevation (Type 2 STEMI). Also see these posts of Type II STEMI. Truly, the Marquette 12 SL algorithm correctly identifies this STEMI. Management?

E-9-1-1 73

E-9-1-1 Coronary STEMI Emergency Department 73

FOAMfrat

DECEMBER 4, 2024

You’re me, and you’re in paramedic school, in the thick of the cardiology section. In the EMS setting, the most common cardiogenic shock patient is most likely a STEMI. The ultimate goal is to optimize coronary perfusion pressure (CPP)—in other words, the amount of blood flow into the coronary arteries.

Coronary 64

Coronary STEMI Epinephrine Critical Care 64

Dr. Smith's ECG Blog

APRIL 9, 2025

The paramedics diagnosis was "Possible Anterolateral STEMI." More proof that a huge STEMI may have normal or near normal initial troponin. Lidocaine had been used for the prevention of VF since the 1960s after coronary care units became a standard setting for the treatment of AMI.

Defibrillator 63

Defibrillator STEMI ED Coronary 63

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

Here is the written paramedic report available after all the events were over: Patient was seen by witnesses to become unresponsive. A 12-lead was recorded, showing "STEMI," but is unavailable. Moreover, when someone has immediate resuscitation of an arrest witnessed by paramedics, they rarely have a GCS of 3 (deep coma).

STEMI 88

STEMI Paramedic E-9-1-1 Epinephrine 88

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

Dr. Smith's ECG Blog

APRIL 2, 2025

A comparison of electrocardiographic changes during reperfusion of acute myocardial infarction by thrombolysis or percutaneous transluminal coronary angioplasty. So even a massive STEMI, if it reperfused quickly, can result in a relatvely low troponin (in contrast to the next case!) Wehrens XH, Doevendans PA, Ophuis TJ, Wellens HJ.

STEMI 75

STEMI Coronary ED ACS 75