EMDocs

JANUARY 8, 2024

For patients with OHCA, use of steroids during CPR is of uncertain benefit. Extracorporeal CPR Use of ECPR for patients with cardiac arrest refractory to standard ACLS is reasonable in select patients when provided within an appropriately trained and equipped system of care. COR 2a, LOE B-R. COR 2a, LOE C-LD. COR 2b, LOE B-R.

Epinephrine 98

Epinephrine Defibrillator Coronary CPR 98

Dr. Smith's ECG Blog

MAY 19, 2020

ECMO Flow was achieved after approximately 1 hour of high quality CPR. This is a troponin I level that is almost exclusively seen in STEMI. So this is either a case of MINOCA, or a case of Type II STEMI. I believe the latter (type II STEMI) is most likely. She then had a 12-lead: What do you think? The K was normal.

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Defibrillator CPR Coronary CAD 52

Dr. Smith's ECG Blog

JULY 14, 2023

Two recent interventions have proven in randomized trials to improve neurologic survival in cardiac arrest: 1) the combination of the ResQPod and the ResQPump (suction device for compression-decompression CPR -- Lancet 2011 ) and 2) Dual Sequential defibrillation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

E-9-1-1 98

E-9-1-1 Defibrillator CPR STEMI 98

REBEL EM

SEPTEMBER 14, 2023

Control: 53.4% D ECLS: 18.2% Control 8.7% Control 38.0% Majority of patients had PCI performed (96.6%) Impella CP was most common mechanical circulatory support in patients without ECLS (85.7%) Death From Any Cause at 30d ECLS: 47.8% Control: 49.0% RR 0.98; 95% CI 0.80 to 1.19; p = 0.81 vs 13.9% (RR 0.58; 95% CI 0.33 vs 22.6% (RR 1.03; 95% CI 0.88

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Life Support Coronary CPR ICU 133

ESO

JANUARY 19, 2024

Working towards better detection Another area ESO has identified as an opportunity to improve is how EMS services detect a possible STEMI or NSTEMI with a 12-lead EKG. Currently, conventional EMS education tends to center symptoms of a STEMI or NSTEMI for males as “typical” and females as “atypical.”

CPR 52

CPR Advanced Life Support Life Support STEMI 52

Dr. Smith's ECG Blog

APRIL 8, 2016

Here is his ED ECG: There is obvious infero-posterior STEMI. What are you worried about in addition to his STEMI? Comments: STEMI with hypokalemia, especially with a long QT, puts the patient at very high risk of Torsades or Ventricular fibrillation (see many references, with abstracts, below). There is also bradycardia.

STEMI 52

STEMI Plasma Defibrillator OR 52

Dr. Smith's ECG Blog

NOVEMBER 19, 2014

Here are three more dramatic cases that illustrate RBBB + LAFB Case 1 of cardiac arrest with unrecognized STEMI, died. The computer read "Right Bundle Branch Block" There is RBBB and LAFB, which can make it difficult to see the end of the QRS. I have annotated it here: The lines mark the end of the QRS and beginning of the ST segment.

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CPR STEMI Coronary ALS 52

ECG Medical Training

MAY 25, 2017

This is an extremely important topic especially for EMS systems that are implementing High Performance CPR , because it is very predictable that you are going to see a lot more patients with return of pulses in the field, and if you don’t have a plan, lots of things can go wrong before arriving at the hospital.

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CPR STEMI EMS Ambulance 52

Dr. Smith's ECG Blog

OCTOBER 20, 2013

Medics found her apneic and pulseless, began CPR, and she was found to be in asystole. Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI. Note that they finally have laid to rest the new or presumably new LBBB as a criteria for STEMI. BP gradually rose.

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STEMI Coronary ACS Emergency Department 52

Dr. Smith's ECG Blog

OCTOBER 28, 2013

It was witnessed, and CPR was performed by trained individuals. She arrived in the ED 37 minutes after 911 was called, with continuing CPR. The last section is a detailed discussion of the research on aVR in both STEMI and NonSTEMI. The following 12-lead ECG was recorded at 11 minutes after ROSC. See image with lines below).

Defibrillator 52

Defibrillator ACS CPR STEMI 52

NAEMSP

MARCH 5, 2024

Air medical transport has been utilized in multiple hospital based programs including trauma, STEMI, and stroke. Cardiac arrest has been proven difficult in flight, but research is still needed with mechanical CPR machines. They have also been utilized with high risk OB, specialized patients with IABP, ECMO, Impella’s etc.

Critical Care 52

Critical Care Medical Transportation CPR EMS 52

Dr. Smith's ECG Blog

SEPTEMBER 16, 2015

It may be difficult to read STEMI in the setting of RBBB. There is, however, a long QT also, with abnormal T-waves, but this is not STEMI. This ECG was recorded prehospital, and the computer read STEMI, so the medics activated the cath lab: What do you think? The ECG is consistent with high lateral STEMI. Called 911.

STEMI 40

STEMI CPR CAD Coronary 40

EMDocs

JANUARY 11, 2024

Brain Oxygenation, Perfusion, Edema, and ICP Statements Takeaway: Avoid 100% oxygen saturation. Instead, target 92-98%. Keep hemoglobin > 7 g/dL. Consider lowering ICP if elevated (head of bed elevation, hyperosmolar therapy, etc.). Valproic acid and levetiracetam are reasonable first-line therapies for EEG or clinical seizure activity.

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Critical Care E-9-1-1 OR ICU 97

Dr. Smith's ECG Blog

AUGUST 9, 2019

When total LM occlusion does present with STE in aVR, there is ALWAYS ST Elevation elsewhere which makes STEMI obvious; in other words, STE is never limited to only aVR but instead it is part of a massive and usually obvious STEMI. All are, however, clearly massive STEMI. This is her ECG: An obvious STEMI, but which artery?

Coronary 52

Coronary STEMI ACS ALS 52

Dr. Smith's ECG Blog

JUNE 11, 2021

Jesse McLaren (@ECGcases), of Emergency Medicine Cases Reviewed by Pendell Meyers and Steve Smith An 85yo with a history of hypertension developed chest pain and collapsed, and had bystander CPR. The patient was brought to the ED as a possible Code STEMI and was seen directly by cardiology. Learning points 1.

EMR 52

EMR STEMI CPR ED 52

Dr. Smith's ECG Blog

OCTOBER 24, 2013

He underwent immediate CPR, was found to be in ventricular fibrillation, and was successfully resuscitated. The physician recorded this ECG, interpreted it as normal, and sent the patient home on an antacid. See explanation below. The patient went home and, in front of his wife, he collapsed. I do not have the post-resuscitation ECG.

CPR 52

CPR ACS Coronary OR 52

Dr. Smith's ECG Blog

MARCH 11, 2016

cm diameter in the apex The presence of thrombus led the clinicians to state that this was a "late presentation STEMI." It does take some time for thrombus to form, but the EKG and the troponin profile show that this was NOT a late presentation STEMI. However, much ST elevation remains, and there is no re-constitution of R-waves.

ALS 52

ALS STEMI OR CPR 52

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

He underwent CPR, and regained a pulse after epinephrine, with an organized narrow complex rhythm at 140, but still with severe shock. In a series of 18 patients with COVID and ST elevation, 8 were diagnosed with STEMI, 6 of whom had an angiogram and it showed obstructive coronary disease. He was intubated and then went pulseless.

E-9-1-1 52

E-9-1-1 STEMI Coronary ALS 52

Dr. Smith's ECG Blog

FEBRUARY 2, 2017

Discussion See this post: STEMI with Life-Threatening Hypokalemia and Incessant Torsades de Pointes I could find very little literature on the treatment of severe life-threatening hypokalemia. In spite of aggressive K replacement, the patient went into ventricular fibrillation. and/or in the presence of acute MI. Is 40 mEq too much?

Plasma 52

Plasma CPR STEMI ALS 52

AmboFOAM

MAY 7, 2017

Might be a good idea to revisit this) You likely practice CPR, cannulation, airway insertion and all the fun stuff, but I guarantee that you will spend more time talking on the radio than doing those things. Think about what you want to say before you say it, and try to get it as concise as possible. Learn it, use it.

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Ambulance CPR Paramedicine Paramedicine 40

Dr. Smith's ECG Blog

OCTOBER 10, 2022

CPR was initiated immediately. 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. 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

NOVEMBER 23, 2022

He underwent CPR and then was shocked out of VF. Both hyperacute T waves and posterior OMI are now formally endorsed as "STEMI equivalents" by the ACC. == MY Comment, by K EN G RAUER, MD ( 11/23 /2022 ): == Cases in which initial ECG findings are subtle before undergoing dramatic change, — are always impressive.

Coronary 52

Coronary Heart Attack ED CPR 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

to greatly decrease risk (although in STEMI, the optimal level is about 4.0-4.5 We could not resuscitate her, but we did have excellent perfusion with LUCAS CPR, such that pulse oximetry had excellent waveform and 100% saturations, end tidal CO2 was 35, and cerebral perfusion monitoring was near normal throughout the attempted resuscitation.

Plasma 40

Plasma STEMI Defibrillator Overdose 40

REBEL EM

JULY 14, 2022

Assigning a patient a single PCAC score upfront may implicitly bias clinicians familiar with the score in how they care for patients. This becomes even more problematic if a patient was made a PCAC III as opposed to a PCAC II simply because of the vasopressor chosen or if they made significant improvements immediately after being scored.

ICU 52

ICU ALS OR CPR 52

Dr. Smith's ECG Blog

MARCH 8, 2025

Angiography was technically challenging as the patient was receiving CPR, but the cardiologist suspected acute stent thrombosis and initiated cangrelor, although no repeat angiography was able to be obtained. In lab, patients are monitored on continuous abbreviated ECG with 5 electrodes. She was defibrillated perhaps 25 times.

E-9-1-1 75

E-9-1-1 OR Defibrillator Coronary 75

EMDocs

FEBRUARY 18, 2025

Were not obviously hitting Sgarbossas critera, so I wouldnt activate a STEMI alert, but it sure doesnt look good. The patient has no pulse so you start CPR. Remember pacemakers rely on muscle to muscle spread of electrical activity, so we expect a wide QRS. The QTc also looks maybe a little prolonged. Are you seeing this right?

STEMI 69

STEMI OR CPR Emergency Department 69

The Good, The Bad & The Ugly Paramedic

OCTOBER 31, 2020

Stoic stalwarts are becoming more likely to call when they suffer a STEMI, rather than putting it off until it’s too late. Bystanders are growing to relish the thought of CPR and saving a life now that the concept is less foreign and frightening. Along with increased insight, however, comes expectation.

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Paramedic Ambulance First Responder CPR 52