Dr. Smith's ECG Blog

SEPTEMBER 1, 2023

It was tested on a large database of known outcomes and was more than twice as senstivity as STEMI criteria and much better than cardiologists. The patient was moved to the critical care area (stabilization room). This is the first version of the AI system. Accuracy was 91% and AUC was 0.95. Cath lab was activated.

STEMI 128

STEMI Critical Care OR ED 128

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.

STEMI 115

STEMI ACS Critical Care Coronary 115

NAEMSP

MARCH 5, 2024

Background Transport of patients to a higher level of care is a decision we make daily in the prehospital setting as well as at the hospital. Air medical transport has been utilized in multiple hospital based programs including trauma, STEMI, and stroke.

Critical Care 52

Critical Care Medical Transportation CPR EMS 52

Dr. Smith's ECG Blog

MARCH 8, 2021

Prehospital ECG: Obvious anterolateral STEMI (Proximal LAD occlusion) The cath lab was activated prehospital by the medics. Interventionalist at the Receiving Hospital: "No STEMI, no cath. Here is one case of a patient I saw. He was a 30-something with chest pain. A male in his 30's complained of sudden severe substernal chest pain.

STEMI 52

STEMI ACS Critical Care OR 52

Dr. Smith's ECG Blog

OCTOBER 6, 2018

We brought the patient into one of our critical care rooms and immediately got more history while recording this repeat ECG: The STE in I has greatly diminished or entirely disappeared. He wrote in his note that "The EKG showed early repolarization in I, V2-V3 but no clear STEMI pattern." We activated the cath lab.

STEMI 40

STEMI Coronary ALS OR 40

Dr. Smith's ECG Blog

DECEMBER 23, 2022

I immediately activated the critical care team and walked the patient to the critical care area, our "Stabilization Room." This is why it is essential that the OMI/NOMI paradigm replace the STEMI/NonSTEMI paradigm. There are relatively large T-waves in V4-V6. Let's record another one." Learning Points: 1.

Critical Care 52

Critical Care STEMI ED OR 52

ESO

APRIL 19, 2024

Director of Hospital Programs, ESO, and Harnessing the Power of Data to transform the Trauma Patient Experience by Heidi Hotz , RN, Director, Trauma-Emergency General Surgery-Surgical Critical Care Programs, Cedars-Sinai Medical Center and Moving the Needle on Trauma Mortality: Collaborative Strategies for Linking Pre-hospital Transfusion by Peter (..)

MIH 105

MIH EMS Paramedic Firefighter 105

Dr. Smith's ECG Blog

MARCH 6, 2023

There was high suspicion of OMI, so patient was brought to critical care area and another ECG was recorded just 7 minutes later as the pain had diminished to 4/10. Here is the repeat ECG at 52 minutes after arrival to triage: Obvious posterolateral STEMI Angiographic findings: 1. V5 and V6 have hyperacute T-waves.

OR 52

OR STEMI ED Critical Care 52

Dr. Smith's ECG Blog

FEBRUARY 15, 2018

Submitted and written by Alex Bracey, with edits by Pendell Meyers and Steve Smith: I was walking through the critical care section of the ED when I overheard a discussion about the following ECG. 3) STEMI criteria failed to identify this acute coronary occlusion, like many others. What do you think?

Coronary 52

Coronary Critical Care STEMI ED 52

ACEP Now

SEPTEMBER 6, 2024

You may have mastered all the latest changes affecting management of sepsis, STEMI, and opiate-use disorder, but there’s no stopping the relentless revisions to our approach to neurologic emergencies. It should sound familiar from its use in the early days for STEMI. Reteplase is not “new” by any stretch of the imagination.

ALS 49

ALS STEMI Ambulance Critical Care 49

Dr. Smith's ECG Blog

AUGUST 13, 2020

He was brought to the critical care area where these rhythms were seen on the monitor: Wide complex tachycardia with no apparent P-waves, and very irregular Consistent with atrial fibrillation with aberrancy A Regular wide complex tachycardia. Instead, he complained of left chest "itchiness". LV Aneurysm? Would you give Thrombolytics?

Critical Care 52

Critical Care OR ACS STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 1, 2022

This EKG was recorded as part of a standing order for critical care. He had been smoking an opiate and suddenly collapsed. He was ventilated with BVM on arrival. He awoke with naloxone. He denied any CP or SOB. An EKG was repeated at 5 minutes The T-wave is less hyperacute. Maybe there is some spontaneous reperfusion?

Overdose 52

Overdose OR Coronary ACS 52

Dr. Smith's ECG Blog

JULY 12, 2020

While calling for some help and arranging to have her transported to our critical care zone, I got this quick ultrasound which confirmed my suspicion: This quick view was all I was able to obtain in the circumstances. The cardiac monitor showed sinus rhythm but the automatic blood pressure cuff was not reading.

E-9-1-1 40

E-9-1-1 ED STEMI OR 40

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). Crit Care Med.

STEMI 52

STEMI Plasma Defibrillator OR 52

Dr. Smith's ECG Blog

SEPTEMBER 3, 2023

He reports that this chest pain feels different than prior chest pain when he had his STEMI/OMI, but is unable to further describe chest pain. Sensitivity was 87% for OMI in our validation study (it was 34% for STEMI criteria). He reports feeling nauseated with emesis. The Queen was not used in real time. Even the Queen can be wrong.

Defibrillator 135

Defibrillator Coronary STEMI CPR 135

Dr. Smith's ECG Blog

OCTOBER 7, 2019

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). In fact, the STE is widespread, mimicking an anterior STEMI. EKG is pictured below: What do you think?

STEMI 40

STEMI EMS Coronary ALS 40

ESO

APRIL 19, 2024

Supporting and advocating for mental health Mental health calls are increasing.

EMS 105

EMS Paramedic Critical Care STEMI 105

Dr. Smith's ECG Blog

MAY 5, 2022

Despite the clinical context, Cardiology was consulted due to concerns for a "STEMI". It is critically important for all EM and critical care providers to have an intimate understanding of hyperkalemia and its ECG findings. From Ken Grauer ( See below ) — with this Figure adapted from LITFL.

E-9-1-1 52

E-9-1-1 OR STEMI ED 52

Dr. Smith's ECG Blog

JANUARY 28, 2012

A middle aged patient who was 3 weeks s/p STEMI came from cardiac rehab where he developed some chest pain, dyspnea and weakness on the treadmill. There is no acute STEMI. This is diagnostic of recent, reperfused STEMI. This is diagnostic of recent, reperfused STEMI. Acute STEMI would have upright T-waves.

STEMI 40

STEMI Coronary Critical Care Emergency Department 40

Dr. Smith's ECG Blog

DECEMBER 16, 2024

She had this ECG recorded: Obvious massive anterior STEMI She was quickly brought to the critical care area and the cath lab was activated. The blood pressure was 170/100 in the critical care area. Here is the ECG at 25 minutes: Terrible LAD STEMI (+) OMI So a CT scan was done which of course showed a normal aorta.

STEMI 105

STEMI Coronary Critical Care ED 105

FOAMfrat

DECEMBER 4, 2024

Fast forward a few years, maybe a critical care class or a few Studio modules, and now we’ve learned that there’s a whole world of vasopressors, inotropes, inopressors, and inodilators out there. In the EMS setting, the most common cardiogenic shock patient is most likely a STEMI. As a result of the increased LVEDP, CPP falls.

Coronary 64

Coronary STEMI Epinephrine Critical Care 64

EMDocs

OCTOBER 29, 2024

Critical Care Ultrasound in Shock: A Comprehensive Review of Ultrasound Protocol for Hemodynamic Assessment in the Intensive Care Unit. m/s)—problematic and elevated > 50 mm Hg (2.5 J Thorac Dis. 2015;7(9):E365-E369. doi:10.3978/J.ISSN.2072-1439.2015.09.22 2072-1439.2015.09.22 J Clin Med. 2024;13(18):5344.

E-9-1-1 98

E-9-1-1 ICU Epinephrine EMS 98

Dr. Smith's ECG Blog

DECEMBER 29, 2024

The PMCardio Queen of Hearts app asks you, before giving an interpretation of OMI ("STEMI-Equivalent"), whether the patient's clinical presentation is high risk for OMI. 20 cases with pseudonormalization Case continued The patient was moved to the critical care area, and cardiology was consulted.

E-9-1-1 66

E-9-1-1 STEMI Critical Care OR 66

Dr. Smith's ECG Blog

NOVEMBER 23, 2024

It is diagnostic of OMI, but this is SUBACUTE OMI I sent this ECG to my "EKG Nerdz" friends, without any clinical info at all and they answered "OMI" The Queen said: "STEMI-Equivalent with High Confidence:" Notice she sees findings in both normal beats and PVCs. There is STE in V5-6. There are new Q-waves in aVL, V5-6.

OR 63

OR Critical Care ALS STEMI 63

Dr. Smith's ECG Blog

MARCH 8, 2025

Multidisciplinary critical care management of electrical storm. There was indication of parasympathetic overdrive ( the acute inferior STEMI with profound bradycardia and junctional escape ). [link] Jentzer, J. Noseworthy, P. Kashou, A. Chrispin, J., Tisdale, J. & Solomon, M. link] Mostofsky, E., Maclure, M., Sherwood, J.

E-9-1-1 75

E-9-1-1 OR Defibrillator Coronary 75