Dr. Smith's ECG Blog

SEPTEMBER 29, 2024

This certainly looks like an anterior STEMI (proximal LAD occlusion), with STE and hyperacute T-waves (HATW) in V2-V6 and I and aVL. On arrival to the ED, this ECG was recorded: What do you think? How do you explain the anterior STEMI(+)OMI immediately after ROSC evolving into posterior OMI 30 minutes later?

STEMI 80

STEMI Coronary Defibrillator OR 80

Dr. Smith's ECG Blog

SEPTEMBER 21, 2020

Are Some Cardiologists Really Limited by Strict Adherence to STEMI millimeter criteria? He was found in ventricular fibrillation and defibrillated, then brought to a local ED which does not have a cath lab. Here is the initial ED ECG: This is pretty obviously and inferior posterior OMI, right? It is a STEMI equivalent.

STEMI 52

STEMI Defibrillator ED ACS 52

EMS 12-Lead

MARCH 19, 2023

It doesn’t meet any conventional STEMI criteria, but there is patently obvious increased area under the curve. Despite immediate chest compressions, and multiple rounds of defibrillation, he could not be resuscitated. To which the lead paramedic replied, “Not cardiac; his symptoms are atypical. Is this OMI?

Coronary 130

Coronary STEMI Paramedic Defibrillator 130

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

He is interested and experienced in healthcare informatics, previously worked with ED-directed EMR design, and is involved in the New York City Health and Hospitals Healthcare Administration Scholars Program (HASP). She arrives in the emergency department (ED) with decreased level of consciousness and shock.

EMR 130

EMR Coronary Defibrillator Life Support 130

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. VF was refractory to amiodarone, lidocaine, double-sequential defibrillation, esmolol, etc. Sensitivity was 87% for OMI in our validation study (it was 34% for STEMI criteria).

Defibrillator 130

Defibrillator Coronary STEMI CPR 130

EMDocs

JANUARY 8, 2024

This post will focus on the key parts of the guideline that affect ED evaluation and management. With respect to timing, for cardiac arrest with a shockable rhythm, it may be reasonable to administer epinephrine after initial defibrillation attempts have failed. Editorial Comment : Yes to PCI after arrest with STEMI on ECG.

Epinephrine 82

Epinephrine Defibrillator Coronary CPR 82

Dr. Smith's ECG Blog

JULY 14, 2023

A 40-something with persistent Ventricular Fibrillation presented after attempted prehospital resuscitation A 40-something with no previous cardiac history presented to the ED in persistent Ventricular Fibrillation after attempted prehospital resuscitation. Finally, head-up CPR (which was not used here), makes for better resuscitation.

E-9-1-1 89

E-9-1-1 Defibrillator CPR STEMI 89

Dr. Smith's ECG Blog

SEPTEMBER 25, 2024

Submitted by Dr. George Mastoras (Twitter @georgemastoras), written by Jesse McLaren It’s a busy day in the ED when you’re sent another ECG to sign off from a patient at triage. A healthy 45-year-old female presented with chest pain, with normal vitals.

OR 66

OR STEMI ACS Coronary 66

Dr. Smith's ECG Blog

AUGUST 17, 2019

So there is definitely no STEMI, and the STE is normal. But after reading this blog, you all know that most OMI do NOT meet STEMI criteria. Bedside echo revealed anteroseptal wall motion abnormality at which point I activated a code STEMI. Defibrillated out of v fib in the cath lab. mm in men over age 40.

STEMI 52

STEMI Defibrillator ED OR 52

Dr. Smith's ECG Blog

MAY 6, 2019

If it is STEMI, it would have to be RBBB with STEMI. Only 5-18% of ED patients with chest pain have a myocardial infarction of any kind. Cardioversion/defibrillation. The patient presented with chest pain. Here is the ECG: What do you think? I frankly did not know what to think. Is it Brugada pattern? Only 1-5% have OMI.

STEMI 52

STEMI Defibrillator OR ALS 52

Dr. Smith's ECG Blog

OCTOBER 3, 2017

Here is his ECG on presentation to the ED, approximately 45 minutes after onset of pain, but with pain improving since onset: What is your interpretation? The initial ECG was interpreted as "normal" by the computer ( Algorithm: Marquette GE / 12SL ) and "no acute ischemic changes" by the ED physician.

CPR 52

CPR Defibrillator STEMI ED 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

She was defibrillated and resuscitated. STEMI MINOCA versus NSTEMI MINOCA STEMI occurs in the presence of transmural ischaemia due to transient or persistent complete occlusion of the infarct-related coronary artery. This has resulted in an under-representation of STEMI MINOCA patients in the literature. From Gue at al.

Emergency Department 52

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

Dr. Smith's ECG Blog

JANUARY 23, 2023

When the ICD was finally interrogated, the syncopal events and shocks correlated with two VF events that were defibrillated successfully. Recall that air is a poor conductor of electricity and will, therefore, generate smaller amplitudes on posterior leads (hence why STEMI criteria requires only >0.5

ACS 52

ACS Coronary Defibrillator STEMI 52

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

RBBB in acute STEMI has a very high mortality. But here there is a large degree of ST elevation in V2-V6, I, and aVL. The paramedics activated the cath lab from the field.

Defibrillator 52

Defibrillator STEMI Paramedic EMS 52

Dr. Smith's ECG Blog

NOVEMBER 30, 2019

They transported to the ED. The history, obtained subsequently, is interesting: The patient had been seen at an outside ED 2 days prior and the K was 2.5 Hospital admission had been recommended, but she left that ED against medical advice. to greatly decrease risk (although in STEMI, the optimal level is about 4.0-4.5

Plasma 52

Plasma STEMI Defibrillator Overdose 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

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. CPR was initiated immediately.

ACS 52

ACS CPR CAD Heart Attack 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

2) The STE in V1 and V2 has an R'-wave and downsloping ST segments, very atypical for STEMI. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab. Smith comment: 1) Brugada ECG may have ST shifts in limb leads as well as precordial leads. Bicarb 20, Lactate 4.2,

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

Dr. Smith's ECG Blog

FEBRUARY 17, 2023

The computer called this Acute STEMI What do you think? STEMI never has a very short QT. There is Bazett, Fridericia, Hodges, Framingham and Rautaharju -- see here at mdcalc: [link] If the ST Elevation here were due to STEMI, it would be an LAD Occlusion. Treatment is by ICD ( implantable cardioverter defibrillator ).

STEMI 52

STEMI Defibrillator OR ED 52

Dr. Smith's ECG Blog

DECEMBER 5, 2019

--If she has fever, she should aggressively take acetaminophen and/or ibuprofen and, if not improving, will need to go to ED for further evaluation. --If If there are any syncopal or presyncopal events, she should be evaluated immediately in the ED. --All All 1st degree relatives should have 1 time EGG. And another finding.

ALS 52

ALS OR Defibrillator STEMI 52