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. She was defibrillated and resuscitated. From Gue at al.

Emergency Department 52

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

Dr. Smith's ECG Blog

JUNE 13, 2024

See this post: Septal STEMI with ST elevation in V1 and V4R, and reciprocal ST depression in V5, V6. EMS arrived to a pulseless patient in V fib. She was successfully defibrillated and taken back to the ED. They sued the the county-operated EMS service for allegedly not dispatching the call fast enough. The family sued.

Defibrillator 92

Defibrillator STEMI EMT EMT 92

Dr. Smith's ECG Blog

JULY 21, 2024

The patient in today’s case is a previously healthy 40-something male who contacted EMS due to acute onset crushing chest pain. The ECG shows obvious STEMI(+) OMI due to probable proximal LAD occlusion. He required multiple defibrillations within a period of a few hours. The below ECG was recorded. What do you think?

Defibrillator 131

Defibrillator Coronary ALS STEMI 131

Dr. Smith's ECG Blog

FEBRUARY 25, 2009

EMS was activated and recorded the following ECG (scanned from a prehospital ECG, so the quality is not perfect): Notice the small Q wave in V1 followed by a very large R-wave, with a prolonged QRS. RBBB in acute STEMI has a very high mortality. This patient is 38 years old with hyperlipidemia. There is a wide S-wave in V6.

Defibrillator 52

Defibrillator STEMI Paramedic EMS 52

Dr. Smith's ECG Blog

SEPTEMBER 20, 2018

There is a very small amount of STE in some of the anterior, lateral, and inferior leads which do NOT meet STEMI criteria. The case was reviewed by all parties, and it was stated correctly that the ECG does not meet the STEMI criteria. He was defibrillated immediately and had return of normal mental status.

STEMI 52

STEMI Coronary ACS Defibrillator 52

Dr. Smith's ECG Blog

JANUARY 30, 2019

She was ventilated by bag-valve-mask by EMS on arrival and was quickly intubated with etomidate and succinylcholine. 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.

E-9-1-1 52

E-9-1-1 CAD STEMI OR 52

Dr. Smith's ECG Blog

OCTOBER 10, 2022

It was reportedly a PEA arrest; there was no recorded V Fib and no defibrillation. The morphology of V2-V4 is very specific in my experience for acute right heart strain (which has many potential etiologies, but none more common and important in EM than acute pulmonary embolism). CPR was initiated immediately.

ACS 52

ACS CPR CAD Heart Attack 52

Dr. Smith's ECG Blog

DECEMBER 22, 2010

After epinephrine, atropine, and defibrillation x 2, there was a return of pulses. There is ST depression in II, III, and aVF that is concerning for reciprocal depression from high lateral STEMI in aVL, where there is some ST elevation. Annals of EM 23(6):1333-1342; June 1994. Exact rhythm during arrest is uncertain.

STEMI 40

STEMI Defibrillator Epinephrine Emergency Department 40

Dr. Smith's ECG Blog

APRIL 9, 2025

The paramedics diagnosis was "Possible Anterolateral STEMI." We rapidly defibrillated her, and with return of normal sinus rhythm. Several minutes later the patient developed V-fib again > 200J defibrillation with return to NSR. The patient then had 2 subsequent episodes of V-fib requiring defibrillation, with return to NSR.

Defibrillator 63

Defibrillator STEMI ED Coronary 63

Dr. Smith's ECG Blog

FEBRUARY 20, 2025

A 12-lead was recorded, showing "STEMI," but is unavailable. Moreover, if you know that catastrophic intracranial hemorrhage can result in an ECG that mimics STEMI, then you know that this patient probably has a severe intracranial hemorrhage. She was BVM ventilated and suctioned. Shortly thereafter, pulses were lost.

STEMI 87

STEMI Paramedic E-9-1-1 Epinephrine 87