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Protocol Change

Peter Canning

For instance, there was no protocol for stroke or STEMI. I dont the exact year these protocols were implemented, but I know that in 2008 they went from a simple typed document to an algorithm format. The document was 222 pages, including 42 medications, 14 procedures, as well as 14 policies.

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Acute chest pain, right bundle branch block, no STEMI criteria, and negative initial troponin.

Dr. Smith's ECG Blog

The paramedic called the EM physician ahead of arrival and discussed the case and ECGs, and both agreed upon activating "Code STEMI" (even though of course it is not STEMI by definition), so that the acute LAD occlusion could be treated as fast as possible. So the cath lab was activated. Long term outcome is unavailable.

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Chest pain with serial ECGs – can you guess the sequence?

Dr. Smith's ECG Blog

Obvious infero-postero-lateral STEMI(+)OMI, regardless of context Now let’s put them in order: what was the sequence? With serial ECGs that are ‘STEMI negative’ the physician could have waited for serial troponin levels or referred the patient as “non-STEMI”. What was the outcome and final diagnosis?

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The Expert Witness re-visits a chest pain Malpractice case using the Queen of Hearts

Dr. Smith's ECG Blog

Her first set of vitals were documented: BP 116/57 Pulse 94bpm Respiratory rate 24/min O2 sat 90% on room air Temp 97F She had been cleaning a Jeep in the sun, and was sunburned. See this post: Septal STEMI with ST elevation in V1 and V4R, and reciprocal ST depression in V5, V6. The physician documented “normal sinus rhythm”.

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OMI-NOMI paradigm established as better than STEMI-NSTEMI with new article

Dr. Smith's ECG Blog

Their OMI Manifesto details how use of standard STEMI criteria results in an unacceptable level of inaccuracy, in which an estimated 25-30% of acute coronary occlusions are missed! The article by Aslanger, Smith et al that is featured above in today’s post has just been published.

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When the conventional algorithm diagnoses the ECG as COMPLETELY NORMAL, but there is in fact OMI, what does the Queen of Hearts PM Cardio AI app say? (with 10 case examples)

Dr. Smith's ECG Blog

Unknown algorithm The Queen gets it right Case 4 How unreliable are computer algorithms in the Diagnosis of STEMI? The patient's prehospital ECG showed that there was massive STEMI and these are hyperacute T-waves "on the way down" as they normalize. Pain was resolving. Diagnosed as Normal by the computer. Troponin negative.

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An elderly male with acute altered mental status and huge ST Elevation

Dr. Smith's ECG Blog

Written by Bobby Nicholson What do you think of this “STEMI”? Second, although there is a lot of ST Elevation which meets STEMI criteria, especially in V3-4, the ST segment is extremely upwardly concave with very large J-waves (J-point notching). With EMS, patient had a GCS of 3 and was saturating 60% on room air. ng/mL and 0.10

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