E-9-1-1, Information and STEMI

VT in a Sick Patient? Paired with 2 old cases (see it at the bottom)

Dr. Smith's ECG Blog

OCTOBER 1, 2024

== MY Comment , by K EN G RAUER, MD ( 8/30 /2024 ): == I was sent the ECG shown in Figure-1 — knowing only that the patient was being seen in the ED ( E mergency D epartment ). Figure-1: The initial ECG in today's case. After seeing ECG #2 — Can you explain: i ) Why no negative P wave was seen in lead V1 of ECG #1?

E-9-1-1

E-9-1-1 STEMI ED OR

Occlusion myocardial infarction is a clinical diagnosis

Dr. Smith's ECG Blog

DECEMBER 11, 2023

Recall from this post referencing this study that "reciprocal STD in aVL is highly sensitive for inferior OMI (far better than STEMI criteria) and excludes pericarditis, but is not specific for OMI." Case continued She was loaded with aspirin 325 mg, and repeat troponin drawn around the time of EKG 1 resulted at 267 ng/L. At midnight.

E-9-1-1

E-9-1-1 ACS Coronary STEMI

Judge for yourself the management of this patient with "NSTEMI, multivessel disease"

Dr. Smith's ECG Blog

SEPTEMBER 10, 2023

I texted this ECG with no information to Dr. Smith, who immediately said: "If CP, then anterior OMI until proven otherwise." Post Cath ECG: Obviously completing MI with LVA morphology, and STE that meets STEMI criteria (but pt is still diagnosed as "NSTEMI"). No TIMI flow was listed in the report.

E-9-1-1

E-9-1-1 ACS STEMI Coronary

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Dr. Smith's ECG Blog

NOVEMBER 15, 2023

Post cath ECG: Now there are hyperacute T-waves again, and recurrent ST depression in V2 This ECG would normally diagnostic of OMI until proven otherwise No further troponins were measured, but it looks like there is recurrent OMI Next day: A CT Coronary Angiogram was done (CTCA) CARDIAC MORPHOLOGY AND FUNCTION: 1. IMPRESSION: 1.

Coronary

Coronary E-9-1-1 STEMI ACS

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

Dr. Smith's ECG Blog

JUNE 17, 2024

Pain improved to 1/10 after EMS administers 324 mg aspirin and the following EKG is obtained at triage. If this EKG were handed to you to screen from triage without any clinical information, what would you think? found normal ECGs in only 3 of 50 patients with massive PE, and 9 of 40 with submassive PE. What do you think?

E-9-1-1

E-9-1-1 ACS Emergency Department Coronary

A man in his 50s with chest pain

Dr. Smith's ECG Blog

MARCH 9, 2023

He had episodes of chest pain off and on all night, until about 1 hour prior to arrival when the pain became constant, crushing, 10/10 chest pain that radiated to both arms. Barely any STE, and thus not meeting STEMI criteria. Only now that the patient has STEMI criteria is he allowed to go to the cath lab, at around 0530.

E-9-1-1

E-9-1-1 STEMI Coronary ALS

Chest pain, a ‘normal’ ECG, a 'normal trop', and low HEART and EDACS scores: Discharge home? Stress test? Many errors here.

Dr. Smith's ECG Blog

APRIL 22, 2022

But these cases show the potential dangers of delayed recognition and treatment of inferior reperfusion Take away 1. Rather than using terms like “STEMI” and “Wellens”, it’s more helpful to describe the underlying pathology and ECG pattern pattern: Occlusion MI, and reperfusion T wave inversion 4. JAMA Intern Med 2019 9.

E-9-1-1

E-9-1-1 STEMI ALS ED

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

Dr. Smith's ECG Blog

NOVEMBER 30, 2022

mm of ST segment elevation, V2 and V3 have 1 mm of elevation, v4 has 2 mm of elevation and v5 around 1.5 Note 1: Levels were significantly lower in takotsubo that presented with T-wave inversion. Reference on Troponins: Xenogiannis I, Vemmou E, Nikolakopoulos I, et al. Learning Points: 1. What do you think? V1 has 0.5

Emergency Department

Emergency Department E-9-1-1 Coronary STEMI

A man in his 70s with chest pain during a bike ride

Dr. Smith's ECG Blog

SEPTEMBER 30, 2019

Meyers comment: Ryan texted me this ECG with no information and my response was "Tough one. No further follow up information is available. For clarity — I’ve put these 2 tracings together in Figure-1. Figure-1: The initial ED ECG ( = E CG # 1) — with comparison to the patient’s baseline ECG done 4 years earlier ( = E CG # 3).

E-9-1-1

E-9-1-1 Coronary STEMI Emergency Department

Is there Terminal QRS Distortion?

Dr. Smith's ECG Blog

OCTOBER 17, 2022

If you were thinking that this is not anterior OMI because there is no reciprocal ST depression , it is important to remember that half of anterior STEMI do NOT have any reciprocal ST depression. If you were thinking that this is pericarditis, that would be possible in the absence of any clinical information. Pericarditis?

E-9-1-1

E-9-1-1 OR STEMI

30 yo woman with trapezius pain. HEART Pathway = 0. Computer "Normal" ECG. Reality: ECG is Diagnostic of LAD Occlusion.

Dr. Smith's ECG Blog

OCTOBER 23, 2022

EMS recorded these prehospital ECGs: Time 0: In V2-V4, there is ST elevation that does not meet STEMI "criteria," of 1.5 If you use something like the HEART score: 1. E EKG: a negative ECG (score = 0) 3. She was having a transient STEMI, briefly. Learning Points : 1. They give extremely valuable information.

E-9-1-1

E-9-1-1 STEMI ED EMS

Extreme shock and cardiac arrest in COVID patient

Dr. Smith's ECG Blog

NOVEMBER 12, 2020

Here they are: Learning Points: 1. 7 These 3 studies, as well as 1 smaller meta-analysis, 6 and another small study, 8 make it clear that troponin is associated with increased severity and mortality in COVID when adjusted for multiple other variables. 12 All STEMI patients had very high cTn typical of STEMI (cTnT > 1.0

E-9-1-1

E-9-1-1 STEMI Coronary ALS

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

Dr. Smith's ECG Blog

MAY 5, 2022

Despite the clinical context, Cardiology was consulted due to concerns for a "STEMI". Hyperkalemia mimics STEMI and OMI in many distributions, but probably the most common is the Brugada morphology in V1-V2 which mimics anterior OMI for those who cannot recognize the Brugada pattern. Limb lead reversal can be easily recognized.

E-9-1-1

E-9-1-1 OR STEMI ED

A 58 year old with Weakness and more than 4 mm ST Elevation in V3

Dr. Smith's ECG Blog

AUGUST 9, 2018

Here it is: The computer reads STEMI What do you think? More from the medic: "LifePak 15 interpretation was STEMI. My response: "I think it is very worrisome for STEMI." It meets STEMI criteria even for a male under age 40, with STE 2.84 No history, meds, or risk factors. Pattern looked to be BER. mm in V2 and 4.08

E-9-1-1

E-9-1-1 STEMI Coronary Ambulance

"Pericarditis" strikes again

Dr. Smith's ECG Blog

DECEMBER 13, 2019

On review of systems the patient reported back pain for approximately 1 week which he was treating with NSAIDs with minimal relief. I texted this to Dr. Smith without any information, and this was his reply: "This could be pericarditis but probably is normal variant." 15-9/6/2017 ). Pericarditis?

E-9-1-1

E-9-1-1 ACS Coronary CAD

What happens when a patient with LAD OMI does not go immediately to the cath lab?

Dr. Smith's ECG Blog

APRIL 3, 2019

I was shown this ECG without any information: QTc = 431 ms What was my response? Not quite a STEMI, but same effect.) There is ST elevation in V2-V4 that does not quite meet "STEMI criteria." Is this a transient STEMI? When Q-waves have developed, it cannot be assumed to be a transient STEMI. Learning Points: 1.

E-9-1-1

E-9-1-1 STEMI OR Coronary

AHA/NCS Statement on Critical Care Management of Post ROSC Patients

EMDocs

JANUARY 11, 2024

The neurologic section was divided into (1) brain oxygenation, perfusion, edema, and intracranial pressure (ICP); (2) seizures and the ictal-interictal continuum (IIC); and (3) sedation and analgesia. Authors state early cath may be of benefit in those with no STEMI, but much of the more recent literature suggests this is more controversial.

Critical Care

Critical Care E-9-1-1 OR ICU

Paramedicine Now

VT in a Sick Patient? Paired with 2 old cases (see it at the bottom)

Occlusion myocardial infarction is a clinical diagnosis

Trending Sources

Judge for yourself the management of this patient with "NSTEMI, multivessel disease"

What does the angiogram show? The Echo? The CT coronary angiogram? How do you explain this?

Another deadly triage ECG missed, and the waiting patient leaves before being seen. What is this nearly pathognomonic ECG?

A man in his 50s with chest pain

Chest pain, a ‘normal’ ECG, a 'normal trop', and low HEART and EDACS scores: Discharge home? Stress test? Many errors here.

Upon arrival to the emergency department, a senior emergency physician looked at the ECG and said "Nothing too exciting."

A man in his 70s with chest pain during a bike ride

Is there Terminal QRS Distortion?

30 yo woman with trapezius pain. HEART Pathway = 0. Computer "Normal" ECG. Reality: ECG is Diagnostic of LAD Occlusion.

Extreme shock and cardiac arrest in COVID patient

Another deadly and confusing ECG. Are you still one of the many people who will be fooled by this ECG, or do you recognize it instantly?

A 58 year old with Weakness and more than 4 mm ST Elevation in V3

"Pericarditis" strikes again

What happens when a patient with LAD OMI does not go immediately to the cath lab?

AHA/NCS Statement on Critical Care Management of Post ROSC Patients

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