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SGEM#421: I Think I’d Have a Heart Attack – Maybe Not in a Rural Area?

The Skeptics' Guide to EM

Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. She is the cofounder of FOAMcast and a […] The post SGEM#421: I Think I’d Have a Heart Attack – Maybe Not in a Rural Area? Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI.

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A man in his 70s with chest pain

Dr. Smith's ECG Blog

He stated it was similar to prior heart attacks. About an hour later, he was then found on the floor in cardiac arrest in the ED. The history in today's case — was that of a man in his 70s who presented to the ED for 2 hours of chest pain , that was still present on arrival in the ED.

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A teenager with chest pain, a troponin below the limit of detection, and "benign early repolarization"

Dr. Smith's ECG Blog

50% of LAD STEMIs do not have reciprocal findings in inferior leads, and many LAD OMIs instead have STE and/or HATWs in inferior leads instead. The ECG easily meets STEMI criteria in all leads V2-V6, as well. 24 yo woman with chest pain: Is this STEMI? This is not "diffuse", this is simply anterior, lateral, and likely apical.

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A man in his 30s with cardiac arrest and STE on the post-ROSC ECG

Dr. Smith's ECG Blog

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. The value of Stat Echo in the ED for confirming clinical and ECG suspicion of acute PE cannot be overstated!

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Pay now (in the evening) or pay later with interest (in the middle of the night).

Dr. Smith's ECG Blog

A 50 something male presented in the evening to ED for evaluation of chest pain that started at 1600. He reports this was similar to how he felt when he had his heart attack 4 years prior, now s/p 4 stents. PMCardio Queen of Hearts AI Model: The Queen of course also thinks it is acute OMI, for the same reasons.

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