Emergency Medicine Cases

AUGUST 8, 2023

We consider electrolyte disturbances and look for ECG signs of hyperkalemia or hypokalemia/hypomagnesemia, and we consider the differential of diffuse ST depression with reciprocal ST elevation in aVR, and false positive STEMI.

STEMI 229

STEMI OR EMS 229

Peter Canning

JANUARY 27, 2025

For instance, there was no protocol for stroke or STEMI. At some point along the way we had protocols for spinal motion restriction, alcohol withdrawal, stroke and STEMI, CPAP, and termination of cardiac arrest resuscitation on scene. There were fewer than 50 protocols in the book, along with pages for 24 medications and 8 procedures.

Allergic Reaction 90

Allergic Reaction Naloxone Paramedic STEMI 90

Dr. Smith's ECG Blog

NOVEMBER 29, 2023

Written by Pendell Meyers Two adult patients in their 50s called EMS for acute chest pain that started within the last hour. Both cases had an EMS ECG that was transmitted to the ED physician asking "should we activate the cath lab?" He diagnosed anterior "STEMI" and activated the cath lab. What do you think? But he did well.

OR 125

OR STEMI EMS ED 125

Dr. Smith's ECG Blog

OCTOBER 1, 2023

He called EMS who brought him to the ED. She knows the baseline is normal, and she knows the STEMI(-) OMI one is diagnostic of OMI, with the highest possible confidence. Here is the EM decision making: "The patient's EKG revealed some repolarization abnormalities but no clear signs of a STEMI. And the pace only quickens.

OR 127

OR STEMI Coronary CAD 127

Pulsara

JANUARY 25, 2024

Metropolitan Emergency Medical Services (MEMS) is a public, non-profit EMS entity serving Little Rock, Arkansas, and its surrounding counties. In 2020, MEMS adopted Pulsara to improve communication with area hospitals for time-sensitive emergencies such as stroke, STEMI, and trauma. MEMS transports around 77,000 patients each year.

Emergency Medical Services 115

Emergency Medical Services EMS STEMI Emergency Department 115

Dr. Smith's ECG Blog

JUNE 7, 2024

Obvious infero-postero-lateral STEMI(+)OMI, regardless of context Now let’s put them in order: what was the sequence? Now let’s look at the actual sequence, with the addition of clinical context, and see how the patient was managed: The patient received aspirin from EMS and arrived at triage painfree (ECG #1). 2 Normal ECG #3.

STEMI 112

STEMI Coronary OR EMS 112

Dr. Smith's ECG Blog

JUNE 17, 2016

Jason was very skeptical of STEMI. This also argues against STEMI. Turns out that the patient regularly called EMS for complaints of chest pain that frequently led to cath lab activation.) He complained of 3 days of diarrhea and abdominal pain. What do you think? Jason, I agree. V4 especially looks like early repolarization.

STEMI 52

STEMI OR Coronary EMS 52

Dr. Smith's ECG Blog

JULY 9, 2024

His family started CPR and called EMS, who arrived to find him in ventricular fibrillation. 15 minutes after EMS arrival, after at least 6 defibrillations, the patient achieved sustained ROSC. Written by Pendell Meyers A man in his 50s was found by his family in cardiac arrest of unknown duration.

Defibrillator 116

Defibrillator STEMI CPR EMS 116

Dr. Smith's ECG Blog

JULY 7, 2024

Written by Jesse McLaren A previously healthy 60 year old developed exertional chest pain with diaphoresis, and called EMS. Here’s the EMS ECG, digitized with PM cardio. First trop was 7,000ng/L (normal 25% of ‘Non-STEMI’ patients with delayed angiography have the exact same pathology of acute coronary occlusion.

STEMI 66

STEMI Coronary ALS OR 66

Dr. Smith's ECG Blog

AUGUST 11, 2024

While STEMI negative, the ECG is diagnostic of proximal LAD occlusion. Transient STEMI” are often managed like non-STEMI with delayed angiography, which is very risky. This case is an example of the steps we can all take in daily practice as the paradigm shifts from STEMI to OMI.

STEMI 99

STEMI Paramedic Coronary EMS 99

ESO

APRIL 19, 2024

From April 2-5, the top fire services and EMS industry thought leaders and data analysts gathered at Wave 2024 to share what trends they’re forecasting for both fields and how they’re enacting change within their own organizations through the power of data-driven insights. Data impacts every aspect of duties, from shifts start to end.

MIH 105

MIH EMS Paramedic Firefighter 105

Dr. Smith's ECG Blog

APRIL 18, 2024

I sent this to the Queen of Hearts So the ECG is both STEMI negative and has no subtle diagnostic signs of occlusion. Non-STEMI guidelines call for “urgent/immediate invasive strategy is indicated in patients with NSTE-ACS who have refractory angina or hemodynamic or electrical instability,” regardless of ECG findings.[1]

STEMI 121

STEMI Coronary ALS CAD 121

The Skeptics' Guide to EM

SEPTEMBER 11, 2021

Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. Guest Skeptic: Dr. Stephen Meigher is the EM Chief Resident training with the Jacobi and Montefiore Emergency Medicine Residency Training Program. The TOMAHAWK Investigators.

EMR 130

EMR Coronary Defibrillator Life Support 130

Emergency Medicine Cases

SEPTEMBER 15, 2020

LVH produces secondary repolarization abnormalities that can mimic STEMI. Signs of occlusion MI in patients with LVH include: new Q waves/loss of R waves, disproportionate and dynamic ST elevation (or ST depression from posterior MI), and hyperacute T waves.

STEMI 130

STEMI Coronary OR EMS 130

Dr. Smith's ECG Blog

JUNE 21, 2023

EMS was called, and they recorded the following ECG on scene at 13:16: What do you think? In this medical system, the EMS provider can then be routed to the ED or to a type of urgent care facility that is open 24 hrs/day and staffed by a primary care provider. In this case, the EMS provider was routed to the urgent care facility.

STEMI 98

STEMI Coronary Defibrillator EMS 98

EMDocs

SEPTEMBER 19, 2023

Episode 86: Tricky Cases Part 2 Case 3: 56-year-old female with history of seizures, actively seizing, EMS called. Patient seized for approximately 20 minutes prior to EMS arrival. Today on the emDOCs cast with Brit Long, MD ( @long_brit) , and Rachel Bridwell, MD ( @rebridwell ), we cover two more challenging cases.

STEMI 98

STEMI Coronary Emergency Department ICU 98

ECG Medical Training

SEPTEMBER 4, 2016

EMS was called to evaluate a male patient in his 60s with a chief complaint of chest pain. Onset: Gradual while walking Provoke: Initially the pain felt better with rest Quality: Described as a dull ache Radiate: The pain radiates to the back Severity: 7/10 Time: 3 hours He states that he feels nauseated and vomited x2 prior to EMS arrival.

STEMI 52

STEMI Paramedic Coronary Emergency Department 52

EMDocs

DECEMBER 23, 2024

His initial EKG is the following: What do you think? Naturally you would assume that this was a large, multicenter trial, right? This was based on 11, thats not a typo, ELEVEN patients. Ok, so what did the PROCAMIO trial find? Ok, so what did the PROCAMIO trial find? Well, the trial was a multicenter prospective open label trial.

ALS 75

ALS OR STEMI EMS 75

EMS 12-Lead

MARCH 19, 2023

Fire/EMS crews found him clammy and uncomfortable. It doesn’t meet any conventional STEMI criteria, but there is patently obvious increased area under the curve. Vital signs were noted to be unremarkable with respect to any hypo-hypertensive crisis, hypoxia, etc. Breath sounds were clear in all lung fields. No appreciable skin pallor.

Coronary 130

Coronary STEMI Paramedic Defibrillator 130

Dr. Smith's ECG Blog

MAY 20, 2024

He called EMS, who arrived on scene about two hours after the onset of pain to find him hypertensive at 220 systolic. The cardiologist recognized that there were EKG changes, but did not take the patient for emergent catheterization because the EKG was “not meeting criteria for STEMI”. The ST depressions in I and aVL have resolved.

CAD 125

CAD STEMI Coronary ACS 125

Dr. Smith's ECG Blog

JUNE 17, 2023

Written by Pendell Meyers A middle aged man called EMS for acute chest pain. EMS recorded this ECG during active symptoms and transmitted it to the ED: I had no information when I was shown the ECG. I believe there is not quite enough STE for formal STEMI criteria, but some might measure 1.0 I said "Not OMI.

OR 52

OR STEMI ALS EMS 52

Emergency Medicine Cases

APRIL 2, 2024

In this ECG Cases blog, Jesse McLaren and Rajiv Thavanathan explore how ECG and POCUS complement each other for patients presenting to the emergency department with shortness of breath or chest pain. They explain complementary diagnostic insights into pericardial effusion and cardiac tamponade, occlusion MI and RV strain.

Emergency Department 334

Emergency Department OR STEMI EMS 334

EMS 12-Lead

JUNE 20, 2022

According to the EMS narrative, this patient initially refused hospital transport and advised that he would seek evaluation at a later time with his personal physician. A prehospital STEMI activation was transmitted to the closest PCI center, and 324mg ASA was administered. A 12 Lead ECG was recorded. A 12 Lead ECG was recorded.

ACS 130

ACS Coronary STEMI CAD 130

Dr. Smith's ECG Blog

OCTOBER 12, 2024

Written by Bobby Nicholson What do you think of this “STEMI”? With EMS, patient had a GCS of 3 and was saturating 60% on room air. He improved to 100% with the addition of non-rebreather, however remained altered and was intubated by EMS with ketamine and succinylcholine. or basilar ischemia. There is high QRS voltage.

STEMI 115

STEMI Coronary Emergency Department ACS 115

Dr. Smith's ECG Blog

MAY 2, 2019

Written by Pendell Meyers I received this prehospital ECG (we receive prehospital ECGs by telemetry from EMS in a large area around our hospital) and was told that there was a patient in her 50s with chest pain who was headed to an outside hospital (which happens to be a catheterization center). Here is the ECG: What do you think?

STEMI 52

STEMI ALS ED OR 52

EMS 12-Lead

JULY 21, 2022

Generally speaking, right bundle branch block does not mimic, or obscure, the ECG diagnosis of acute STEMI the way left bundle branch block does. Case Review EMS is called to the residence of a 69 y/o M with a chief complaint of chest pain. Concept Review How do you identify right bundle branch block (RBBB) on the 12 lead ECG?

STEMI 130

STEMI Coronary OR EMS 130

Dr. Smith's ECG Blog

SEPTEMBER 29, 2023

A 60-something woman called EMS for chest pain. Waiting to cath a transient STEMI can be hazardous. This case comes from Jason Winter, of The Facebook Clinical Electrocardiology ECG Page. Here is her first prehospital ECG: What do you think? There is very low voltage in the precordial leads, with a total QRS amplitude of only 3.5

STEMI 121

STEMI EMS OR ED 121

Dr. Smith's ECG Blog

FEBRUARY 13, 2023

There’s inferior ST depression which is reciprocal to subtle lateral convex ST elevation, and the precordial T waves are subtly hyperacute – all concerning for STEMI(-)OMI of proximal LAD. There’s ST elevation I/aVL/V2 that meet STEMI criteria. This is obvious STEMI(+)OMI of proximal LAD. Non-STEMI or STEMI(-)OMI?

STEMI 52

STEMI Paramedic Coronary ALS 52

Dr. Smith's ECG Blog

JULY 25, 2024

EMS arrived and found him in Ventricular Fibrillation (VF). Cardiac arrest #3: ST depression, Is it STEMI? This patient was witnessed by bystanders to collapse. They started CPR. He was defibrillated into VT. He then underwent dual sequential defibrillation into asystole. After 1 mg of epinephrine they achieved ROSC.

Defibrillator 124

Defibrillator Coronary Epinephrine ACS 124

EMS 12-Lead

MAY 20, 2022

Fire/EMS personnel find her laying supine on the kitchen floor, awake and verbal, although acutely ill. This worried the crew of potential acute coronary syndrome and STEMI was activated pre-hospital. As it currently stands, an ST/S ratio >15% should raise awareness for new anterior STEMI.

Coronary 130

Coronary STEMI Firefighter ED 130

Dr. Smith's ECG Blog

APRIL 12, 2013

A male in his 40's who had been discharged 6 hours prior after stenting of an inferoposterior STEMI had sudden severe SOB at home 2 hours prior to calling 911. Is this acute STEMI? Is this an acute STEMI? -- Unlikely! He had no chest pain. Medications were aspirin, clopidogrel, metoprolol, and simvastatin.

STEMI 52

STEMI ED Coronary OR 52

Dr. Smith's ECG Blog

MAY 23, 2023

EMS arrived and recorded this ECG: What do you think? Notice on the right side of the image how the algorithm correctly measures STE sufficient in V1 and V2 to meet STEMI criteria in a man older than age 40. As most would agree, this ECG shows highly specific findings of anterolateral OMI, even with STEMI criteria in this case.

STEMI 98

STEMI Coronary Paramedic OR 98

Dr. Smith's ECG Blog

OCTOBER 17, 2024

The prehospital and ED computer interpretation was inferior STEMI: There’s normal sinus rhythm, first degree AV block and RBBB, normal axis and normal voltages. The paramedic notes called STEMI into question: “EMS disagree with monitor for STEMI callout. Do either, both, or neither have occlusion MI? Vitals were normal.

STEMI 73

STEMI Paramedic Coronary ED 73

Dr. Smith's ECG Blog

AUGUST 15, 2019

He had multiple cardiovascular risk factors and the EM physician strongly suspected ACS. Over the next few hours, four other general cardiologists "signed off on the initial ECG without recognizing STEMI." Learning Points: STEMI criteria misses 25-40% of OMI, like this case for example. mm of the "required" 1.0

STEMI 52

STEMI ACS OR EMS 52

Dr. Smith's ECG Blog

DECEMBER 9, 2023

He has a history of STEMI and heart failure. link] Case continued The conventional algorithm diagnosed STEMI and so did the paramedics. A Coronary angiogram from 8 years prior revealed that he had had an inferior posterior STEMI at the time due to 100% occlusion of the proximal RCA. A 50-something had syncope while driving.

STEMI 115

STEMI Coronary ED Paramedic 115

Dr. Smith's ECG Blog

OCTOBER 10, 2024

EMS arrived and recorded vital signs within normal limits and the following ECG during active pain: EMS1 @ 0157: What do you think? Unfortunately you can see that the conventional Zoll algorithm sees nothing even to suggest AMI, let alone STEMI. During EMS transport, the pain suddenly resolved.

STEMI 108

STEMI EMS Coronary OR 108

Emergency Medicine Cases

OCTOBER 17, 2023

The post ECG Cases 46 ECG in Fever and Infectious Disease appeared first on Emergency Medicine Cases.

OR 266

OR STEMI EMS 266