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What can you find with continuous ST monitoring in the ED?

Dr. Smith's ECG Blog

This was written by one of our fine residents, who will soon be an EMS fellow: Michael Perlmutter Case A mid-50s male came to the ED with a burning sensation that was acutely worse while at home. He came to the ED at the urging of his wife.

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Prehospital Cath Lab Activation for inferior "STEMI" -- do you agree?

Dr. Smith's ECG Blog

Here is the prehospital ECG: The computer says STEMI Based on this and the presence of chest pain, the medics did a prehospital activation of the cath lab. A 40-something male complained of 3 days of chest pressure. He called 911. He had some pulmonary edema and hypoxia. What do you think? Interpretation: There is clear atrial flutter.

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Is this STEMI or NSTEMI? Neither. It is OMI.

Dr. Smith's ECG Blog

interesting spontaneous reperfusion case 1413140 prehospital STEMI first ED ECG is here, with 3/10 pain: But this is the same patient just 10 minutes before, with 7/10 pain Isn't it ridiculous to say that the patient has both a STEMI and an NSTEMI? ACS is dynamic. It can't be given one static name.

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Chest pain and Bradycardia

Dr. Smith's ECG Blog

Diagnosis: Atrial Fibrillation with complete (3rd degree) AV block and inferoposterior STEMI. In the 1980's, it was believed that the right precordial ST depression that frequently accompanies inferior STEMI was due to "anterior subendocardial ischemia." On arrival, here is the ED ECG: No significant change.

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40 year old woman with acute chest pain and prehospital activation that was cancelled!

Dr. Smith's ECG Blog

Our transport time to the ED was 30 min. Unfortunately, the ED declined as it was viewed as an NSTE. Lake County Ambulance obtained ECG within 9 minutes and transmitted to ED. Serial ECG's obtained, none meeting true STEMI criteria, but dynamic changes noted. We are hopeful for her recovery.

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International Prehospital Medicine Institute Literature Review, July 2025

JEMS

ST-segment Elevation Myocardial Infarction (STEMI) criteria have been the traditional method of cath lab activation. However, patients with occlusions that do not have STE may not activate the system and at least a quarter of the non-STEMI cases have an associated coronary artery occlusion.

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The ‘One Big Beautiful Bill’—And the EMS Revenue Collapse No One’s Ready For

JEMS

However, these figures fail to account for downstream costs due to misdiagnosis, delayed care, or subsequent ED visits. 23 Utilization of terminology, for example, non-emergent, is problematic because field assessment can miss subtleties that ED evaluations catch. ” 31 This term is repeated in the CMS final report on ET3.

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