Emergency Medicine Cases

SEPTEMBER 21, 2021

Jesse McLaren explains 'Late STEMI' and how reperfusion strategies should not be based on time of symptom onset. The post ECG Cases 25: ‘Late STEMI’ – How acute is the coronary occlusion? In this ECG Cases blog we look at 10 patients with potentially ischemic symptoms. appeared first on Emergency Medicine Cases.

Coronary 130

Coronary STEMI EMS 130

Emergency Medicine Cases

JANUARY 28, 2020

And for STEMI too. The post JJ 16 Heparin for ACS and STEMI appeared first on Emergency Medicine Cases. We’re expected to routinely give heparin for all these NSTEMI and unstable angina patients with any ischemic changes seen on the ECG, right? But should we?

ACS 130

ACS STEMI OR EMS 130

Emergency Medicine Cases

OCTOBER 22, 2019

Can you identify which were early repolarization and which were anterior STEMI? The post ECG Cases 2: Early Repolarization or Anterior STEMI? In this ECG Cases blog we present ECGs from 7 patients who presented with chest pain and mild anterior ST elevation. appeared first on Emergency Medicine Cases.

STEMI 130

STEMI OR EMS 130

Emergency Medicine Cases

MAY 10, 2023

In this ECG Cases blog we look at 10 cases of patients with chest pain, including false positive STEMI, false negative STEMI, and other causes to help hone your ECG interpretation skills in time-sensitive cases where those very ECG skills might save a life.

STEMI 130

STEMI EMS 130

Emergency Medicine Cases

MARCH 10, 2020

10 patients presented with the "STEMI-equivalent" ST elevation in aVR with diffuse ST depression. The post ECG cases 7: ST elevation in aVR, STEMI-equivalent? Which had acute coronary occlusion? Jesse McLaren guides us through the differential diagnosis of ST elevation in aVR with diffuse ST depression in this ECG Cases blog.

STEMI 130

STEMI Coronary EMS 130

Dr. Smith's ECG Blog

JANUARY 3, 2024

Interpretation : diagnostic of acute anterior OMI with STE less than STEMI criteria in V1-V4, hyperacute T waves in V2-V4, and suspiciously flat isoelectric ST segments in III and aVF suspicious for reciprocal findings. Now it even meets STEMI criteria, and HATWs continue to inflate. So the cath lab was not activated. Ongoing OMI.

STEMI 79

STEMI EMS ED OR 79

Emergency Medicine Cases

DECEMBER 16, 2019

The post ECG Cases 4: Lateral STEMI or Occlusion MI? In this ECG Cases blog we look at seven patients with potentially ischemic symptoms and subtle ECG changes in the lateral leads. Which had acute coronary occlusion? Introducing the concept of Occlusion MI - a paradigm shift in ECG diagnosis of MI.

STEMI 130

STEMI OR Coronary 130

The Skeptics' Guide to EM

NOVEMBER 25, 2023

Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. Delayed First Medical Contact to Reperfusion Time Increases Mortality in Rural EMS Patients with STEMI. We looked at 101 STEMI patients from two rural EDs. Date: November 22, 2023 Reference: Stopyra et al. AEM November 2023.

Heart Attack 326

Heart Attack STEMI Emergency Medical Services Coronary 326

ACEP Now

DECEMBER 11, 2023

Many conditions outside of acute coronary syndrome (ACS) mimic ST-elevation myocardial infarction (STEMI), but only a handful of cases have reported ST-elevations (STE) in the setting of pancreatic inflammation where underlying ACS was excluded. Mimics of ST elevation myocardial infarction (STEMI). Accessed November 29, 2023.

STEMI 52

STEMI Coronary ACS Critical Care 52

ECG & Echo Learning

JUNE 28, 2023

Posterior (posterolateral) acute myocardial infarction (STEMI) The heart is rotated 30° to the left in the thorax. The answer is rather simple: the probability that the patient has NSTE-ACS/NSTEMI is small and the vast majority has STE-ACS/STEMI. Leads V7–V9 must be placed to reveal the ST-segment elevations.

STEMI 52

STEMI ACS OR 52

Dr. Smith's ECG Blog

DECEMBER 5, 2023

Beyond STEMI: Diagnosing Acute Coronary Occlusion on the ECG. The Queen of Hearts AI app can do it for you. With explainability too.

Coronary 117

Coronary STEMI 117

Emergency Medicine Cases

FEBRUARY 13, 2024

The post ECG Cases 48 – ECG Interpretation in Cardiac Arrest appeared first on Emergency Medicine Cases.

STEMI 268

STEMI OR EMS 268

Dr. Smith's ECG Blog

JUNE 8, 2023

STEMI negative : the EMS automated interpretation read, “STEMI negative. According to the STEMI paradigm, the patient doesn’t have an acute coronary occlusion and doesn't need emergent reperfusion, so the paramedics can bring them to the ED for assessment, without involving cardiologists. Inferior infarct, age undetermined.

STEMI 60

STEMI Coronary Paramedic ALS 60

Emergency Medicine Cases

MAY 7, 2019

The post EM Quick Hits 4 Acetaminophen Overdose & Warfarin Interaction, Dental Infections, MTP RABT Score, Statins for STEMI, Cricothyrotomy Tips appeared first on Emergency Medicine Cases.

Overdose 130

Overdose STEMI EMS 130

Emergency Medicine Cases

JUNE 6, 2023

We discover that for STEMI/OMI vs subendocardial ischemia, we should look for STEMI(-)OMI, subacute OMI, and OMI in the presence of LBBB and RBBB, and consider the differential for diffuse ST depression with reciprocal ST elevation in aVR.

STEMI 234

STEMI EMS 234

Dr. Smith's ECG Blog

JANUARY 21, 2023

ECG met STEMI criteria and was labeled STEMI by computer interpretation. J waves can also be induced by Occlusion MI (5), STEMI mimics including takotsubo and myocarditis complicated by ventricular arrhythmias (6, 7), and subarachnoid hemorrhage with VF (8). Take home : Not all STEs are STEMIs or OMIs. What do you think?

STEMI 52

STEMI ALS EMS OR 52

Core EM

FEBRUARY 23, 2024

EKG Show Details EKG Characteristics Rate 54 Rhythm Sinus Bradycardia Intervals Normal PR, QRS, QT Intervals Axis Normal ST Segments ST Depression in Leads V2-V6 Diagnosis Diagnosis: Posterior STEMI Questions What is the next test that should be obtained in the management of this patient? Sources Burns, E., Cadogan, M., & Cadogan, E.

STEMI 130

STEMI Coronary Emergency Department OR 130

Dr. Smith's ECG Blog

APRIL 4, 2023

This patient could have very easily been overlooked, both because the ECG was STEMI negative and because the Q waves were attributed to an “old infarct”. Fortunately, Dr. Cho was not looking for STEMI ECG criteria but for an acute coronary occlusion. OMI or STEMI? As cardiology documented, “possible STEMI.

STEMI 52

STEMI Coronary OR ACS 52

Prehospital Emergency Care Podcast

JUNE 29, 2022

The PEC Podcast with host Dr. Maia Dorsett brings you our Deep Dive Series with: Daniel Joseph MD Kevin Burns EMT-P, PA-C Aman Shah MD who discuss their manuscript: STEMI Equivalents and Their Incidence during EMS Transport Click here to download today! As always THANK YOU for listening.

STEMI 52

STEMI EMT EMT EMS 52

Dr. Smith's ECG Blog

MAY 31, 2023

Cath lab declined as it is not a STEMI." And now this finding is even formally endorsed as a "STEMI equivalent" in the 2022 ACC guidelines!!! Another myocardial wall is sacrificed at the altar of the STEMI/NonSTEMI mindset. Do NOT give it unless you are committed to the cath lab!! Cath attending is aware. It is a mass delusion.

STEMI 74

STEMI Coronary ACS OR 74

Dr. Smith's ECG Blog

DECEMBER 22, 2022

Take home messages: 1- In STEMI/NSTEMI paradigm you search for STE on ECG. If this patient was managed according to the STEMI/NSTEMI paradigm (although he would be a candidate for early invasive treatment), he would probably be taken to the cath lab hours later. Here is the post-intervention angiogram and post-PCI ECG. 2021.21026.

STEMI 52

STEMI EMR Coronary OR 52

Dr. Smith's ECG Blog

JUNE 19, 2023

This ECG was read as “No STEMI” with no prior available for comparison. It is true this ECG does not meet STEMI criteria (there is 1.0 The Queen of Hearts sees it of course: Still none of these three ECGs meet STEMI criteria. Do you think we discussed this patient's 2-3 hour delay to reperfusion in our quarterly "STEMI meeting"?

STEMI 52

STEMI Coronary ACS Defibrillator 52

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. The post ECG Cases 44 ECG Interpretation in Epigastric pain, Vomiting appeared first on Emergency Medicine Cases.

STEMI 201

STEMI OR EMS 201

ECG & Echo Learning

MARCH 8, 2023

TIMI Risk Scores for NSTE-ACS (NSTEMI, UA) and STE-ACS ( STEMI ) can be calculated below. TIMI, GRACE and PURSUIT are such risk models. The higher the estimated risk, the earlier should angiography be performed.

STEMI 40

STEMI E-9-1-1 ACS Coronary 40

ECG & Echo Learning

JANUARY 18, 2023

STEMI , ST-segment elevation acute myocardial infarction ). 1 Initial diagnosis of STEMI ECG Management Recommendation Level of evidence A 12-lead ECG should be interpreted immediately (within 10 minutes) at first medical contact. I C If possible, patients should bypass non-PCI centres to a PCI-capable centre.

STEMI 40

STEMI Coronary OR Defibrillator 40

Emergency Medicine Cases

DECEMBER 20, 2022

In patients with chest pain + ST elevation, consider false positive STEMI including early repolarization, LVH and Brugada-pattern. In patients with cocaine chest pain who are STEMI negative, beware STEMI(-)OMI including subtle ST elevation, hyperacute T waves, reciprocal change, and refractory ischemia.

STEMI 130

STEMI EMS 130

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 108

STEMI Coronary ALS CAD 108

Emergency Medicine Cases

JUNE 21, 2022

In this ECG Cases blog we review 8 cases of patients with prehospital ECGs and explore prehospital ECGs for diagnosing STEMI, Occlusion MI, false STEMI, code STEMI, dynamic ischemic changes, truncated voltages. Can you avoid the pitfalls and spot the pearls that help to make the diagnosis?

STEMI 130

STEMI Paramedic EMS 130

Dr. Smith's ECG Blog

JULY 31, 2020

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.

STEMI 52

STEMI Coronary EMR ALS 52

The Bottom Line

APRIL 26, 2024

DOI: 10.1056/NEJMoa2312572 Clinical Question In adults presenting with STEMI and cardiogenic shock does the use of a microaxial flow pump (Impella CP) compared to standard care reduce death from any cause at day 180? Background Cardiogenic shock is a frequent complication of STEMI and […]

STEMI 76

STEMI ALS OR 76

EMS 20/20

NOVEMBER 22, 2023

The guys review a nutty situation where a responder is sandwiched between a DNR and a very serious diagnosis. and also their partner. The guys review a nutty situation where a responder is sandwiched between a DNR and a very serious diagnosis. and also their partner.

STEMI 40

STEMI 40

University of Maryland Department of Emergency Med

MAY 7, 2023

52 yo M with chest pain and shortness of breath, ECG as shown, do you activate cath lab? The posterior descending artery (PDA) s. Click to view the rest

STEMI 52

STEMI 52

Dr. Smith's ECG Blog

NOVEMBER 27, 2023

The biggest problem with STEMI criteria are false negatives – because this costs patient’s myocardium, with greater mortality and morbidity. For this reason, ECGs need first to be interpreted in isolation, and then applied to the patient. Could this false positive cath lab activation been prevented?

STEMI 80

STEMI Coronary OR ED 80

Dr. Smith's ECG Blog

FEBRUARY 9, 2024

Posterior leads are unnecessary if anterior leads are diagnostic According to the STEMI paradigm an ECG has to have ST elevation to diagnose acute coronary occlusion, and if there’s no ST elevation on anterior leads you can look for it on posterior leads. Do you need posterior leads? If so, how will they change management?

STEMI 103

STEMI ACS Coronary OR 103

Dr. Smith's ECG Blog

MARCH 31, 2024

The interventional cardiologist then canceled the activation and returned the patient to the ED without doing an angiogram ("Not a STEMI"). I advised that perhaps posterior leads would help to persuade the interventionalist, since the 2022 ACC recommendations include posterior STEMI as a formal STEMI equivalent, but only officially by 0.5

STEMI 83

STEMI ACS ED 83

Dr. Smith's ECG Blog

APRIL 6, 2024

In fact, it read: ** **ACUTE MI / STEMI ** ** The physicians caring for the patient activated the cath lab for "STEMI". But the conventional algorithm diagnosed STEMI, and an emergency physician activated the cath team based on this ECG. To an experienced interpreter, it is clearly not due to OMI.

STEMI 94

STEMI 94

ECG Medical Training

SEPTEMBER 4, 2016

At the hospital a 12-lead ECG is recorded within 10 minutes and read by the attending physician, who activates the “Code STEMI” protocol. Is this a STEMI? So technically it is a STEMI equivalent. The STEMI guidelines require 2 mm of ST-segment elevation in leads V2 and V3 for men (1.5 The answer is yes!

STEMI 52

STEMI Paramedic Coronary Emergency Department 52