Tag Archives: STEMI mimics

STEMI Mimics and STEMI Equivalents

Here’s my presentation from the VA EMS Symposium on 11/08/2013. STEMI Equivalents and STEMI Mimics from Tom Bouthillet

The early repolarization experiment

Entry Img

Any paramedic who has studied the STEMI mimics has heard of the classic benign early repolarization pattern of a "fish-hooked" J-point with upwardly concave (smiley-faced) ST-segment, often best appreciated in lead V4. But, as the excellent work of Stephen Smith, M.D. demonstrates, not all cases of early repolarization present this way, and it can often […]

Discussion for 51 Year Old Male: Chest Pain

Entry Img

Here is the conclusion to 51 year old male: Chest Pain. You may wish to review the case. Here is the ECG again:   There is a regular sinus rhythm at a rate of about 70. The QRS is narrow. The axis is normal, at about 15 degrees. Let's take a look at the constellation […]

Elderly Female: Chest Pain-Discussion

Entry Img

This is the discussion for Elderly Female: Chest Pain. You may wish to review the case. Ok, this was not an obvious case, at least, not until the end.  As far as the patient goes, I think we all agree about the differentials: ACS vs. possible aortic dissection (due to the pain radiating to her […]

47 year old female CC: Chest pain – Discussion

Entry Img

Thanks for all the comments! I’m not allowed to blog while I’m on duty (the policy has nothing to do with me personally) so if it seems like I’m not responding, I’m probably just at work. The paramedic who submitted this case has requested the follow-up information from his supervisor, but unfortunately she’s out-of-town for […]

41 year old male CC: Chest pain – Answer

Entry Img

Thank you for all of the excellent comments on this case! I was delighted to see such a high level dialog when I checked my blog this morning. Normally I would to answer each of you individually, but since there are 22 comments (so far) I thought I would try a different strategy and post […]

41 year old male CC: Chest pain

Entry Img

A 41 year old male is pulled over during morning rush-hour by sheriff’s deputies. He states that he is on his way to the hospital because he is having chest pain. EMS is called to the scene. The patient is awake, alert, and oriented to person, place, time, and event. His skin is pink, warm, […]

PowerPoint Presentation on Strain Patterns!

This is an awesome PowerPoint presentation from one of my favorite ECG textbooks, 12-Lead ECG – The Art of Interpretation. You owe it to yourself to purchase this book (and no, they don’t pay me to say that). Make sure you use “full screen” so you can see all of the features of this important […]

Left ventricular hypertrophy – Part II

Entry Img

I know I promised to go over the voltage criteria for left ventricular hypertrophy (LVH) but I lied! If you’re really interested you can check out the Wikipedia article HERE, the ECG Learning Center HERE, or Tom Evans’ crib sheet HERE. Personally? I think it’s a distraction. As far as STEMI recognition goes, it misses […]

62 year old male CC: Chest pain

Entry Img

62 year old male presents to the emergency department complaining of chest discomfort. Past medical history is significant for dyslipidemia and ulcerative colitis. Also prior history of significant tobacco use. Maternal history of CAD. Maternal and paternal history of CVA. The patient’s only medication is Lipitor but he took an aspinin en route to the […]

Page 1 of 3123

EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation
Comments
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
The option was indeed turned on! As for non-CP presentations of ACS, I absolutely believe that these warrant the same level of urgency as the "typical" presentations. Both men and women, young and old, all commonly present without classic chest pain. Besides, how much difference is there between "burning in the epigastrium," and "pain in…
2014-08-21 17:10:37
Austin
“Bad heartburn” – 82 y.o. female without chest pain.
You took the words right off of my keyboard, Jason! A little bit of critical thinking works wonders when faced with "protocol versus best interests of the patient" type decisions. Not to encourage deviation from protocols and such, but it is a much less severe trespass if you bend the rules a bit as long…
2014-08-21 16:33:27
Brooks Walsh MD
“Bad heartburn” – 82 y.o. female without chest pain.
My uninformed opinion? I pretty much agree with AHA - if they aren't hypoxic, no need. I'm not sure how terrible superoxia really is, short-term, but why bother if it doesn't help?
2014-08-21 16:31:05
jason
“Bad heartburn” – 82 y.o. female without chest pain.
Chris Watford- as you probably know the "acute MI suspected" detection function in the LP12/15 is a programable option. I suspect the software didn't miss this but rather it wasn't turned on. As for treatment everyone has pretty much got it down. Finally as for activation. Absolutely! Don't real care if the protocol allows for…
2014-08-21 16:30:34
Austin
“Bad heartburn” – 82 y.o. female without chest pain.
There's not much I think I can add at this point, but I will comment on a couple of things. The reciprocal changes indicate to me that there is likely RCA involvement. Also, I've recently been hearing quite a bit about withholding O2 in ACS patients like this. Dr. Walsh, do you have any opinions…
2014-08-21 16:23:21

STEMI Expert?

  • Click here to find out!
  • 12-Lead ECG Challenge Smartphone App

    Photobucket

    12-Lead ECG Challenge Smartphone App - $5.99

  • Apple iOS
  • Android
  • Amazon
  • Web Based

  • FRN-TV video review
  • iMedicalApps.com review
  • Interested in resuscitation?

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    Visitor Map / Stats

    Locations of visitors to this page


    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS