EMS 12-Lead

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review by Dr. Stephen Smith @SmithECGBlog CASE My colleagues and I responded to a 49 y/o Male who called 911 after experiencing new onset chest discomfort that forced him to pull over while driving. At the time of initial contact, he expressed symptom alleviation and felt that Fire/EMS services were no longer necessary. He at least agreed to a full examination in the ambulance and stated that

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW Peer review with commentary by Dr. Stephen Smith CASE An adult male calls 911 for new onset central chest discomfort (approximately 20 minutes duration at the time of EMS activation) that radiates to the back. Paramedics find him uncomfortable and clammy with 9/10 pain severity. His blood pressure is 162/104. HLD is the only medical history disclosed. This is the time-zero ECG at 2206 hours. V2-V5

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW UPDATE: Dr Stephen Smith has kindly shared with me the latest research into descriptive analysis of the Hyperacute T wave. His comments are provided at the end of the post. CASE A 46 y/o Female experiences sudden onset chest pressure while kickboxing. There is associated diaphoresis, nausea, and one episode of vomiting. Personal medical history is unremarkable, and she does not take any prescriptio

David Didlake Firefighter / Paramedic Acute Care Nurse Practitioner @DidlakeDW The below ECG is an example of a patently obvious pre-hospital Cath activation. It is undeniable. There is simply no room for ambiguity. And this is where conventional STEMI criteria offers some diagnostic utility -- its specificity. That is, when certain criteria is present, odds are that it can be no other than the pathology in question. Marriott would classify this ECG as Grade II Sclarovsky-Bir