Tag Archives: STEMI

53 year old female CC: Chest discomfort and shortness of breath

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Here’s an awesome case submitted by Nathan Stanaway of Grady EMS in Atlanta, GA. The patient is a 53 year old female c/o chest discomfort and mild dyspnea. The pain is described as “severe” and she gives the pain a 10/10. Past medical history is significant for migraine headaches and anxiety. Patient is a poor […]

58 year old male CC: Chest discomfort

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Here’s another case from a faithful reader who wishes to remain anonymous. No, these are not all from the same anonymous reader! EMS responds to a 58 year old male complaining of chest discomfort. Onset: 30 min ago while mopping hot tar on roof Provoke: Nothing makes the pain better or worse Quality: Dull pressure […]

Are all STEMI patients the same?

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When it comes to regionalized STEMI care, we treat all STEMI patients the same. But are they the same? The answer is, "No!" Most EMS protocols include a maximum ground transport time of 30-60 when bypassing non-PCI hospitals (AHA Mission: Lifeline calls them "STEMI Referral Hospitals"). The idea is that when the "first medical contact-to-balloon" […]

77 year old male CC: Palpitations

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EMS is called to the residence of a 77 year old male complaining of palpitations. Upon arrival, paramedics find the patient lying in bed. He is awake but lethargic. He is oriented to person, place, and time. The patient’s skin is cool, pale, and diaphoretic. He admits to chest discomfort and mild shortness of breath. […]

66 year old male CC: Chest pain

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EMS is called to the parking lot of a local fast food restaurant for a 66 year old male complaining of chest pain. On arrival, the patient appears acutely ill. His skin is pale/ashen but dry. He is rubbing his chest and there is a grimace on his face. He is not conversant but he […]

54 year old male CC: Chest pain

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EMS is called to the doctor’s office to evaluate a 54 year old male complaining of chest pain. On arrival, the patient is alert and oriented to person, place, time, and event. However, he is anxious and his skin is pale and diaphoretic. He is on oxygen via NC @ 4 LPM. An IV has […]

12-Lead ECG Case Studies

My department is starting a 12-lead ECG “case of the month” as part of our continuing education. Each month, I will select an ECG that was transmitted from the field and resulted in a cath lab activation. Whenever possible, I will include the “before” and “after” angiograms so that the paramedics receive feedback about the […]

What's the heart rhythm?

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You are called to the residence of 85 year old male complaining of chest discomfort. Note: The details of the history and clinical presentation have been lost. The cardiac monitor is attached. What's your interpretation of this ECG? *** UPDATE *** Some very interesting comments so far…. Let's see if a review of the 12 […]

Prehospital 12 lead ECG programs

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I posted this series of questions today at JEMS Connect. Please feel free to respond here or there. Does your service perform prehospital 12 lead ECGs? Does the prehospital 12 lead ECG help determine your transport destination? Is the cath lab activated based on the prehospital 12 lead ECG? Does your program rely on the […]

If time is muscle, what's taking so long?

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That’s that tag line of a tremendous article that appeared in the March 2007 issue of Emergency Medical Services entitled Out-of-Hospital STEMI Alert by David Jaslow, MD, MPH, EMT-P, FAAEM. I think the tag line sums up the frustration many of us “STEMI activists” feel when our prehospital 12 lead ECG programs flounder. Here are […]

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