Interesting ECG that got me....

[Clare]

02 for STEMI is verboten here unless they are de-saturated

Same here, oxygen in general is absolutely contraindicated in all patients unless there is an indication for it. We have had it smashed into us over and over that we must not give oxygen unless there is clinical evidence of hypoxaemia; particularly in those patients with stroke and myocardial ischaemia.

I have almost seen a crew dukeing it out over their positions on giving oxygen; one pro and one against; it was like .... damn guys its just bloody oxygen, chill!

 

[Fish]

I am responding to this thread without reading the other responses so that my interpretation is not biased.


I see LVH, with lateral Ischemia. No STEMI seen here, ACS patient. Treat with a normal chest pain protocol, and show your findings on the ECG to the receiving ER Doc.


Now on to read the other responses to see what others thought

 

[Handsome Robb]

02 for STEMI is verboten here unless they are de-saturated

Same here, oxygen in general is absolutely contraindicated in all patients unless there is an indication for it. We have had it smashed into us over and over that we must not give oxygen unless there is clinical evidence of hypoxaemia; particularly in those patients with stroke and myocardial ischaemia.

I have almost seen a crew dukeing it out over their positions on giving oxygen; one pro and one against; it was like .... damn guys its just bloody oxygen, chill!

I agree that not everyone needs oxygen. The two patients I've activated on, this one and one that was a very obvious inferior MI both were brought in on a nasal cannula by yours truly.

Unfortunately, even if they're at 100% I still have to give o2, the way our protocol is written. Most all say "Assess oxygenation and administer O2 as needed". Our ACS and Stroke protocol both say "Assess oxygenation and administer O2", takes the option of withholding it away from us.

With that said, this thread is about ECG interp, so no more O2 arguments por favor

Had another pair of borderline ones today. 92 year old with nonspecific chest pain and SOB with rhales bilaterally. LBBB on the 12 and both her and her son were very adamant she had a "perfect EKG" last week. I called a doc and we deferred the activation due to her age and the fact that neither of us thought it was a STEMI.

Second one was a syncopal with weakness as a primary complaint, 84 year old female denied any Hx, allergies or medications...take that for what it's worth... V1 and 2 had 1.5mm STE, no reciprocal changes though, she also had a "perfect" ECG not too long ago per her, her son and her daughter. Had been seeing a cardiologist because of new pedal edema She adamantly AMAd and went POV.

These borderline 12-leads are making my head spin.

 

[Christopher]

Had another pair of borderline ones today. 92 year old with nonspecific chest pain and SOB with rhales bilaterally. LBBB on the 12 and both her and her son were very adamant she had a "perfect EKG" last week. I called a doc and we deferred the activation due to her age and the fact that neither of us thought it was a STEMI.

New or suspected new LBBB is not a STEMI equivalent. So no need to fret over activation. LBBB with primary changes is, however, a STEMI equivalent.

Second one was a syncopal with weakness as a primary complaint, 84 year old female denied any Hx, allergies or medications...take that for what it's worth... V1 and 2 had 1.5mm STE, no reciprocal changes though, she also had a "perfect" ECG not too long ago per her, her son and her daughter. Had been seeing a cardiologist because of new pedal edema She adamantly AMAd and went POV.

V1 and V2 can have ST-elevation normally, at 84yo it is less likely to be normal, but what you're describing might be Left Ventricular Aneurysm (LVA).

These borderline 12-leads are making my head spin.

Highly functioning systems haven't replaced us with machines because there is such a large gray area in ECG interpretation.