Whadda u think?

[gotbeerz001]

Pic removed for editing... Post again later

 

[Angel]

im biting my finger nails in anticipation.

 

[gotbeerz001]

im biting my finger nails in anticipation.

Derp.

 

[gotbeerz001]

I think I see a little bit of elevation in V2....

 

[gotbeerz001]

.....

 

[STXmedic]

I think I see a little bit of a LBBB with tremendous S waves in V2...

 

[Angel]

Ummm.....

 

[zzyzx]

Was the patient even having chest pain?

 

[gotbeerz001]

Significant distress. He was in the cath lab in short order.

 

[zzyzx]

I would say that this is one of those ECG's that is concerning, but that outside of the hospital we can't determine if it's a truly STEMI or not. The BBB makes is really hard to read, and we don't have an old ECG to see if this is a new BBB. However, in my opinion something like this is also pretty simple. If the guy is having chest pain, looks sick, and has a concerning ECG, just take him to the hospital with the cath lab.

 

[STXmedic]

He certainly meets Sgarbossa criteria for >5mm in any lead, but that's the least sensitive of the three criteria. It's difficult to determine whether or not he meets Dr. Smith's modified criteria, which increases the specificity. At ~17mm elevation, I wouldn't be surprised though.

 

[gotbeerz001]

I would say that this is one of those ECG's that is concerning, but that outside of the hospital we can't determine if it's a truly STEMI or not. The BBB makes is really hard to read, and we don't have an old ECG to see if this is a new BBB. However, in my opinion something like this is also pretty simple. If the guy is having chest pain, looks sick, and has a concerning ECG, just take him to the hospital with the cath lab.

It met every criteria I needed to see to justify C3 STEMI activation in about 3 seconds. I had 3 more strips a few minutes apart all with same (or even more extreme tracings).

I initially posted it with a hint of sarcasm since the values were so extreme. [emoji482]

 

[STXmedic]

What criteria must you meet to declare a STEMI alert?

 

[gotbeerz001]

Generally Sgarbossa is followed. We will call it if the machine determines it as such (liability). Take imposters into consideration. Transmit to receiving hospital for verification.

Simply put, based on pt presentation and 12L, this was a no-brainer.

 

[STXmedic]

We need ACS symptoms plus STE in two contiguous leads, in the absence of LBBB. So we can't activate off of Sgarbossa. I'd have to run that guy in as P1 CP.

 

[johnrsemt]

I think I would take him to the hospital even if he was NOT having chest pain. and probably alert the Cath lab too

 

[teedubbyaw]

We need ACS symptoms plus STE in two contiguous leads, in the absence of LBBB. So we can't activate off of Sgarbossa. I'd have to run that guy in as P1 CP.

You can't use your own discretion on that? We have the same protocol, but it's providers discretion if MI is suspected.

 

[STXmedic]

You can't use your own discretion on that? We have the same protocol, but it's providers discretion if MI is suspected.

I could probably declare a Heart Alert and they'd activate (since they just go off what we tell them- we don't have to transmit). I'd get a pretty good talking to if I was wrong. Then again, I think they'd expect nothing less with my history... Lol