Remove Circulation Remove Dysrhythmia Remove STEMI
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Severe shock, obtunded, and a diagnostic prehospital ECG. Also: How did this happen?

Dr. Smith's ECG Blog

to greatly decrease risk (although in STEMI, the optimal level is about 4.0-4.5 mEq of K pushed fast and circulated theoretically would raise serum K immediately by 1.0 I could find very little literature on the treatment of severe life-threatening hypokalemia. If the patient is at 1.8, that will raise it to 5.1 mEq/L, from 1.9

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An athletic 30-something woman with acute substernal chest pressure

Dr. Smith's ECG Blog

It is equivalent to a transient STEMI. Now you have ECG and troponin evidence of ischemia, AND ventricular dysrhythmia, which means this is NOT a stable ACS. Circulation. Circulation, 137(19), p.e523. If you would not have activated the cath lab based on the first ECG, you really should strongly think about it now.

SCAD 52
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A man in his 70s with weakness and syncope

Dr. Smith's ECG Blog

A prior ECG from 1 month ago was available: The presentation ECG was interpreted as STEMI and the patient was transferred emergently to the nearest PCI center. There were no dysrhythmias on cardiac monitor during observation. Circulation, 117, 1890–1893. [3]: So maybe she is better than I am. Is there fever again?

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Diffuse Subendocardial Ischemia on the ECG. Left main? 3-vessel disease? No!

Dr. Smith's ECG Blog

Clinical Course The paramedic activated a “Code STEMI” alert and transported the patient nearly 50 miles to the closest tertiary medical center. 2 The astute paramedic recognized this possibility and announced a CODE STEMI. Circulation. Circulation 67, No. Circulation 1970;41:623-627 9. What do you see?

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Hyperthermia and ST Elevation

Dr. Smith's ECG Blog

2) The STE in V1 and V2 has an R'-wave and downsloping ST segments, very atypical for STEMI. Cardiology was consulted and they agreed that the EKG had an atypical morphology for STEMI and did not activate the cath lab. Circulation, 117, 1890–1893. [3]: See additional image at the bottom of this post. Bicarb 20, Lactate 4.2,