STEMI Imitators for EMS and Episode 196
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Welcome to Episode 196
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NSW Widow and Ambulance Response Time
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EMS News—
ALS vs. BLS Cost vs Benefit Discussion
Budget Cuts for EMS in Alabama Regions
Washington, D.C. Medical Director Steps Down
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Tip This Week — False Positives for STEMIs
Paramedics and medics (EMT-I) treating cardiac patients in the field are often taught to look for and diagnose S-T elevation myocardial infarctions (STEMI) in the field. EMS providers do this using their heart monitors and performing a 12-lead electro cardiogram (ECG) as well as adding in information from physical assessment and patient history.
With more awareness about STEMI recognition and treatment, some cardiac centers are noticing a larger number of “false positive” STEMI patients coming in to their cath labs. The question is now being asked, are we ruling out STEMI imitators carefully enough in the field and in community hospitals. I add the local hospitals because the local ER docs may make the same mistaken diagnosis based on presentation and ECG evidence, too (based on evidence from one article linked below).
The two easiest STEMI imitators are the bundle branch blocks. Left bundle branch blocks almost always present with an S-T segment elevation, and while Right bundle branch blocks usually present with S-T segment depression, this may not always be the case. Bundle branch blocks are most easily identified by the presence of a wide QRS segment (greater than .17 seconds). While any patient presenting with symptoms of MI including chest pain, shortness of breathe, diaphoresis, and other signs of shock who has a wide complex QRS segment on their ECG with ST Elevation MIGHT indeed be having an MI – the ECG S-T segment is not diagnostic for this and your system may have to rely on cardiac markers in the blood tests to make a decision.
Other typical STEMI imitators include Left Ventricular Hypertrophy, Pericarditis, and Ventricular Aneurysm. Follow the links below to several articles and resources on STEMI imitators and how paramedics and medics can better identify them in the field.
Listener Tom on STEMI imitators and 12 lead diagnosis
STEMI Team Approach and Diagnostics Transcript PDF
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Song this Week – Geoff Smith with “Some Huggin’ & Some Kissin’”
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Until next time, Scene safety, BSI!
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Comments on STEMI Imitators for EMS and Episode 196
Jamie,
Great idea on bringing conference speakers to your service instead of sending a few people to the conference. This can work especially well if several services collaborate for a joint training or help a speaker visit several units over several days. This helps spread out the cost.
Also remember there are a lot of experts close to home. You, me, and lots of our blogging/podcasting friends can help listeners find experts that are close to home that they may not even be aware.