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STEMI

I almost always enjoy working with medics, and this past Sunday was no exception. I’ve been entertaining the idea of going to paramedic school prior to medical school, and with that thought in mind I have been studying a bit of ECG interpretation along with the ALS protocols for my city.

The call came over as chest pain, and we responded with lights and sirens through the melting snow to a Russian neighborhood a few miles away. Carrying up the lifepak12, I was thankful that the elevator was big enough for the stretcher, and then not so thankful when the apartment’s hallway was too tight for it. Oh well.

We walk into the bedroom and find a 62-year-old Russian male with his eyes closed and a tight-lipped grimace across his face. He doesn’t speak much English, but luckily his wife does, and we get by on a little of our own.

“Serdsuh balit?” (ignore my terrible Russian spelling, this is roughly how it sounds though).. which translates to “chest pain?”

“Da.. Da” … “yes, yes”

I quickly begin attaching a BP cuff, pulse oximeter, and electrodes for a 3-lead ECG while the medic continues asking questions and gets ready to start a line (IV). The story goes that this gentlemen was out shoveling snow (we got pounded by the snow storm the previous day) and began getting crushing chest pain along with weakness, and his wife made him come back inside where they called us. A classic shoveling snow story, perfect.

I have the 3-lead by now, and it shows some ST elevations in lead I, with depressions in lead III. The medic gives him aspirin, and his blood pressure comes back elevated (around 158/90), so he also gets some nitroglycerin (no relief for his symptoms though). Time for a better look at his heart, and we setup a 12-lead. This is what we see:

ST elevations in precordial leads V2-V6… this guy is definitely having an acute anterolateral MI (a heart attack centered around front-left portion of his heart). In addition, he was bradycardic (the ECG shown was a repeat 12-lead done later), around 48-54 bpm and so I suggested giving atropine enroute, the medic agreed. As we were leaving we called a notification to the closest hospital, informing them we had a STEMI patient. STEMI stands for ST Elevation Myocardial Infarction, which refers to a specific type of heart attack. The atropine brought up his rate some, but not by much, and we were to the hospital 3 minutes later where we arrived to find… essentially no one waiting for us. For those that don’t know, a STEMI patient is top-priority and even minutes can mean lost heart muscle.

We quickly found the doctor that was supposed to receive us, explained we suspected an anterolateral STEMI, and then told the story of how he felt chest pain while shoveling snow. For some reason, the words “shoveling snow” made her jump into action, and we were quickly brought into the cardiac room. They performed their own 12-lead, and I soon overheard the doctor on the phone with the cardiologist saying the words “anterolateral MI”, which gave me much satisfaction as just a lowly EMT. All-in-all, it was a pretty good call, with a fast response by us and a mildly delayed, but effective response by the hospital.

Oh, and for any medics that might be reading this and are wondering why we didn’t give morphine, it was simply because morphine is not a standing order for us, and we were literally 5 minutes from the hospital. It’s very unlikely telemetry would have given approval with our short transport time, and the patient was given morphine within 3 minutes of arriving in the ED along with a slough of other drugs.

Moral of the story, I definitely want to be a medic.

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Categories: EMT
  1. medical student
    May 31, 2011 at 3:20 am

    Did you do the 3-lead en route? Because if you sat there waiting to do an EKG in the apt (which probably took what 10-15 minutes before you got him to the stretcher to get on the bus), he lost more heart muscle from that than the doc waiting for you to tell her he was “shoveling snow”… haha

    • NYEMT
      May 31, 2011 at 7:27 am

      Protocol in most areas, including NYC is to perform a 3 lead and 12 lead on scene for anyone experiencing chest pain. 10-15 minutes? I think you must be joking, it takes under 60 seconds to place electrodes, and exactly 30 seconds from the time you press “12-lead” on the monitor to the time
      it has printed and been transmitted to the receiving facility. So, more like 2-3 minutes of time to perform a 12 lead in a stable environment (12’s in a moving ambulance often don’t look very good). I do enjoy your assumption that we made a mistake by doing the ECG on scene though, goes to show what little doctors generally know about EMS.

  2. medical student
    May 31, 2011 at 4:03 pm

    I think the assumptions go both ways (see your judgments on docs/nurses in your other posts)… But you’re right, unless docs are EMT’s/Medics before med school, they get little, if any, exposure to your field.

    Didn’t think about the “moving” ambulance, minor detail, haha…. And I also didn’t know the EKG’s can be sent ahead to the hospital (duh, guess I just worked in a backwoods ER in Texas). That makes it pretty helpful actually, then the doc potentially can be ready to make a diagnosis and get the orders rolling before you even arrive with the pt.

    Thanks for the info!

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