{"id":9575,"date":"2024-04-18T11:12:44","date_gmt":"2024-04-18T18:12:44","guid":{"rendered":"https:\/\/dhs.lacounty.gov\/emergency-medical-services-agency\/?page_id=9575"},"modified":"2024-04-22T14:31:59","modified_gmt":"2024-04-22T21:31:59","slug":"emergency-medical-services-ecg-april-2024-issue","status":"publish","type":"page","link":"https:\/\/dhs.lacounty.gov\/emergency-medical-services-agency\/home\/emergi-press\/emergency-medical-services-ecg-april-2024-issue\/","title":{"rendered":"EMERGENCY MEDICAL SERVICES-ECG APRIL 2024 Issue"},"content":{"rendered":"

[vc_row][vc_column][vc_column_text]<\/p>\n

\n
\n

ECG OF THE MONTH- April 2024<\/strong><\/span><\/p>\n

Case Presentation: <\/strong><\/p>\n

Paramedics respond to a 42-year-old female with dizziness, chest tightness, and shortness of breath. Her symptoms started about 30 minutes prior to EMS arrival while she was jogging. Her spouse called 911 because she \u201cdidn\u2019t look right and seemed anxious.\u201d Initial vital signs on scene are BP:132\/61 HR: 95 RR: 20 SpO2: 99%.<\/p>\n<\/div>\n<\/div>\n

[\/vc_column_text][vc_tta_accordion][vc_tta_section title=”1. What is your interpretation of this ECG?<\/strong>” tab_id=”1713475303788-9fc56093-fb8a”][vc_column_text]\"\"<\/strong><\/p>\n

Rate:<\/strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 ~90 bpm<\/p>\n

Rhythm:<\/strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 Normal sinus rhythm. There is a p wave before every QRS complex.<\/p>\n

ST Segment Elevation >1mm
\n<\/strong>In 2 or more contiguous
\n<\/strong>Leads?<\/strong>\u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0 \u00a0No<\/p>\n

Ischemic Changes:<\/strong>\u00a0 \u00a0 \u00a0 ST depression and t-wave inversion in the anterior\/lateral leads (I, aVL, V2-V6).[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”2. Learn more about this ECG pattern<\/strong>” tab_id=”1713475243373-a0669f9e-521f”][vc_column_text]This ECG suggests myocardial ischemia. There are ST segment depressions and t-wave inversions in contiguous leads (lateral \u2013 I, aVL, V5, V6; anterior \u2013 V2-V4). Though not a STEMI, non-ST elevation acute coronary syndromes are cardiac emergencies that should be recognized by EMS clinicians. The patient is experiencing ischemia to the heart and requires emergent inpatient hospital management.<\/p>\n

Acute coronary syndrome is a catch all term that refers to syndromes resulting from acute blockage (\u201cocclusion\u201d) of coronary vessels. Prehospital clinicians often focus on recognizing STEMI, because this determines destination routing to a SRC for emergency cardiac catheterization. Patients can have myocardial infarction (\u201cheart attacks\u201d) that do not have ST elevation, known as non-ST Elevation Myocardial Infarction (NSTEMI). These patients typically \u201crule in\u201d for a myocardial infarction with emergency department laboratory studies (i.e. troponin). While patients with NSTEMI do not go to the cardiac catheterization lab immediately like STEMI patients, they typically require medical management and cardiac catheterization during their hospital admission.<\/p>\n

\"\"
\nFigure 1. Examples of ST segment depression in myocardial ischemia. Image Source: LITFL https:\/\/litfl.com\/wp-content\/uploads\/2018\/08\/ST-segment-morphology-in-myocardial-ischaemia%EF%BB%BF.jpg<\/a><\/u> accessed 3\/25\/2024[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”3. How would you manage this patient in the field?<\/strong>” tab_id=”1713475325073-8a578255-6853″][vc_column_text]This patient\u2019s ECG shows signs of cardiac ischemia. Cardiac ischemia\/infarction symptoms can present atypically, especially in women. Although this patient does not explicitly describe chest \u201cpain\u201d her dizziness, chest \u201ctightness\u201d and shortness of breath are cardiac symptoms. Chest Pain \u2013 Suspected Cardiac is the provider impression and the patient should be managed in accordance with TP \u2013 1211 \u2013 Cardiac Chest Pain<\/u><\/a>.[\/vc_column_text][\/vc_tta_section][vc_tta_section title=”4. ECG Case follow up:<\/strong>” tab_id=”1713463097812-0c983760-306b”][vc_column_text]The patient is not hypoxic and does not require supplemental oxygen. ASA 325mg chewable is administered as well as Nitroglycerin 0.4mg SL which improves her pain. She is not a STEMI, so her destination is the MAR. Her evaluation in the emergency department reveals an elevated troponin that rules her in for a NSTEMI. She is admitted to the cardiology service where she receives a cardiac catheterization the next day.[\/vc_column_text][\/vc_tta_section][\/vc_tta_accordion][vc_column_text]<\/p>\n

\n

Author: Denise Whitfield, MD, MBA
\nReferences
\n1. Burns E, Cadogan M. Myocardial Ischaemia. https:\/\/litfl.com\/myocardial-ischaemia-ecg-library\/<\/u><\/a>. Accessed 3\/25\/24.[\/vc_column_text][\/vc_column][\/vc_row]<\/p>\n<\/div>","protected":false},"excerpt":{"rendered":"

[vc_row][vc_column][vc_column_text] ECG OF THE MONTH- April 2024 Case Presentation: Paramedics respond to a 42-year-old female with dizziness, chest tightness, and shortness of breath. Her symptoms started about 30 minutes prior to EMS arrival while she was jogging. Her spouse called 911 because she \u201cdidn\u2019t look right and seemed anxious.\u201d Initial vital signs on scene are […]<\/p>\n","protected":false},"author":39,"featured_media":0,"parent":704,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-templates\/template-basic-page.php","meta":{"_oasis_is_in_workflow":0,"_oasis_original":0,"_monsterinsights_skip_tracking":false,"_monsterinsights_sitenote_active":false,"_monsterinsights_sitenote_note":"","_monsterinsights_sitenote_category":0,"footnotes":"","_links_to":"","_links_to_target":""},"categories":[],"tags":[],"class_list":["post-9575","page","type-page","status-publish","hentry"],"yoast_head":"\nEMERGENCY MEDICAL SERVICES-ECG APRIL 2024 Issue - Emergency Medical Services Agency<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/dhs.lacounty.gov\/emergency-medical-services-agency\/home\/emergi-press\/emergency-medical-services-ecg-april-2024-issue\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"EMERGENCY MEDICAL SERVICES-ECG APRIL 2024 Issue - Emergency Medical Services Agency\" \/>\n<meta property=\"og:description\" content=\"[vc_row][vc_column][vc_column_text] ECG OF THE MONTH- April 2024 Case Presentation: Paramedics respond to a 42-year-old female with dizziness, chest tightness, and shortness of breath. 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