Three EKGs shown to me - which if any need emergent reperfusion?

Written by Pendell MeyersWe commonly get feedback from readers who are skeptical that we can pick out the subtle NSTEMI occlusions from the endless onslaught of triage/EMS EKGs. Some believe that one cannot learn to pick out subtle true positive STE or hyperacute T-waves without sacrificing specificity.We see countless EKGs constantly (as do all EM physicians) plus more because other providers constantly send us EKGs in addition. I see countless abnormal-looking EKGs to which I respond " I don ' t see any evidence of occlusion " , and only a tiny percentage of diagnostic EKGs among those shown to me.So take a look at these three EKGs I was shown during a single shift the other day. Imagine how you would handle these and see if you think it ' s impossible to differentiate the few OMIs from the countless abnormal but meaningless EKGs.The only information I had in all three cases was a middle aged patient with chest pain. I could not see or evaluate the patient at the time of making the EMS/triage decisions (to activate the cath lab or not). Here they are:ECG#1:ECG#2:ECG#3:What would you say in each of these cases brought to you in the middle of your shift?My responses: #1 I suspect false positive ST elevation, do not activate the lab, and please get a 12-lead on a machine that does not cut off the QRS voltage so we can see the true ratios of QRS and ST deviations. Clear J-waves and typical morphology make BER extremely likely.#2 STEMI equivalent because of hyp...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs