Prehospital electrocardiogram shortens ischaemic time in patients with ST-segment elevation myocardial infarction.

This study evaluated whether prehospital 12-lead electrocardiogram (ECG) could shorten system delay in STEMI management. METHODS: From November 2015 to November 2017, 15 ambulances equipped with X Series Monitor/ Defibrillator (Zoll Medical Corporation) were used in the catchment area of Queen Mary Hospital, Hong Kong. Prehospital ECG was performed for patients with chest pain; the data were tele-transmitted to attending emergency physicians at the Accident and Emergency Department (AED) for rapid assessment. Data from patients with STEMI who were transported by these 15 ambulances were compared with data from patients with STEMI who were transported by ambulances without prehospital ECG or who used self-arranged transport. RESULTS: Data were analysed from 197 patients with STEMI. The median patient delay for activation of the emergency response system was 90 minutes; 12% of patients experienced a delay of>12 hours. There was a significant difference in delay between patients transported by ambulance and those who used self-arranged transport (P
Source: Hong Kong Medical Journal - Category: General Medicine Tags: Hong Kong Med J Source Type: research

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CONCLUSION: As reimbursement for emergency medicine in Germany was recently rearranged, quality benchmarking has gained incremental importance. Mandatory joint quality measurement in both concepts ensuring gap analysis and process improvement is encouraged. PMID: 31970463 [PubMed - as supplied by publisher]
Source: Herz - Category: Cardiology Tags: Herz Source Type: research
ConclusionManagement of pulmonary embolism in our cardiology department is characterized by the frequent use of non-invasive techniques on the diagnostic view and appeal to heparin on the therapeutic view.
Source: Archives of Cardiovascular Diseases Supplements - Category: Cardiology Source Type: research
CONCLUSIONS: LA is a safe and effective tool in HoFH subjects even in pregnancy. Evidence based guidelines for the management of these patients during pregnancy are still lacking. PMID: 31818440 [PubMed - in process]
Source: Atherosclerosis Supplements - Category: Cardiology Authors: Tags: Atheroscler Suppl Source Type: research
ConclusionsThe prevalence of AHF protocols is rather high but the contents seem to vary. Difficulty of diagnosing suspected AHF seems to be moderate compared with other pre ‐hospital conditions.
Source: ESC Heart Failure - Category: Cardiology Authors: Tags: Original Research Article Source Type: research
Post by Smith and MeyersSam Ghali (https://twitter.com/EM_RESUS) just asked me (Smith):" Steve, do left main coronary artery *occlusions* (actual ones with transmural ischemia) have ST Depression or ST Elevation in aVR? "Smith and Meyers answer:First, LM occlusion is uncommon in the ED because most of these die before they can get a 12-lead recorded.But if they do present:The very common presentation of diffuse STD with reciprocal STE in aVR is NOT left main occlusion, though it might be due to subtotal LM ACS, but is much more often due to non-ACS conditions, especially demand ischemia. ...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
Publication date: Available online 24 June 2019Source: Journal of Cardiology CasesAuthor(s): Hiroki Okabe, Shinjo Sonoda, Koji Abe, Hideki Doi, Toshiyuki Matsumura, Yutaka OtsujiAbstractA 59-year-old female was brought to our emergency room with severe chest pain. Based on the electrocardiogram (ECG) and echocardiography, an acute coronary syndrome (ACS) was suspected. Her initial ECG showed ST elevation in the inferior leads (II, III, and aVF), which had progressed to involve the anterior leads (V2-V4) by the time she was shifted to the catheterization room. A coronary angiogram revealed total occlusion of the mid-left an...
Source: Journal of Cardiology Cases - Category: Cardiology Source Type: research
Written by Pendell MeyersA male in his 60s with no known past medical history presented at midnight with chest pain over the past 3 hours. The pain started just after eating, and at first he thought it was " reflux, " however he decided to call 911 after a few hours when it did not improve.Here is his presenting ECG:What do you think?Here are the relevant findings:Slight STE in V12.5 mm STE in V2Slight STD in V4-V6Definite STD in II, III, and aVFHyperacute T-waves in V2, and likely also in aVLThese findings are highly specific for LAD occlusion. We have many cases of this pattern on this blog, involving STE and h...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
A patient with DM presented with acute chest pain.Here was his ED ECG:There isLVH in limb leads, with a 17 mm R-wave in aVL, and deep S-wave in inferior leads.With this much voltage, one expects some repolarization abnormalities.Indeed, there is a bit of ST depression in aVL (discordant to the tall R-wave) that does not appear to be out of proportion.There is inferior ST Elevation, but the S-waves are also of high voltage.Is this an inferior STEMI?  Or is the LVH with expected repolarization abnormalities? There is also some ST depression in V2.  Possible posterior involvement?CommentTo me, the inferior ST E...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
This study aims at investigating the still poorly clear pathogenesis of migraine and the potential role of anti-CGRP mAbs in the scenario of prophylaxis of migraine. Introduction: Migraine Clinic Migraine consists in unilateral headache accompanied by a cluster of other sensory, autonomic and cognitive symptoms and it has been identified by the global burden of disease (GBD) study 2016 as the sixth most prevalent disorder and one of the main causes of disability all over the world, often occuring in working age and in young adult and middle-aged women (Collaborators, 2018). Hence, migraine represents a very serious...
Source: Frontiers in Pharmacology - Category: Drugs & Pharmacology Source Type: research
This ECG was presented in a conference.The patient had presented many times for SOB.  On this occasion he was intubated for respiratory failure due to presumed asthma.I was asked to interpret his ECG in the conference.  I had never seen it before.ECG-1:What do you think I said?Here is the computer interpretation:This is what I said: " This is diagnostic of an acute inferior MI.  There is upsloping ST elevation in III, with reciprocal ST depression in aVL.  You do NOT see this in normal variant STE, nor in pericarditis.  The only time you see this without ischemia is when there is an abnor...
Source: Dr. Smith's ECG Blog - Category: Cardiology Authors: Source Type: blogs
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