STEMI Mimic?

[Summit]

We typically dont get follow up information on pt's. Especially when taken to main STEMI Centers outside of our area unfortunately.

Always a challenge for EMS, but this would be a great ask of your agency educator or that facilities EMS coordinator: can we get some follow up for edu purposes?

 

[Tigger]

Like I said above, it's not a STEMI, I described my reasons why above (https://www.emtlife.com/threads/stemi-mimic.48053/#post-681280). That's OK. Nobody is going to knock you for doing what you think was right and trying to follow your protocols.

There is the patient's baseline and then your baseline that you took. If you do serial 12-leads, you can see if the next 12-lead deviates from the baseline set that YOU took.

When you put the patient on the monitor, either a 3-lead or 4-lead, it is usually called "monitor mode". When you do a 12-lead, it is usually called "diagnostic mode". They use different filters that can hide, create, or reveal ST changes. It is possible to put the patient on the 3 or 4 lead, see ST changes, but for those ST changes to go away when you do a 12-lead. At the same time, it is possibly to put the patient on the 3 or 4 lead, not see ST changes, but for ST changes to be revealed when you do a 12-lead. Usually though, if there is ST elevation or lack of, it'll be the same for the 12-lead. It's possible for there to be a difference in diagnostic and monitor mode, something important to note, but it is not usually the case. Christopher Watford wrote all about it here http://ems12lead.com/2014/03/10/understanding-ecg-filtering/, but most of it goes above my head.

It is quite common for 4 lead EKGs to appear to be STEMIs and then be completely gone when placed in diagnostic mode, I feel like this happens at least once a month for me.

I dont entirely understand your statement.......I dont know what her "normal" ekg looks like.....Just what i took on scene and followed protocol and my best judgement as a new medic.

I didnt see any evolvement of st elevation because the 12 leads were taken minutes apart or less....

Taking 12-leads minutes apart is probably not particularly clinically useful. Taking them every 15 minutes or so certainly could be but I would not expect changes to manifest over the course of a few minutes. I suppose it is possible though.

The point that I trying to make: When I am confronted with a suspicious EKG, one of the things that helps me decide whether or not it is a STEMI is the presence of evolving changes. If I witness no changes to their EKG and the patient does not have a story suggestive of ACS (among other factors), I am less , but not completely unlikely to consider it a STEMI and everything that comes with it. I am not saying "treat the patient not the monitor" but rather consider the whole picture and remember that are many STEMI mimickers. Most mimickers will not prevent with changes in serial EKGs.

 

[mrhunt]

Im in the habit of taking Serial 12 leads cause we often have **STEMI ALERT** Popup on our monitors without it being a stemi AT ALL......and we have to adjust leads slightly or just keep re-running them to get the message to go away....So thats sorta my way of eliminating the "error" portion of it....

despite no pain, She's had multiple MI's and Pt stated "i feel exactly like im having another one" .......Extremely weak out of pt's baseline (ive ran on her before) and Nausea.... So i feel like there was SOMETHING there.....And signinifcant history.

 

[Tigger]

Im in the habit of taking Serial 12 leads cause we often have **STEMI ALERT** Popup on our monitors without it being a stemi AT ALL......and we have to adjust leads slightly or just keep re-running them to get the message to go away....So thats sorta my way of eliminating the "error" portion of it....

despite no pain, She's had multiple MI's and Pt stated "i feel exactly like im having another one" .......Extremely weak out of pt's baseline (ive ran on her before) and Nausea.... So i feel like there was SOMETHING there.....And signinifcant history.

Yea that might change my outlook a little bit, the original scenario did not include this.

The monitor's interpretation can mean pretty much nothing. If it says STEMI and it isn't I just go on with my life. I won't try to make it go away, and re-arranging the leads sort of limits the effectiveness of serial EKGs.

 

[mrhunt]

Our stemi 12 leads are auto transmitted to all supervisors, management and up from there. So even if the monitor says stemi and it clearly isnt one its our companies policy to STILL to a physician consult to remove without any shadow of a doubt that were doing the right thing and not just ignoring a potential stemi just cause we dont see one. Liability sake i suppose.

Sometimes doing multiple 12 leads on this OBVIOUS fake stemi's will lead to the 3rd one having a totally different readout and we can continue to transport to the local facility instead of making a big deal out of it.......If that makes sense.

 

[Tigger]

Our stemi 12 leads are auto transmitted to all supervisors, management and up from there. So even if the monitor says stemi and it clearly isnt one its our companies policy to STILL to a physician consult to remove without any shadow of a doubt that were doing the right thing and not just ignoring a potential stemi just cause we dont see one. Liability sake i suppose.

Sometimes doing multiple 12 leads on this OBVIOUS fake stemi's will lead to the 3rd one having a totally different readout and we can continue to transport to the local facility instead of making a big deal out of it.......If that makes sense.

It does not make any sense, but I get it. You can't just change the policies.