This document provides information on STEMI, NSTEMI, and STEMI mimics for paramedics. It discusses the importance of accurate 12-lead ECG interpretation for identifying STEMIs to reduce door-to-balloon times and improve outcomes. It outlines criteria for calling a "Code STEMI" to activate the cardiac catheterization lab as well as situations where a "Medical Stat" or routine transport would be more appropriate based on the 12-lead findings. The goal is to minimize false STEMI activations while still rapidly identifying true STEMIs.
21. Cardiac Anatomy in Relation to Coronary Artery Right coronary artery Septal wall V 1 -V 2 Left anterior descending artery Anterior wall V 3 -V 4 Left main coronary artery Circumflex artery Lateral wall I, aVL, V 5 -V 6
22. Associations Between Changes on 12-Lead ECG and Cardiac Anatomy aVF inferior III inferior V 3 anterior V 6 lateral aVL lateral II inferior V 2 septal V 5 lateral aVR I lateral V 1 septal V 4 anterior
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24. Inferior MI Localization aVF inferior III inferior V 3 anterior V 6 lateral aVL lateral II inferior V 2 septal V 5 lateral aVR I lateral V 1 septal V 4 anterior
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27. Lateral MI Localization aVF inferior III inferior V 3 anterior V 6 lateral aVL lateral II inferior V 2 septal V 5 lateral aVR I lateral V 1 septal V 4 anterior
29. Septal MI Localization aVF inferior III inferior V 3 anterior V 6 lateral aVL lateral II inferior V 2 septal V 5 lateral aVR I lateral V 1 septal V 4 anterior
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31. Inferior MI Localization aVF inferior III inferior V 3 anterior V 6 lateral aVL lateral II inferior V 2 septal V 5 lateral aVR I lateral V 1 septal V 4 anterior
79. Key to this is Pre-Hospital Cardiac Triage And accurate 12 lead interpretation! DON’T TELL ANYONE, BUT EMS HAS BEEN DOING 12 LEADS FOR ALMOST 40 YEARS!!!
80. First field 12 lead Seattle Medic One Circa 1969
83. Time to Treatment in PCI (Nallamothu 2007 NEJM 357:1631) What this means: Beyond a D2B ≤90 Minutes… Every 15-minutes of Delay Mortality
84. Why the big push for PCI????? Better Outcomes, Lower Mortality, Less Complications
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87. Understanding the Intervals Onset of symptoms of STEMI 9-1-1 EMS dispatch EMS on-scene Call 9-1-1 Call fast ACP S2B: S/S Onset to Balloon E2B: EMS to Balloon C2B: Call to Balloon D2B: Door to Balloon Hospital B A L L O O N R2R: Recognition (12 lead) to Re-perfusion
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92. CODE STEMI is the “Level 1 Trauma” of the Cardiac World “Medical Stat” is the Level II and Level III
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94. CAN WE DO BETTER? (and what happens if we don’t???????)
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98. 3 Levels of Notification CODE STEMI Medical STAT Business as Usual Routine Radio report