Chest pain and implications for EMS. Review the history, physical and treatment of chest pain. Learn the most important causes of chest pain in the EMS setting and see great EKG examples of MI and the EKG mimics of cardiac ischemia.

1. Chest Pain EMS Implications Wayne Guerra MD, MBA Porter/Littleton/Parker Adventist EMS Pain is inevitable; suffering is optional.

2. Before I refuse to take your questions, I have an opening statement. Ronald Reagan Wayne Guerra MD, MBA

4. The Father of Medicine patient confidentiality physicians record their findings and their medicinal methods rejected the superstition and magic 460 BC to 380 BC Wayne Guerra MD, MBA

6. www.iTriageHealth.com Wayne Guerra MD, MBA Differential Diagnosis of Chest Pain is Vast

16. BP Discrepancy http://bit.ly/hkAZE Wayne Guerra MD, MBA

17. Diagnostics Wayne Guerra MD, MBA

18. EKG Get One You Can Read! Wayne Guerra MD, MBA

23. Early Repolarization Wayne Guerra MD, MBA

24. Acute Pericarditis PR depression ST Elevation Wayne Guerra MD, MBA

25. LV Aneurysm Wayne Guerra MD, MBA

26. EKG Changes: Mimics of MI Dave Sanko: ACS and 12 Lead Review Wayne Guerra MD, MBA ECG Finding Acute Pericarditis Myocardial Infarction Early Repolarization ST-segment shape Concave upward Convex upward Concave upward Q waves Absent Present Absent Reciprocal ST-segment changes Absent Present Absent Location of ST-segment elevation Limb and precordial leads Area of involved artery Precordial leads ST/T ratio in lead V6 >0.25 N/A <0.25 Loss of R-wave voltage Absent Present Absent PR-segment depression Present Absent Absent

27. AMI 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 Dave Sanko: ACS and 12 Lead Review Wayne Guerra MD, MBA

28. Acute Anterior MI Wayne Guerra MD, MBA

29. Acute Ant-Lat MI Wayne Guerra MD, MBA

30. Acute Inferior MI Wayne Guerra MD, MBA

31. Acute Posterior MI http://bit.ly/2Klwk2 Wayne Guerra MD, MBA

32. Acute Right Ventricular MI Wayne Guerra MD, MBA

33. Cardiac Alert Wayne Guerra MD, MBA

40. S1Q3T3 Wayne Guerra MD, MBA

51. Wayne Guerra MD, MBA

53. Case 1 Wayne Guerra MD, MBA

54. Case 1: EKG After 1 NTG Diagnosis? Wayne Guerra MD, MBA

57. EKG with CP Wayne Guerra MD, MBA

58. Pain Free After 1 NTG Diagnosis? Wayne Guerra MD, MBA

60. Wayne Guerra MD, MBA