OMI vs STEMI: Understanding Critical EKG Patterns in EMS (Part 2)

In this episode of The Erik and Matt Show, Dr. Erik Axene and Matt Ball continue to discuss the vital differences between Occlusive Myocardial Infarction (OMI) and STEMI, two critical conditions that can make the difference between life and death in pre-hospital care. While STEMI recognition has long been the standard, new research shows that focusing solely on STEMI could lead to missing up to 25% of heart attack patients. Tune in as Erik and Matt discuss essential EKG patterns and what every EMS provider needs to know to provide the best care possible.

Explore more EMS resources, training programs, and expert insights on our website: https://axenece.com

Transcript

Erik: [00:00:00] That's badness in a patient that looks, you know, it's that patient that looks like they're having a STEMI. Oh man. I shouldn't have said that.

Narrator: You are listening to EMS with your hosts, Eric Axene and Matt Ball. 

Matt: Let's get to it, man. All right. So in part one, we talked about this new, uh, I would say again, like we said in part one, the [00:00:30] pathophysiology has not changed in heart attacks. 

Erik: Right. 

Matt: Right. But it's not all about STEMIs. And so there's a new catchphrase terms, OMIs, occlusive myocardial infarctions.

And so why don't you go ahead and review what we talked about in part one. 

Erik: Yeah, so we talked a little bit about, like you said, the pathophysiology is unchanged. We're just wanting to recognize more. If you're only looking for STEMIs, you're missing, you know, up to 25 percent of this patient population.

It's super sick. So, to be at our [00:01:00] best to optimize the care we provide, we've got to be looking for other patterns. And so we wanted to cover those five patterns today. And we talked about the first two, um, is, uh, inferior MIs. We talked about how a two, three AVF, you're looking for elevation to meet classic STEMI criteria.

You have to have a certain amount of elevation, but what we were saying was any subtle elevation at all. In the context of what looks like it could be a STEMI, a sick patient, right? Um, any occlusion, [00:01:30] any elevation at all could indicate an occlusion in that inferior, that right sided coronary system. And is a pathophysiology of badness.

Right. And, uh, that's highly suggestive of, of something that's going to need the cath lab. 

Matt: Yeah. 

Erik: And, uh, so if we're only looking for that one or more millimeters of elevation in 2, 3 AVF, we're going to miss. 

Matt: Right. 

Erik: lesions that are highly suggestive of an occlusion of the coronary system. 

Matt: And it's important to note that it's lead placement is very [00:02:00] important.

Like make sure that your, your, your leads are stuck, right? Your placement is right. The patient's not moving. Cause I mean, you're talking about small little changes that if you're off could have those changes. Um, and the reason is that you said this in part one is the tissue size. The right side is not as muscular as the left side.

So you're not going to have as much, Amplitude as you would in the left side. 

Erik: Right. Well, we've all seen that tomb stoning, right? Yeah, exactly. That's pretty impressive. And to do that, to move that much, you gotta have a lot of muscle. So, you know, the right side could be [00:02:30] hypertrophied too, and it could have more muscle than it's supposed to have.

Yeah, 

Matt: but then that elevation is gonna be more prominent. Right. So that's gonna be easier to find. 

Erik: Yep. So we got two factors and we talk about this in our EKG basics to deflect the EKG leads on that paper. You need muscle with electricity in it. And then that's so the more muscle you have, the more the deflection, but then you also have to consider the lead.

How far away is the lead from the heart, right? Which is going to come into play later when we talk about another. [00:03:00] Yeah, I think that's three or four coming up. Yeah. So, um, that, that's a huge factor. So we talked about that. That was the first one. 

Matt: Yep, any inferior elevation, don't even have to have reciprocal changes, any inferior elevation should raise a red flag, forward it on, talk to a doctor, 

Erik: go from there.

And again, make sure you're following your protocols. Of course. And talk to your medical director, like we talked about. Talk to your FTO, your training division there for EMS, EMS chief, 

Matt: EMS captain, whoever. 

Erik: Maybe they need to adjust things. Talk to your hospital systems, ask these [00:03:30] questions, you know, hey, forward them this podcast, Dr.

Axine and Matt were talking about. Uh, this thing called an OMI and I'd never heard of it before and I learned a lot. Yeah, look, go look at the data. Go, we should put the link up for this. Is it data or data? I say data. You just said data, data, data, data. I'm so confused. I'm married to a Canadian. So my wife will say, Oh, I'm so sorry about that.

You know, 

Matt: she's going to love that. 

Erik: Oh, [00:04:00] I've had a friend. You had a shirt that said Canada. America's hat. And what he said, I 

Matt: love my kid. 

Erik: My dad's Canadian. My wife's Canadian. I've got tons of family up in lower mainland. Oh yeah. Yeah. So, uh, anyway, but they say words funny so that, I don't know. Like, my wife, we go to the grocery store.

It's not produce. I say produce. She says produce. It's not a laboratory. It's a laboratory. It's not a capillary. It's a capillary. I mean, there's some weird stuff [00:04:30] up there in Canada. Does she say aluminium? Yeah. She does not. Yeah, she does. She does not? Well, I mean, she's been Americanized now. Yeah, yeah, yeah.

She says aluminum, like say schedule? Well, she probably would have. Well, see, she grew up in, with a family from New Zealand too. So a lot of that. She's all over the map. Like the spelling, like honor is H O N O U R. 

Matt: Yeah, right. 

Erik: I don't know why they kept the U in glamour. But we lost it with honor. Anyway, so back to this.

[00:05:00] So the other one we talked about, the second one. Yeah, this one's 

Matt: complicated. 

Erik: It is. And I think this is the one that I had to review. Honestly, as an ER doc, we had this confessions from an ER doc. We did in part 

Matt: one. We double checked that what we were saying was correct. 

Erik: So check me on this. There's nothing wrong with that.

Yeah, I'm learning stuff. I love learning things. So your friend here, a doctor, is learning new things. I did learn this in medical school, but I didn't understand its significance until the 

Matt: last few 

Erik: months. 

Matt: Alright, 

Erik: so. So, [00:05:30] a bifascicular block. So, two parts to the bifascicular block. The easy one is looking for the right bundle.

Matt: Right. 

Erik: So, on the right fascicle, we got some blocking of that, the, the, the right fascicular area, right? That's the right bundle. A right bundle plus a left anterior fascicular block. Uh, now the left anterior fascicular block, three things to look for. Again. Pretty simple. I'm trying to make it as simple as I can.

You need left axis deviation. We talked about one and AVF, right? If they're both up, we're [00:06:00] good. Normal axis. If the AVF is down, okay, this is not normal because we want them both up. If one's down, we've got to figure out if it's right or left. So the AVF tells you what it is, right? So if, if it's down, you're pushing the turn signal down and that's.

Turns your car left, right? I mean, if you go the other direction. The car doesn't 

Matt: turn left. No, you do. You're signaling that you're to go left. Some people have that confused. 

Erik: Now, if AVF is up, and 1 is [00:06:30] down. Now, when you turn it up, you go to the right. Right. Okay, so left anterior fascicular block, AVF will be down, 1 is up.

Right. And the other two things we look for, To define a left anterior fascicular block, in addition to left axis deviation, we want to see QR complexes in 2 3 AVF, and QS complexes in, um, yes, RS, sorry, no, QR, QR, yeah, and one in AVL. 

Matt: Now, QS, [00:07:00] RS in 1 and AVL. I'm sorry, RS in 1 and AVL. This is super complicated.

That's why we're mixing our words 

Erik: up. RS, 1 and AVL, QR in 2, 3, AVF. And so those three things, um, are, are what, uh, we're going to use to find that left anterior fascicular block. And in conjunction with the right bundle, that's badness. in a patient that looks, you know, it's that patient that looks like they're having a STEMI and you look at the EKG.

Hey, no ST elevation. We're good. Ooh, wait, hold [00:07:30] on. Let me check these other things. Oh my gosh. This looks like he's got the bifacicular block we talked about. Let's transmit this EKG and let's, uh, let's call the hospital. 

Matt: Talk to however your process works in your system, whether you have to call your med control, call the receiving facility, talk to your doctor.

Hey doc, this is what I'm seeing. And so I, heard that this could be, you know, indicative of an OMI, what do you think? And if he says, you're an idiot. Yes, sir. And then later he comes back and the proponent, Oh, I guess I'm not an idiot [00:08:00] after all. 

Erik: I felt that way too, as an ER doctor, when I call that cardiologist in from home with a STEMI, they get in the car.

They're very good at coming, very supportive of me as an ER doctor and my patients. But you, you guys transmit those. I mean, they see the twinkling before they even, yeah, we have. ways that we do it that are HIPAA compliant, where we talk, we send these things to the cardiologist who's on his way to the hospital.

Cath lab is activated. They, they, they don't, they don't question me. They just do it. The problem [00:08:30] happens when they get to the ER. Sometimes the cardiologist looks at the EKG and, and, and I've even had cardiologists get mad. And even I, in my opinion, rude, um, bless their hearts. I mean, they're just trying to do their job.

Just like I'm trying to do my job. 

Matt: Probably they're tired. 

Erik: Two in the morning. Who knows? Yeah, that's right. Yeah. Yeah. So two in the morning I'd look, they look at the EKG, you know, and it's, dang it, this isn't a STEMI, you know, let me in for this, you know, and I, and I'll explain, you know, uh, you know, one of [00:09:00] these lesions potentially.

And, and they say, that's not ST elevation. We don't activate it based on these things. So the hospitals really need to look at the data and make these decisions in conjunction with, you know, with the cardiologist and, and uh, they got to decide what to do. So these lesions are really important and it's not just you that gets, you know, the ER doctor complaining.

As an ER doctor, the cardiologist will complain too sometimes. And I got to defend my patient. So let's go to the third lesion. Third lesion. What's our third one? Alright, so the third [00:09:30] lesion is the, uh, the small, hyper acute T waves. So, um, in, uh, T waves that are out of proportion from the preceding R wave is concerning.

So, um, you're, you're looking, let's just say you're looking at the inferior leads again, 2, 

Narrator: 3 AVF. 

Erik: And you're looking at that R wave and the T wave is taller. That's concerning. Highly suggestive of a heart attack or an occlusive lesion of the coronary system on the right coronary artery. [00:10:00] So, again, just to beat this home, you know, you're looking at those inferior leads, no ST elevation.

Right. But nothing, but you 

Matt: see, 

Erik: hyper acute teeth, small, hyper acute T waves. What that means is you've, the T wave is taller than that proceeding R complex. 

Matt: So when you say, and we talked about this beforehand, when you say hyper acute, how is hyper acute? different from a peak T wave, which we would typically look for, for a hyperkalemic [00:10:30] patient.

And not just look at that and go, oh, maybe their potassium is a little out of whack, and that's why they're having these peak T waves. 

Erik: Good, good question. So, the subtleties here with the relatively small peak wave, you're not going to see a lot of this, but one of the things that's classic for a hyperkalemic T wave is its symmetry.

Like a church steeple, right? Whereas with the hyper acute T waves, there's some asymmetry there at the base and it doesn't quite look normal, but I don't want you to get caught up [00:11:00] on that with this one, in my opinion, because these are smaller and you may lose some of that subtlety with it being symmetric or not symmetric.

And, and, uh, but the point here, I think what I would focus on again, I always like to think of us riding out together, which we've done in the past. And you and I are looking at an EKG and we see that those T waves in 2 3 AVF are taller than the preceding R wave. And the patient looks gray like a STEMI.

Matt: And it's only in 2 3 AVF that you'll [00:11:30] see this? 

Erik: No, you can see it in other, uh, other areas as well. The example that I gave is in the inferior leads, um, and some of the subtleties of this are again, we're presenting information, Matt, and I think you'd agree with me. We got to research this, but, and we got the link provided again, please check it out for yourself.

Yeah. Um, but that's, that's, that's really subtle, but really important. 

Matt: Got it. 

Erik: So that's the third legion. 

Matt: Got it. 

Erik: Anything we should talk about more with that? 

Matt: I don't [00:12:00] think so. You said it's, yeah, typically two, three AVF. Yeah. Inferior leads. You'll see hyper acute T 

Erik: with or without reciprocal changes, you know, ST elevation.

So 

Matt: that's 

Erik: right. And any pattern, any of the, whether you're looking at one in AVL, the lateral leads or whatever it is, concerning. All right. So the fourth pattern now we're going to look for is. Again, we've talked about this before. Looking at the EKG, you're looking at the [00:12:30] patient, patient looks terrible, and you're looking at this and there's no star, star, star, you know, STEMI, oh man, right?

But then you look closer and you see ST depression in one V1 through V4 somewhere, classically V2, I would say. And so what do we do with that one? Your posterior. The posterior, right? Or 15 lead, some people call it 15 lead. Right, 15 lead, right. So I think this is the learning point. This is something I didn't know.

And I don't think we taught this [00:13:00] either, but we did cover the posterior. Am I 

Matt: exactly? 

Erik: And when we take the EKG and we flip it and then it shows up at what looks like ST elevation, if you haven't done that before, you should watch that lecture as a gray lecture, take your EKG. That shows V2. You see the V2 depression, ST depression, you're going to hold that up, flip it over and look it up at the light and you can see what looks like ST elevation, which is the key there.

But what was kind of interesting with this one was that [00:13:30] even if The 15 lead or the posterior mi, even if it leads V seven through nine, those, those posterior leads, three leads that you move to the back, 

Matt: right? 

Erik: Yeah. Um, even if they don't show ST elevation because you had depression in leads V one through four and none of it in V five and six mm-Hmm.

right? Yeah. Um, that alone is highly suggestive of something blocking the coronary artery system. I'm about to sneeze. Bless you. 

Matt: Thank you. [00:14:00] 

Erik: So, uh, sneezing has no association that, you know, it's like, phew. 

Matt: Is it true that your heart stops every time you sneeze? 

Erik: No, I'm not going to say. 

Matt: You've never heard that?

Erik: No, but I heard, uh, I'm not going to say what I heard. Uh oh. Never mind. I wanted to say something. Well, I guess it's all medical, right? 

Matt: I don't know. I just We're, we're on a podcast. Send it. What are you going to say? 

Erik: A sneeze is one 16th of an orgasm . I shouldn't have said that. I'm sorry. I just, I, I don't know if that's true or not.

Matt: Well, we'll explore that . [00:14:30] 

Erik: Oh man, I shouldn't have said that, but, oh, that's funny. From a medical, purely medical. Well, if it's medical science, then we're allowed to say, but, uh, the sneezing actually is very traumatic to the body. Uh, the, the power. It's traumatic and the force. No, seriously, you can really damage things.

Well, I've heard, 

Matt: like I know people, and I'm sure you've seen this work. We're getting way off topic, but it's kind of interesting that a whole, they'll hold it. And it's super bad. I work with the 

Erik: doctor that does that. Okay. I'm like, dude, don't do that. Cause I'm gonna have to cover for you. [00:15:00] 

Matt: You got to let it out.

Let it 

Erik: go. 

Matt: Yeah. I mean cover. Well, of course go do the Dracula. 

Erik: Yeah. Or the grab a, grab a. Yeah, if I have a big sneeze and there's just nothing I can do, I'll just lift up my scrubs and sneeze into my chest hairs. 

Matt: I was going to say something. 

Erik: Oh no, don't do it. I already went down the wrong path. We've got to get back on track here.

Alright, let's get 

Matt: back. Let's get this back on the road. Alright, so. So I think the 

Erik: thing we learned here. Posteriors. Yeah. So, when you get, when you see [00:15:30] ST depression in leads, any of the leads in V1 through 4, and leads 5 and 6 have to be normal, and when you see that ST depression, immediately you should think, wow, this could be a STEMI, this could be that occlusive, no, I shouldn't say STEMI again, I'm falling into that trap, 

Matt: it 

Erik: doesn't matter, it's an occlusive MI, we've got pathophysiology happening in the coronary artery system that's going to need reperfusion, right?

Potentially. Potentially. Potentially. It won't show up as a stemi, but just as dangerous potentially. Yes. [00:16:00] And uh, you flip the EKG, you can see the stemi. Uh, and this is one of those patterns that I think most cardiologists are aware of. Mm-Hmm. that I think would be amenable to go into the cath lab. Yeah. Um, and it's taught as such.

But the thing that I think is different that most people don't know is that when we get that posterior Right, and, and you're waiting to see stemi Yeah. You may not see it, but that's okay. 

Matt: That's a huge indicator. Yeah. 

Erik: And we talked about the reason for this too, the heart. I can't, I don't want to stay on my mic here.[00:16:30] 

Uh, the heart is an anterior, the heart is an anterior structure, right? So the leads are here because you want the leads as close as possible. And so when you start putting leads around the back, now you're putting posterior, the thoracic cavity. Now the heart's further away. Remember we talked about that.

Distance tissue. Yeah. So I think we have to be very careful. And so I'll be clear when you get the post here, the 15 lead, it may not show Stammy, but that doesn't mean it isn't right. It doesn't mean that is not an [00:17:00] occlusive 

Matt: MI. 

Erik: So it's good 

Matt: to get the 15 lead because like you said, having that data, having that information to document that you have it, but again, it's not, it's not, if you don't have elevation does not mean you're not dealing with a STEMI.

So like with all of these things, transmit it. communicate with the physician, tell them what your thoughts are and let them make the decision. But you, if you do that, you have as a pre hospital, as a paramedic, you have done your job. 

Erik: Yep. Uh, that's the fourth one. So here's the [00:17:30] last one, Matt. So this one I've been Teach, we've been teaching this for years, uh, you and I, and I know this is one of those patterns of, of really a proximal left coronary lesion.

This is worse than the Widowmaker. I mean, this is bad. These are the ones that, that used to show up classically as a cardiac arrest, but we're getting there so quickly to these homes and getting them so quickly to the ER, we're actually finding these and get them to the cath lab. So this is AVR.[00:18:00] 

Elevation. Yeah. Which we never used to look at. AAV r you. I didn't 

Matt: even look at AAV R. No, never 

Erik: have you Don't we used to call a VR the RI mean, this is terrible. This is a term we should never use. Mm-Hmm. , uh, retard. The, the retard lead. Really? That's what in medical school, that's what we would call the R lead.

Really? Because we didn't use it. 

Matt: Yeah, yeah, yeah. It was 

Erik: like, what is that for? And it doesn't, anyway, that's not true at all. This, this, this R lead needs reperfusion. There's 

Matt: a lot of things that a VR is used for now. 

Erik: Yeah. 

Matt: VTAC identification. [00:18:30] Yep, that's right. This, now we got another thing. So it's actually a fairly important lead.

Erik: And I will say, I gotta say that word. It's such a, I have a friend. Yeah, terrible word. Friends with, uh, children with some disabilities. And, uh, we need to change that. Man, they're patients. They're just as valuable as anybody else that we need to take care of. And, um, sometimes we use words flippantly because maybe we've never known anybody.

Matt: Right. Which was not what you were doing. No, no, simply saying that's just the way. That 

Erik: was my attitude 20 years ago. I was an idiot. Well, 

Matt: that's 

Erik: what [00:19:00] was 

Matt: taught to you in school. Yeah. Yeah. So, 

Erik: but the, the reason we would say that though, is because we didn't appreciate the significance of that lead. So, so, and I think sometimes when we're ignorant of things, Right.

We don't appreciate them. With that population of kids or adults, even with disabilities, there are beautiful patient population that we can do a lot of good for. And sometimes we don't fully appreciate that population until we know it or have friends with it. Same thing with obesity, right? Yeah. You know, we'll say some pretty nasty things for those [00:19:30] patients that need a bariatric bed.

You know what I'm talking about? They're beautiful patients, uh, in a tough patient population sometimes. 

Matt: We don't know. I think a lot of times we make judgments about why they got that way. We have no idea why they got that way. It might have been something out of, they might have sustained an injury that's prevented them from exercising.

I mean, there's lots of different reasons. And when you 

Erik: put those EKG leads on a patient like that, an obese patient, man, you gotta be careful. There's so much tissue. You gotta really have good lead placement. You really do. Um, so, [00:20:00] so this last lesion though, it's not just AVR elevation, it's AVR. So it's AVR 

Matt: elevation is what we're looking 

Erik: for.

Plus. Plus. Diffuse ST depression. If you see AVR elevation with diffuse ST depression Globally. 

Matt: Yeah. 

Erik: Uh, it doesn't have to be every single lead, but a lot of it. And again, just to keep it simple, AVR elevation with diffuse ST depression, specifically those lateral leads. AVL 5 6. But you'll see it [00:20:30] everywhere, potentially.

And that is highly suggestive of what's called a left proximal main lesion. So that left coronary artery at the base of it coming off of your aorta. Now this is plugging your M. I. V. coming into your So bad. So bad. This is beyond Widowmaker, right? So this is proximal to the widowmaker. So anyway, that left circumflex in the left anterior descending branch off of the left main.

Yeah. 

Matt: This is the big daddy. This 

Erik: is the big daddy. Yeah. So this will kill you if you don't get this quickly to the hospital. Yeah. Again, this is 

Matt: blocking [00:21:00] your hydrant if you're a firefighter. Yes. This is blocking your intake. LDH. Your five inch coming into your pump call an LDH. Right. 

Erik: The 

Matt: large diameter hose, that what you're saying?

Correct? Yeah. LDH or i's your main intake valve? Yeah. Oh, main 

Erik: intake. That's a new term I learned. There you go. I've been calling it LDH. Well, no, no, no. It's good. 

Matt: LDH is the hose. 

Erik: Yeah. 

Matt: And then where you connect your LDH to the, to the engine is your MIV. Right. 

Erik: Yeah. So that's exactly what's going on here.

And so if you see that it's not going to show ST elevation on the EKG, you got to pick this up. Right. It's one of those [00:21:30] lesions that won't meet STEMI criteria. In many hospitals and many systems 

Matt: dismiss this. And meanwhile, your patient could very quickly get ready to go rest on you. 

Erik: Yeah. So those are the five lesions, Matt.

And I think again, like we said earlier in part one, I don't know if we stressed it in part two, but I'm going to say it again, if you're listening to this and you didn't know it, you owe it to our community to spread the word forward. This to people, you know, have them watch this podcast so we can educate people.

We need to spread the word for these things. We need to get [00:22:00] these medical directors to, to, to look at this, those training divisions to train this. 

Matt: And you know what I think we're going to do is we're actually going to make, I don't know if you'd call it a cheat sheet, but we're actually going to make. a sheet and we'll put it on our website once we get it made and distribute it for free, that you guys can print out, laminate, whatever you want to do and put it in the back of your ambulance.

So that way, I 

Erik: love it. 

Matt: If you go on a call, chest pain call, you have a patient that looks, man, this guy doesn't look good. [00:22:30] And you run a 12 lead and you're not seeing any stiff, any ST segment elevation, right? The classic stuff. Let's do this. You can pull this form out and go, wait a minute. Let me look at these other five indicators.

That's a great idea. So we can do that. 

Erik: We can definitely create that. 

Matt: We'll get it on our website. We'll offer it for free so that, because it's so important that we're not missing, we 

Erik: could call it instead of STEM use, we'll say, can't miss EKG patterns 

Matt: or OMI. Yeah. I mean, again, To reiterate, we've said it over and over again, and I think it's important because people are going to [00:23:00] think like, oh, this is a new thing.

No, it's not a new thing. We're still talking about heart attacks. We're talking about lack of blood flow to the heart muscle, right? The coronary arteries are being blocked. All of that is exactly the same. All this is saying is that you can't just use ST segment elevation to identify an MI. It's not just that.

There's more than that. And these five things are those other things. And then on top of that, you also have, I think it's important to note, you [00:23:30] have NSTEMIs. You have times, or there are times, when a patient will have no EKG changes, but still be having a heart attack. Right. Right. And so that's why it's important as pre hospital providers, we're looking for these EKG, uh, indicators, but it's not 100%.

And it's not definitive. If your patient looks like crap, if they're pale, diaphoretic, vomiting, complaining of crushing chest pains, or a little grandma that just says, oh, I don't feel good, you know, always keep [00:24:00] that in your differential diagnosis. Like, are they having an MI? Or is this a heart attack? 

Erik: Oh, MI is a good term.

Yeah, MI is a good term. It's an 

Matt: appropriate term. It turns not stemming necessarily, but always keep that in the back of your mind. Always transmit your stuff, communicate your, your presentation to the physician. If you think, Hey, we might need to activate on this patient because of X, Y, Z. And these are five things that are new that not everybody might be familiar with.

Erik: Well said, man. Yeah. We got to, if we want to, you know, our mission statement [00:24:30] as educators, EMS educators is to, is to improve the health. And wellness of our communities, right? And we do that through education. If we don't know what to look for, we're going to hurt people. 100%. We've got to get this down. If you, again, if you learn something new from these Part 1 or Part 2, you've spread the word.

Do the right thing. You know, we don't, we don't stand to gain anything. Well, we actually all stand to gain a whole lot in a community, our community of education, but, but [00:25:00] we need to get this word out. People, I'm seeing too many municipalities, too many hospital systems, too many agencies that aren't looking for these things.

Matt: Let's bring it home and even say you're at the fire station because I've had this happen. We've had this happen in my department where one of our members. I'm not feeling really good. I got some pain in my chest. Or, you know, maybe they're at the station or whatever and they run to the station. Hey, let's run a 12 lead on this patient.

Let's see what they're doing, you know. Yeah. You run a 12 lead on one of your own. One of our own. Yeah. Right? Our brothers, our [00:25:30] sisters. Yeah. And you run that 12 lead and you're like, well, no STEMI. No STEMI. It's going on. We're good. You're good to go. You know, whatever. And then they're like, okay, yeah, it must be just some indigestion or angina or something.

And they go back to work. And then two hours later, they're dead on the floor because we didn't look and, oh, we missed that they've got elevation and AVR with diffuse depression. Oh, uh oh, we missed that. This, this is super important. For us to, it's just as important as looking for STEMIs. 

Erik: You know, I don't mean to complicate things, but we [00:26:00] also have to appreciate the fact that, and I've had many patients like this before, um, is that you think a patient's having a STEMI by looking at them, they're nice and gray with chest pain, and then the EKG doesn't show anything.

Right. And sometimes it's legitimately not a STEMI that's causing the symptoms, an aortic infection. You know, maybe an aneurysm or an aortic dissection. There's different reasons. Pericardial tamponade. I mean, who knows? A pneumo? I mean, there's a lot of stuff out there that's emergent and life threatening [00:26:30] that's not occlusive coronary pathophysiology that you can't get in the back of an ambulance.

Right. You know, in addition to being very careful with the EKG, and if you don't see STEMI, be curious. 

Matt: Yeah. Well, what's causing this pain? 

Erik: Check the pulses. Are the pulses symmetric? Could this be a dissection? Look at your pulse pressures. What do those look like? Really good lung exam. Listen to the heart.

Do you hear muffled heart sounds with distended neck veins? Did this patient just, was he in a car accident with chest [00:27:00] trauma? Good history. Good. There's a lot of good stuff. And this is what education is all about, is helping to equip you with the knowledge so you could take care of your patient. That's why we're so passionate of what we do.

And that's why we do what we do. That's why we sit here and work hard to try to educate people. 

Matt: I was, uh, you know, and I think I've said this before, is we're kind of like medical detectives as paramedics, EMTs, paramedics. Our job is to go in and ask the questions and we go where the evidence leads us, right?

Just like a [00:27:30] detective on a, on a case. It's 

Erik: a good example. Right? You're 

Matt: going where the evidence leads you. And so if you're doing good assessments, Uh, asking the right questions, doing the appropriate exams, looking at the findings and saying, okay, where is this taking me? Right? Don't make a pre, we always talk about, don't put the blinders on and think, oh, this must be a heart attack because you could miss something else.

Right? So it's super important. Uh, information. Um, and again, we're going to do a whole CE hour on this. It might even be more than an hour. And 

Erik: I love, we're going to make that [00:28:00] deliverable, the placard or something that people can put in their pocket or post on the wall or share with their phone. 

Matt: Yeah, we'll do that.

Yeah, we'll 

Erik: do that. We'll get that done soon. Um, but again, to close this out, what can our listeners do, our viewers do to help spread the word? I, I, I'm not a social media guru like you. So we like, but yeah, 

Matt: like our, you know, like our page, uh, or, you know, subscribe to our YouTube channel. Um, subscribe to our, if you're watching on Apple podcasts or Spotify.

Uh, [00:28:30] like our podcast that helps us, um, you can share that link with anybody that is a pre hospital provider, physician, medical director, EMS person, share that. This is, this is all free that we do. We don't, you know, make any money off this. We are actually real quick, we're working with CAPC to hopefully in the future, you guys may be able to get.

That's the actual CE credit for listening to these podcasts. So we're working on that. Can I, 

Erik: I got to share one more thing. I think that's, you know, we've got thousands of students all over the country, you and I, and we, it's an [00:29:00] honor to teach them. I mean, that's a high calling and a high responsibility and a weight that motivates you and I to stay up to date.

Right. And so when you watch our CEs online and you, and you, Subscribe to our, our stuff. We want to keep that cutting edge. We're always revisiting and learning. And we learned a lot with these, with this cardiac pathophysiology. And so that's one of the benefits I know. It's one thing to watch CEs, but it's another thing to watch CEs that you know are up to date.

So important. See you in the next one. Be [00:29:30] safe out there.

Narrator: Thank you for listening to EMS, the Erik and Matt Show.