Why STEMI Isn’t Enough Anymore: The EMS OMI Criteria Update

STEMI is out. OMI is in. In this episode of The Erik and Matt Show (EMS), Dr. Axene and Matt Ball unpack the newest data on occlusive myocardial infarction (OMI) criteria—and why sticking to traditional STEMI patterns could cause you to miss up to 34% of heart attacks. They break down the April 2025 literature, discuss real-world EMS implications, and challenge every provider to rethink how they read 12-leads. Whether you're a medic, medical director, or firefighter-paramedic, this one's a must-listen.

We discussed this topic several months ago but an article just came out this month with some new information. Here is a link to the article.

Transcript

(Transcript is automatically generated)

Matt: [00:00:00] Initially you're gonna look for that STEMI, that ST segment elevation. Yeah. You don't see it. What we're saying is you're not done 

Erik: Because change to us, um, for survival means danger.

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

Matt: Well, we just got back from Boston

Erik: Back when the earth was young. Yep. 

Matt: Yeah, that one [00:00:30] we all had have our things we said yes. Little. Yeah. Ticks or quirks or, yeah. Isms. Nerf and nervous. Ticks. Isms. Yeah. But yeah, we just got back from Boston. You spoke?

Yeah. At a conference. 

Erik: Uhhuh. Uh, 

Matt: it was a great conference. 

Erik: It was a really good conference. 

Matt: Met some great people. 

Erik: Yeah. Really cool, fun, excited, passionate people about EMS. Yeah. Yeah, for sure. Brad Newberry and Yep. His staff 

Matt: Chief Rubin from Duxbury, 

Erik: some of those Harvard professors. Really tip of the spear with, [00:01:00] with, with, uh, yeah.

Disaster management. Yeah. It's really cool. 

Matt: Good stuff. Yeah. Talked about, uh, death notification stuff. Mental, uh, mental health for first responders. Just a lot of good talks. Right. But your talk. Was on a topic that we've discussed on the podcast. Yeah. And it is becoming more and more a hot topic, I think in EMS.

Erik: It is, yeah. You know, it's interesting to, to see people, you know, I, I had people raise their hand if mm-hmm. They were familiar with something or most of the people raise their [00:01:30] hand. Mm-hmm. But then there were some of the stuff that we talked about and, and only one person raised their hand. Mm-hmm. There were a couple hundred people there.

Yeah. And, and, uh, it was. We had a similar experience on the east coast at a different area. Mm-hmm. You know, I don't want to say who it was. Right. But no one knew what we were talking about. Yes. You know, and, and so some of this stuff is kind of cutting edge and some of the stuff we're looking at just came out this month.

Matt: Yeah. April of 2025. Yes. 

Erik: Context. Yeah. And a lot of what I was 

Matt: April 1st as [00:02:00] This is not an April Fool day joke. No. Yeah, that's right. April 1st. This is real. That's right. 

Erik: Yeah. It came out this month. Uh, so that's, uh, this is really kind of cutting edge, kind of the tip of the spear kind of stuff. And, and the, the scary thing is that if you're not aware of these things, you could be missing what.

Uh, even more than I thought, but yeah, 25 to 

Matt: 34%, I believe I said 

Erik: 25% right then. 

Matt: Well, that's what most of the data has said. I think this one actually goes up to 34. 

Erik: 34. I think it said 25 to 34%. If you're only 25, yeah, [00:02:30] 30. If you're only looking for the STEMI pattern, you're gonna miss 25 to 34% of occlusive lesions. So what does that mean? We're so stuck in the STEMI paradigm that sometimes we even forget what that means. Occlusive MI. Right. And that's, so the, the STEMI is, is a pattern we look for to flag us. Wow. This patient needs to be reperfused. Mm-hmm. Because they have blockage of their coronary artery.

If you don't get it reperfused, [00:03:00] emergently in the cath lab, then you're gonna lose heart cells. Yeah. And the whole adage of. Time is hard. Mm-hmm. Right. So, um, the problem is, is that if you're only looking for the STEMI flag, yeah. You're gonna miss 25 to 34% of heart attacks. Mm-hmm. Occlusive mis in your community.

Yeah. So if you're listening to this and you're not looking for these patterns, you, you could be missing one third of all of the heart attacks, right. Of all the people that need emergent catheterization. You're [00:03:30] missing. It could be even more than a third Yeah. Of them. That is, to me, that's why this is so mind blowing.

Mm-hmm. And that's why we have so many people come after this, after the conference wanting more information. Yeah. Professors coming up to us and saying, I'm not teaching this. I need these. And I've had a, I, I've lost count of the number of people who've contacted me wanting the slides. Mm-hmm. Yeah. So, uh, this is pretty cool stuff.

Matt: It is, and we did, like I said, we did a podcast on this last year, six months or so ago, eight months or so. Yeah. And that was [00:04:00] the data at that time. But it has evolved. We're learning more. And you know, that's one of the things that, you know, as a, as a physician, you know mm-hmm. You guys are very scientifically minded.

Right. And you realize that things, data evolves and changes. Mm-hmm. The way that we practice and. Uh, you know, as EMS providers, we need to think that way as well. Whether we're fire based EMS or private EMS doesn't matter, 

Erik: right? 

Matt: If, if you're an EMS provider, you need to understand [00:04:30] that just because that's how you learned it in school, 5, 10, 15, or 20 years ago.

Erik: Yeah, 

Matt: it's totally different now. Things change, and I know that's a very difficult thing to do in the fire service. They don't like change. Well, that's not what I was taught 20 years ago, and it's like. Okay. But I mean, it's no different than fire tactics. Like we change, you know, and sometimes the change is good.

Sometimes we realize after doing it for it for a while, like, eh, this didn't really make an impact or wasn't really good, [00:05:00] but this is data that we need to at least be paying attention to. 

Erik: And I'm so glad you brought that up. Uh, and we talked about this in Boston is, uh, unfortunately with, with change, we, our brain is so wired against change.

That's right. Is that we will actually be presented with a new and innovative idea that is clearly better and we will still resist it. Yeah. Just because it's changed. Yeah. Even though it's better. Yeah. And those paradigm shifts aren't uncommon. We talked about Copernicus going from a geocentric [00:05:30] solar system, which is not true.

To a heliocentric solar system. Mm-hmm. I mean, there are people out there that still believe in a flat earth. You know, it's like, it's, it's ridiculous. Yeah. Driving 

Matt: to Denton, Texas, there's a guy that drives around in his car. He is got flat Earth and all this stuff all over his car. Oh yeah. Oh yeah. He'll go down to the square and, 

Erik: no, no, that's, that's absolutely ridiculous.

We know that's to be not true. 

Matt: Well, the pictures are false, Erik. 

Erik: Yeah, yeah, they're right. The pictures 

Matt: that you see all over the internet are false, 

Erik: you know. Thousands of years ago, the, the Hellenistic, the Greeks were [00:06:00] the first ones we're off. We're getting way off first actually saw the sphErikal. It's, it's, yeah, it's silly anyway, but, um, but, but even that though, in defense of the flat earthers, I mean, the change is tough.

Matt: That's how our minds Yeah. 

Erik: Resist it. And it's the amygdala, right? It's that little, that part of the brain, both sides of the brain actually connected to the hippocampus. Um, that it resists change. Mm-hmm. Because change to us, um, for survival means danger. Mm-hmm. We [00:06:30] get into a system, we wanna be comfortable.

Something's different. Yeah. Ooh, red flag. Yeah. You know, you get home and somebody's been in your, your wife's jewelry box. It's like, ooh. Somebody been in the house. Danger. Danger. Right. Well, the same thing's happening with the paradigm shift from STEMIs. Mm-hmm. Right now we're comfortable with the STEMIs and a lot of advancements have come from the STEMI paradigm.

I mean, yes, it, we've gone from QA 30 years ago to STEMI today, and we have now created this, this ER pathway from this. [00:07:00] Pre-hospital environment to the cath lab where we have expedited people's reperfusion. Mm-hmm. And, and we we're getting people into the cath lab in minutes 

Matt: and that's why it's important, you know, I have this conversation a lot of times with people, like, why do we need to know all this stuff?

Like, you know, just pick 'em to the hospital and it's. It's having a dramatic impact on out outcome patient outcomes. 

Erik: Yeah. 

Matt: You know, dramatic impacts on that. The earlier we can identify mm-hmm. Potential patterns. Now I always say this when I'm teaching, uh, STEMI stuff, [00:07:30] and I, I'm, I'm not a great, I mean, I can read 12 leads proficiently.

Yeah. You know, I can catch, I look at it from the lens of what do I need to catch as a pre-hospital provider. We were talking about this before, like Dr. Yu, that. 

Erik: Our electrophysiologist we interviewed. Yeah. The 

Matt: genius guy like 

Erik: Dr. Ra. All these guys who, that's 

Matt: all they do all day, right? That's all they study.

That's all they do is EKG patterns and all these different, like there's no way as a paramedic or even an ER physician that you're gonna [00:08:00] be an expert in all these things. No. Right. So we're not suggesting that you need to go out and, I mean, if that's your thing, if you get, you know, enjoy studying these things, go for it.

More power to you have at it. Um, these. OMI criteria mm-hmm. Are very complicated and they're evolving. 

Erik: Mm-hmm. 

Matt: Right. You certainly need to be familiar with the fact that there are some criteria out there, and we're gonna talk about some AI assistance. Mm-hmm. And you'll give data on that. That's pretty interesting.

But I guess my point is, is [00:08:30] that when I'm teaching Eek G STEMI stuff, our job is, my job as a paramedic is not to say 100% that this patient's having a heart attack. Right. Or that they have, you know, a, an occlusion somewhere. My job is to look for patterns that they could be and then forward that along to you in the er.

Yeah. And then you look at it with your years and years of schooling, uh, you make a decision and then you probably pass it on to a Dr. Garra mm-hmm. Or somebody [00:09:00] like that, and then they make the final decision on what they're gonna do. Right. But early identification is huge with these patients. 

Erik: Yeah. So this is a screening tool.

Yeah. The EKG is a screening tool. Exactly. You should be getting EKGs that are non, not stem, not STEMIs. You should be getting EKGs that are not signs of occlusive mi. Right. Um, the, the goal is to capture everyone that. Having one, right? Knowing that you're gonna capture some that didn't have it at the beginning.

Right? Those are called false positives, right? And that's what we're [00:09:30] supposed to have. Yeah. Uh, and, and, and we're supposed to even do screening on people who don't have any occlusive disease at all. Right? So those would be a, a, a, a, uh, a true, positive, true negative, right? Mm-hmm. Yeah. Um, what we, what we do not want to have are those false negatives, right.

That's a screening tool is poor if you have false negatives. Right. That's, that's, that's kind of the goal here. Yeah. And that's the problem with the STEMI paradigm is that right now you're getting an eek G on someone and you're, you're reading the [00:10:00] EKG and you're looking for a STEMI. Mm-hmm. And if it doesn't show STEMI, then it's, it's immediately brought into the bucket of a non STEMI.

Mm-hmm. 

Matt: Yep. Right. And then it's kind of dismissed. I mean, I know in my experience with the doctors, they've, I remember one case in particular, a guy having crushing chest pain, diaphoretic. It had multiple MIS in the past. I think I've told this story before. Get to the er. He's no elevation. 

Erik: Yeah. But I'm 

Matt: basing it off my patient presentation.

Erik: Right. 

Matt: And the ER doctor looks at the e kg, this ist a STEMI literally throws the [00:10:30] 12 lead down and walks out of the room. 

Erik: And that's shortsighted and foolish. Yeah. Yeah. Um, but let me explain something about the ER perspective. Okay. So, uh, in the ER, when you bring in a patient that's a cardiac patient with an EKG, scary or not, right?

Mm-hmm. If it's not a STEMI in the er. It doesn't go emergently to the cath lab. Right. What I'll do is I'll monitor the patient, run some serial troponins, right? Some serial EKGs is just part of the process of getting admitted to the hospital. They're not going home. Right? [00:11:00] The the problem is, is that we're delaying revascularization. Right. And so right now in the current paradigm in the emergency room, I will see a patient that's not a STEMI. I'll get them admitted, I'll get the cardiology consult. Some ER doctors write the admin orders, some don't. Some have hospitalists that do all that work, whatever the point is, across the country really globally.

Mm-hmm. Um, if it's not a STEMI, it's going to delay. The revascularization of a blockage [00:11:30] potentially. Right. What we're finding with the data is that there are a lot of false negatives. Mm-hmm. See, right now it's really important we understand this, is that if you find a STEMI, it's gonna go to the cath lab.

And when it goes to the cath lab, it may not be a STEMI actually. Oh, it's always a STEMI. It's always ST. Elevation pattern. Right. But there's no occlusion. But what we're looking for is in STEMIs. Right. That's a, that's a pattern. Right. What we're looking for is occlusive lesions that are blocking blood flow to an area of the myocardium.

Right. Because that myocardium [00:12:00] will die without blood. That's right. And that's the goal. It's not STEMIs. Yeah. That's a pattern. Yes. Uh, if you don't see a STEMI, all right. Oh, just back up. If you do see a STEMI. It's gonna go to the cath lab. Mm-hmm. If it goes to the cath lab and it was benign early repo.

Mm-hmm. Or you know, angina or Right. Prince Metals, angina, or maybe pErikarditis or whatever, right? Or Taco Sous, we've talked about that before. They're gonna have clean coronaries. Yeah. That would be a false positive, [00:12:30] right? It had St. Elevation looked like a STEMI, but it went to the cath lab. It was a false positive.

Right? If it's not a STEMI, so EKG does not show STEMI, right? You take it to the er. You get your serial tropes, they get to the cath lab eventually and it shows a fully occluded Yeah. L-A-D-L-A-D or something like that. Right. Or, uh, they also measure flow rates with this mm-hmm. With TIMI flow rate. But, uh, basically by definition it's shown to be an occlusive lesion.

Right. [00:13:00] Those would then be a false negative. Right. Initially we said it's not a STEMI or non STEMI. Right. In our mind, we think not a heart attack. Right. Well, that's not true. Yeah. It just didn't have the STEMI pattern on it. Right. So the whole problem is called, it's called confirmation bias. Mm-hmm. When you're using the pattern to determine the index test, right.

Ah, that that's not right. Statistically, that's wrong. Right? Right. So what we need to do is we need to open up the blinders a little bit to look [00:13:30] for other patterns. Mm-hmm. And these 11 patterns. That are outlined in this literature that came out this month. Yeah. Shows a significant minority, mm-hmm. Of patients, you know, up to a third, maybe even more than a third.

Matt: Yeah. Significant minority doesn't, anytime you put minority, that sounds bad, but it's 34% if you're in that 34% of patients. Yep. That's pretty important to you. 

Erik: Yeah, that's right. The majority of those occlusive lesions will be a STEMI pattern. Right. But a significant [00:14:00] number maybe is a better word to use, A significant number of patients, even more than a third of all occlusive lesions will show up as an, as a a, not a stem pattern, but something else.

Yeah. So, right, right. So, so this whole idea of the possibility and actually the data showing it now mm-hmm. Is the false negatives that we're seeing in the hospital. Right. And And the scary thing again, just to back up, 'cause this is getting complicated, right? The goal for us in the prehospital environment is to identify someone who [00:14:30] could have an occlusive lesion.

Right. That's the goal. Okay. That's the goal. That's the goal. Yep. Most of them will look like STEMIs. Yeah. But some don't look like them. So we have to open up our eyes to look for those other patterns. 

Matt: So as a paramedic, I think that you need to keep in your head that it's, you have your patient with chest pain or you suspect is having some sort of a cardiac event, right?

You run a 12 lead on them. Initially, you're gonna look for that STEMI, that st segment elevation. Yeah. You don't see it. What we're saying is you're not done. [00:15:00] That doesn't mean now that they're not having some sort of an occlusion going on. Mm-hmm. And so you need to take a deeper look. Yes. Initially look for that, that ST elevation.

Yeah. But then if they're not having that, you need to look for these other signs. And I, and I, the other thing I get. Uh, guys get hung on is they feel like they have to memorize this stuff. Mm-hmm. It's like scar criteria when that first came out. Yeah. Like, everybody's like, I can't, then don't memorize it.

Like, I mean, I know Scar Bosa because I've taught it for years. Yeah. So after teaching [00:15:30] it numerous times, I know it pretty well, but I get it. Like if there's so much stuff that we have to know. Like, you don't need to memorize scar bosa. 

Erik: Yeah. What 

Matt: you need to memorize is the indications to look for scara.

Right, right. Left bundle or a pacemaker and then say, oh, they've got a pacemaker. Oh, scar bosa criteria. Let me get out my chart that you should have in the back of the ambulance and let me look at what is scar bosa and you know, reference that to my 12 lead and okay, are they having it? That's fine. Yep, that's [00:16:00] perfectly fine.

Or now we have AI that's going to, that can do that. Yeah. Yeah. And these criteria are very complicated and there's a lot of 'em. Right. And so I think the more, and we'll post a link to this article Yeah. On there so people can reference this article and read it. It's a good article and it has pictures. So it's very firefighter friendly.

Erik: And we, we are, again, we're, we're filming a, uh, our high risk cardiac course. 

Matt: Right. 

Erik: And we'll be, that will be coming out soon too. Well, 

Matt: we'll go in depth of 

Erik: all the Yes. Right. That's our next, that's our next thing in the queue to film. [00:16:30] Yes. So we're, we're going to, and that will, we'll go over these patterns 

Matt: Yes.

In detail with. And with all this stuff. Yeah. This is just kind of an overview of, like you said, it's the paradigm shift. For years, ever since I've been a paramedic, it's STEMIs. STEMIs is a heart attack. You know, STEMIs means they're having an mi, whatever, and now they're saying, mm, not always. Yeah. Right?

Yes. Look for your STEMIs. But now we're finding the data is finding that there's these false negatives. Yes. These patients are sitting in the hospitals [00:17:00] dying. Their, their cardiac, uh, muscle is dying because. And even physicians are. Mm-hmm. They're doing the same thing. So we, this is cutting edge stuff, and you guys can be on the cutting edge of this 

Erik: and, and every physician I've spoken to did not know some of these patterns.

It's, it's every, it's not just us in the pre-hospital environ. No. Nobody's behind. Everybody's behind. I printed this out. We're all stuck in a paradigm. 

Matt: I printed this out this morning and it had new stuff on it that we hadn't Yeah. Heard talked about yet. Right, right. So this is an evolving thing. 

Erik: Yeah. 

Matt: Uh, and it's just something [00:17:30] to, to have on your mind, talk to your medical director about, this is changing.

There's more data coming out. 

Erik: And, and speaking of data, I think it's important for people to understand something, all of us to understand this. Physicians, paramedics, EMTs, all of us should understand that. Uh. In the past, we did not send some of these patterns to the cath lab emergently because of the risk.

Uh, like there's a, there's a survival risk. There's, you're taking a risk going into the cath lab, right? By [00:18:00] taking everybody with some of these patterns to the cath lab, they used to think that there was no survival benefit to it. So they didn't, it was not an indication to emergently go to the cath lab.

Right? But today what we have found is that some of these patterns have double the mortality risk, right? And so. So they really do need to go emergently to the cath lab. Right. And if they don't, they, they have a high risk of dying now, I think the best that you've gotta tell the story. Brenda's story.

Matt: Mm-hmm. You tell it, you know it better than I do. 

Erik: Well [00:18:30] you, you and I both know Oh yeah. A nurse friend of ours. Yep. And her 31-year-old son was working out at the gym. Well, lemme back up a second. This, what's really cool about this mm-hmm. Is that we filmed the first OMI Yeah. Podcast. Podcast. That's right.

About six months ago. 

Matt: Yeah. Something like that. Six, eight months ago. Yeah. 

Erik: Yeah. And she had watched that and, and she had, um, was familiar with some of these lesions anyway. Mm-hmm. Her son goes to the, the urgent care, uh, for some chest pain he was having [00:19:00] while running at the gym. Got the EKG at urgent care, which.

Well, we've posted and, and it's, it's clearly one of these signs. Yes. They didn't recognize it. Sent him home. 

Matt: Yeah. 'cause they were looking for STEMIs. 

Erik: Right. Right. And he was chest pain free. 

Matt: Yeah. 

Erik: Which is actually part of this pattern. That's right. Yes. And so, uh, Brenda saw the pattern. He went back to the ER and in the E-R-E-K-G showed the same pattern again.

Brenda has literally texted me. Thank you [00:19:30] for the podcast. You saved my son's life. 

Matt: That's worth 

Erik: doing. They had tremendous difficulty getting him admitted to the hospital, even at the er. 'cause the ER doctor recognized the sign that Brenda showed him, but the cardiologist did not. Yes. Well, no. I think he recognized it, but he didn't 

Matt: believe in the, 

Erik: yeah.

Yeah. Well, he went to the cath lab that night. Fully occluded widow maker the LADA hundred percent. Does the cardiologist 

Matt: believe it now? 

Erik: Probably. Yeah. So, uh, and, and in the cardiologist's defense, they're [00:20:00] looking at data that, yes, it may just be older, but uh, the new data shows that these patterns, um, are highly suggestive of an occlusive mi Right?

And we need to be looking at them. And it's not just the pattern. We gotta look at the patient, gotta evaluate your patient, right? We know. These patients that have an occluded mi, or sorry, the O mi. Mm-hmm. Occlusive mi, they look gray. Yeah. We know they're sick, they're sweaty, they're sick, they're vomiting.

Yeah. Uh, it, you know, 

Matt: yeah, 

Erik: right. 

Matt: There's something going on 

Erik: here, right? Yeah. And then there's those [00:20:30] patients that it's like, oh, they don't look good, but I've seen worse. But, you know, and then you look at the EKG and it's like, whoa. This is one of those patterns. These patterns could tip the scales for you and the, and the care team.

Yeah. The cardiologist as well. So we need to be spot on with these. 

Matt: There's, you know, to back up and to, and this is more for the lay people. Yeah. If somebody's having chest pain go to a hospital. 

Erik: Yeah. 

Matt: Just, I just wanna throw that in there. Yeah, yeah, yeah. Like, do not go to an urgent care if you are having.

Signs and symptoms of a heart attack or a [00:21:00] stroke or some major thing. 

Erik: Yeah. 

Matt: Don't go to an urgent care. Go to a hospital, preferably a PCI capable. 

Erik: Yep. And it's not just the left arm, right? Yeah, right. Radi, any pain? It's, it's actually both arms or no arms. The right arm. I mean, it could be 

Matt: jar like, yes. I, I mean, we've talked, yeah, the patient presentation is all over the map.

I've had big, huge tattooed guys that look like they just got out of prison. Rolling around screaming and crying like a little girl having heart attacks. And then I've had little 80-year-old ladies. I just [00:21:30] don't feel right having a huge mi 

Erik: Yeah, that's so 

Matt: there's no, there's no, um, set pattern. Everybody's different.

Erik: I like, I like how you went back to the lay person because if, if someone's having. An occlusive mi it may be just weakness. Yeah. It may be jaw pain. It could be elbow pain. Uh, I mean, it could be vomiting. No, we're not saying saying, just 'cause your 

Matt: jaw's hurting. You're having a heart attack. That's not what we're saying.

We're just, but it could be, but it could be. But yes, it's, you know, yeah. 

Erik: It's, uh, it's hard because it's very hard. It's, it's the number one killer of people. That's right. 18 million people die [00:22:00] every year. From, from cardiovascular disease. Right. And if you're feeling any form of chest pain, shortness of breath, weakness with radiating pain to your arms or your jaw, um, if you start sweating, you know, in the context of these symptoms.

Yep. You need to get to the ER as quickly as you can. Yeah. Call nine one one. That's right. Call 9 1 

Matt: 1. Yeah. 'cause we have, uh, the ability we can check, you know, run an EKG on you. Yep. Aspirin is a huge medication to give probably's the only 

Erik: [00:22:30] thing we do that really saves lives, 

Matt: say that's the most, and not the Nitro, not anything else.

The aspirin is, 

Erik: and I I think early recognition. You said that earlier too. Well, yes. Yeah. I mean that, that's really But as far, yeah, the 

Matt: early Exactly. We can, so I'll tell you one thing, one of the things that I've changed in my practice that I didn't used to do, I used to hate doing 12 leads in the house.

I'm like, this is stupid. Why am I gonna hook up all these wires on this patient just to get 'em up and unhook 'em all just to get 'em on the cotton and hook 'em back up again? Yeah, and I've changed the way that [00:23:00] I do that now because I realize I can, especially if I'm up like in an apartment or in a nursing home, we have multiple nursing homes in in my city.

Right. You know, I might be on the third floor. I might be a five plus minute walk back to the ambulance. Well. When I go to those facilities, I will take the cell phone with me. Mm-hmm. And run the 12 lead. And if I see, especially if it's late at night, if it's on a weekend, a holiday or something like that, and I know like there's no calf team at the [00:23:30] hospital right now, I'll run that 12 lead.

And if it comes out that they're having a STEMI or I. See something like this. Transmit, transmit and call 'em immediately because that starts their clock. 

Erik: That's exactly right. Yeah. And that's why the early recognition is so important. Yes. Is you start to mobilize the cath. It's not just the cardiologist, it's little cath lab team.

Right. It's clearing the cath lab. Yep. It's when they know something's coming, things. Things happen faster, move faster. Yeah. And 

Matt: that saves lives. Yes. Yeah. A hundred percent. Yes. A hundred percent. Yeah. We need to look at this. I, a friend of mine did a talk [00:24:00] once about STEMIs. Mm-hmm. Uh, or mis and it was bullets to the heart.

And, you know, when we go on a, you go on a sucking chest wound patient that's been shot in the chest. Yeah. Like, we all kind of get our adrenaline up and we're like, oh, this is, and then when we go in a STEMI patient, we're like, I mean. We kind of get excited, but not to that level. Yeah. The end result's the same.

The the heart is going to die. It's going to stop beating. Yeah. So these patients are going to die on you if you don't get 'em there quick. 

Erik: That's right. And that's what happened with Brenda's son. That's right. 31-year-old. [00:24:30] And now, um, Brenda's son. Um, he has a son too. 

Matt: Yeah. 

Erik: And that son nearly lost his dad.

Matt: That's, it's huge. 

Erik: Brenda nearly lost a son. 

Matt: Yeah. 

Erik: Um, because of, uh, a lack of recognition of a pattern that we should all know. That's right. I will say one more thing, and I agree with you, uh, going in and memorizing every tiny little detail of these things. Um. Uh, I think is, is hard work and I think, and it's sometimes [00:25:00] maybe, uh, feels daunting.

Sure. But, but again, I think we, I think we owe it to our patients to. Try to, to try do our best to learn all of these patterns. Yeah. Understanding though the, at the end there are some great AI tools 

Matt: Yeah. 

Erik: That can back you up. 

Matt: Well, what was the data you said on the 

Erik: Yeah, it's crazy. I mean, the, the AI tool was I think 98.4% specific.

No. Sensitive. I [00:25:30] think there were a lot of false positives. Mm-hmm. But it didn't miss people. Right, which is really the goal, right? Um, and then they were compared to a group of physicians and they were at 80.4%. Uh, as far as being sensitive. So they, they didn't have as many false positives. Right. But they're missing people, right.

With these patterns. So I think that, I think the good news is, and I think PM cardio is one of the more mm-hmm. Well known AI free EKG, [00:26:00] um, apps you can use. I tested it out on some of these lesions trying to trip it up and I couldn't trip it up really. But I'll say this though, do not rely on these things.

You, we need to know them. And, and, and you said it really well, SCARA, for example mm-hmm. Is like knowing to look for the signs of Scara. Mm-hmm. You know, okay. I've got a left bundle branch block here. Right. I've got a wide QRS. Right. I'm gonna pull out. The reminder of those criteria. Yeah, because I recognize that it's a left bundle.

Matt: That's right. 

Erik: And so [00:26:30] then I can, I can get the details on my hand, my app, and then I can use another app to even take a picture of it. That's right. Those are, those are really smart things to do. It, it, you know, it's almost like a checklist. Yeah. It's like in my mind, I've got a checklist of these 11 lesions here.

Yeah. And I can identify the South African flag sign. That's right. I can identify Wellins, I can identify de winters and I can identify, you know, film langers, all these new patterns, right? I can identify that [00:27:00] potential. It's like, Hey, you know what? I studied and you say this better than anybody. What do you study when you're looking for counterfeit bills?

Matt: Oh yeah, you studied the real thing.

Erik: Study the real thing. 

Matt: Normal sinus rhythm. 

Erik: Yeah, that's exactly right. So if you study normal and you see something that's not normal. Oh my gosh. There's something wrong here. That's when you pull these things out, you start, okay. Oh, you know what this looks like. South African flag sign.

I'm gonna pull this. Sure Enough. S St. Elevation in one s, St. Elevation in a VL and V two with St. Depression in lead [00:27:30] three. Yeah. Wow. I think I got one. And then you And this patient transmitted it transmitted and this patient looks sick. Yes. Yes. Yeah, that's right. 

This one good thing about this article is, and I'll, like I said, I'll put a link in there.

Yeah. Is that it has a great. Diagram a breakdown of each one of these signs. It does with pictures of what the leads of the, the changes look like. Yep. So that I'm gonna take that personally and laminate it mm-hmm. And put it in my protocol book on my ambulance. Yep. That way, if that happens, because again, it's just like I said, [00:28:00] with scara. Yep. 

Matt: It's gonna be hard to memorize these, but once you start to use them, it'll take time. And if you, every time you do a 12 lead, you pull that out over time, it's gonna get stuck in your brain. That's, and you're gonna have 'em memorized. Yep. You know, if you're using 'em a lot. But again, reference that, send off your 12 lead and say, Hey Doc, this is what I think's going on.

Can you double check me? 

Erik: Yep. And I, and then. And I love it that you said that because it's the, that's the danger is, is relying too much on technology. That's right. And, uh, I, and I fall into the same [00:28:30] bucket, uh, when I'm in the ER wanting to rely on a CT scan. Mm-hmm. You know, there's nothing that can ever replace my hands on a patient's abdomen.

Matt: That's right. 

Erik: Palpating, in fact, one of our colleagues mm-hmm. 

Matt: Recently. Yep. 

Erik: I was with him. Yep. I did the belly exam at our conference room table downstairs. Mm-hmm. I'm like, wow, this exam is impressive for an appendicitis. I took him to the er, er doctor hardly touched him and said, that's probably a gallbladder, and uh, I'm gonna, I'll [00:29:00] get the ultrasound.

I don't think we need to do a ct. Hmm. I kind of looked at his exam and I looked, I knew what my exam was. Mm-hmm. And I said, I think I'd examine him again and I'd really. Want to have you consider getting a CT scan. I'm concerned about it, this being an appendicitis and sure enough, I mean, we knew it and it from the beginning, uh, you know, it, it wasn't a gallbladder right.

It was appendic. He went to the operating room for an appendicitis. My point for that is CT scans are great. They're [00:29:30] confirmatory studies. Mm-hmm. But you've gotta be good with your, with your, your own assessment. Yeah. You know, your own. Recognition of this not being a normal EKG and then, and then identifying the potential pattern, transmitting it.

Matt: Yep. 

Erik: Communicating your concerns and getting 'em to the right hospital at the right amount of time. It's a good way to end it. See you the next one. Be safe out there.

Narrator: Thank you for listening to EMS, the Erik and Matt [00:30:00] show.