2/16/2014 1 Code STEMI or No Code STEMI Stuart P Swadron MD FRCPC FACEP FAAEM University of Southern California Improving Appropriateness of Emergent Cath Lab Activation 1. Avoid False Positives 2. Avoid False Negatives Code STEMI or No Code STEMI
2/16/2014
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Stuart P Swadron MD FRCPC FACEP FAAEMUniversity of Southern California
Improving Appropriateness of
Emergent Cath Lab Activation
1. Avoid False Positives
2. Avoid False Negatives
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CK-MB CK-MB Normal
200 ED Patients with Chest Pain and STE
• SYNDROME % PATIENTS
• LVH 25
• LBBB 15
• AMI 15
• Benign Early Repolarization 12
• RBBB 5
• Intraventricular Conduction Delay 5
• Aneurysm 3
• Pericarditis 2
• Undefined 18
Source: Brady WJ, Chari. Emergency Medicine Reports 19 (1998)
Plea for
sanity
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Plea for
sanity
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Plea for
sanity
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Give me 15 friggin’ minutes!
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LBBB and AMI
•CASE
• 47 year old male with chest pain x 2 hrs
• No previous cardiac history
LBBB and AMI
•CASE ONE
•VIDEOQuickTime™ and a
H.264 decompressorare needed to see this picture.
LBBB and AMI
•CASE ONE - EKG
LBBB and AMI
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LBBB and AMI LBBB and AMI
LBBB and AMI LBBB and AMI
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LBBB and AMI
BMJ 311 : 1660 (23 December 1995)
LBBB and AMI
Am Heart J 2011;161:698-704.
401 patients with CP and LBBB (New 64%)
116 patients (29%) had MI
MI
RATES
86% with concordant ECG changes
27% without concordant ECG changes
LBBB and AMI
•INAPPROPRIATE DISCORDANCE
LBBB and AMI
•EXCESSIVE CONCORDANCE
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Thank
you!
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mailto:[email protected]:[email protected]