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Chest Pain  EMS Implications Wayne Guerra MD, MBA Porter/Littleton/Parker Adventist EMS Pain is inevitable; suffering is optional.
Before I refuse to take your questions, I have an opening statement. Ronald Reagan  Wayne Guerra MD, MBA
Objectives ,[object Object],[object Object],[object Object],[object Object],[object Object],Experience is something you don't get until just after you need it. Wayne Guerra MD, MBA
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
To EMS or Not EMS? ,[object Object],[object Object],[object Object],http://heartdisease.about.com/cs/heartattacks/a/chestpainEMS.htm Wayne Guerra MD, MBA
www.iTriageHealth.com Wayne Guerra MD, MBA Differential Diagnosis of Chest Pain is Vast
Possible Causes ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
History ,[object Object],[object Object],[object Object],[object Object],[object Object],JAMA. 283(24):3223–3229, 2000 Wayne Guerra MD, MBA
“ Atypical” Chest Pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Circulation,  III: e435-e437, 2005  Wayne Guerra MD, MBA
“ Atypical” Chest Pain ,[object Object],[object Object],[object Object],[object Object],Arch Intern Med. 145: 65-69, 1985.  Wayne Guerra MD, MBA
“ Atypical” Chest Pain ,[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
“ Atypical” Chest Pain ,[object Object],[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
History ,[object Object],[object Object],Wayne Guerra MD, MBA
History ,[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Physical ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],http://bit.ly/2o0U2N Wayne Guerra MD, MBA
BP Discrepancy http://bit.ly/hkAZE Wayne Guerra MD, MBA
Diagnostics Wayne Guerra MD, MBA
EKG Get One You Can Read! Wayne Guerra MD, MBA
Stratergery For A Good Tracing  ,[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Importance of CVD an ACS ,[object Object],[object Object],http://bit.ly/hkAZE Wayne Guerra MD, MBA
EKG Mimics of MI ,[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
LVH With Strain ,[object Object],[object Object],Wayne Guerra MD, MBA
Early Repolarization Wayne Guerra MD, MBA
Acute Pericarditis PR depression ST Elevation Wayne Guerra MD, MBA
LV Aneurysm Wayne Guerra MD, MBA
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
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
Acute Anterior MI Wayne Guerra MD, MBA
Acute Ant-Lat MI Wayne Guerra MD, MBA
Acute Inferior MI Wayne Guerra MD, MBA
Acute Posterior MI http://bit.ly/2Klwk2 Wayne Guerra MD, MBA
Acute Right Ventricular MI Wayne Guerra MD, MBA
Cardiac Alert Wayne Guerra MD, MBA
Acute MI and LBBB ,[object Object],[object Object],[object Object],[object Object],http://bit.ly/2g9EcZ Wayne Guerra MD, MBA
Unstable angina ,[object Object],[object Object],[object Object],[object Object],[object Object],http://bit.ly/PlrtS Wayne Guerra MD, MBA
Pulmonary Embolus ,[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Pulmonary Embolus Increased Risk ,[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Pulmonary Embolus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Pulmonary Embolus ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
S1Q3T3 Wayne Guerra MD, MBA
Aortic Dissection ,[object Object],[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Aortic Dissection ,[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Esophageal Rupture ,[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Esophageal Rupture ,[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Esophageal Rupture ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Esophageal Rupture ,[object Object],[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Tension Pneumothorax ,[object Object],[object Object],Wayne Guerra MD, MBA
Tension Pneumothorax ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Tension Pneumothorax EMS Treatment ,[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Needle Thoracostomy ,[object Object],[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Wayne Guerra MD, MBA
Case 1 ,[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Case 1 Wayne Guerra MD, MBA
Case 1: EKG After 1 NTG Diagnosis? Wayne Guerra MD, MBA
Prinzmetal's Angina ,[object Object],[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
Case 2 ,[object Object],[object Object],[object Object],[object Object],[object Object],Wayne Guerra MD, MBA
EKG with CP Wayne Guerra MD, MBA
Pain Free After 1 NTG Diagnosis? Wayne Guerra MD, MBA
Wellens Syndrome ,[object Object],[object Object],[object Object],http://bit.ly/15RAYb Wayne Guerra MD, MBA
Wayne Guerra MD, MBA

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Chest Pain: EMS Review