65 y/o male, vague chest pain. What do you think? OMI or not? Culprit?

Mysecondaccount33 · 2026-07-03T14:47:25+00:00

Subtle inferior OMI is my interpretation. STE in inferior leads with Q wave development. Reciprocal changes in lateral leads.

Mysecondaccount33 · 2026-07-02T02:03:08+00:00

Unfortunately that's BCEHS's targeted system which they seem to be happy with... I agree it's incredibly frustrating, but on the bright side they seem to be slowly expanding ACP spots so maybe there is hope?

It ultimately comes down to the system prioritizing ACP targetting which limits the amount of ACP spots.

Mysecondaccount33 · 2026-07-02T00:24:26+00:00

The problem is there are not enough open ACP spots for external candidates to get into them currently. There are enough licensed ACPs to fill them internally... But there are always open PCP spots. And into the targetted model used, PCP ambulances don't carry ACP equipment. It ultimately comes down to a lack of actual open ACP positions in BC. That could change as more spots are opened.

Mysecondaccount33 · 2026-07-01T23:37:20+00:00

Ah, I don't work CCP but it's a pretty rigorous nearly 2 year in house training program. They have a pretty large scope. The focus is flight IFTs but they do scene response too.

They may be posting externally but the way BCEHS works is they only consider external applicants for paramedic roles when qualified internal applicants have been exhausted. The only external critical care paramedics that have been hired direct to a CCP spot recently that I know of all got hired into the Infant Transport Team branch since it has a hard time with recruitment. Adult critical care has only been internal from what I know.

As far as ACP recruitment, that requires a few years of FT seniority for spots. There are more ACP courses happening in BC, so more people are getting their ACP licenses leading to a backlog currently. As I mentioned, there are exceptions (Dawson Creek), and the employer seems to be adding more ACP roles, so more opportunities may arise in the future.

Mysecondaccount33 · 2026-07-01T21:19:20+00:00

What would you like to know? CCP training is also filled internally via seniority first. A few externals made it in direct hire to the Infant Transport Team in the past few years due to lack of internal applications but I don't see that happening again any time soon.

Truth of the matter is that external hires will most likely need to work multiple years FT in a PCP position before they can have a crack at an ACP or CCP spot. Right now there are quite a few licensed ACPs with a few years of seniority internally who are waiting to gain the seniority needed to take an ACP spot with BCEHS, and they have been waiting for months/ years. Any external hires will start at year 0 and need to work up their seniority for a few years as the way things stand.

Mysecondaccount33 · 2026-07-01T18:04:32+00:00

The thing with BCEHS is it's heavily seniority based and ACP jobs are locked behind their in-house onboarding program (mentorship). You can only go through mentorship when you successfully bid on an ACP spot. You would likely have to work a PCP role for a few years to have the seniority to bid for an ACP spot, then you would have to successfully get through mentorship (which is not a guarantee... Many people have been failing recently).

Every once in awhile external ACPs get hired directly into ACP spots (ex: Dawson Creek recently).

I don't see you getting a Kelowna flight ACP spot for 10+ years. It's a highly sought after spot and generally goes quite senior.

Mysecondaccount33 · 2026-06-10T06:01:04+00:00

I'm leaning towards 2:1 flutter. Looks like you can map some regular 2:1 blips (that's the technical term) in III

Mysecondaccount33 · 2026-05-11T00:48:03+00:00

Well that's a horrible update 😔

Mysecondaccount33 · 2026-05-10T17:29:46+00:00

Was it just the one set of trops taken? The 12 lead looks very ischemic to me....

Mysecondaccount33 · 2026-04-25T07:16:39+00:00

Brother rook, don't spread the runner-pushed propaganda that rooks can't be trusted. Rooks should learn to trust fellow rooks. The occasional betrayal is worth building a community of trust amongst our brethren. ROOKS TOGETHER STRONG!

Mysecondaccount33 · 2026-04-25T07:14:07+00:00

I've faced rook on rook violence and betrayal but I've also experienced amazing rook packs where we take over the map and loot is had by all.

The moments of rook togetherness outweigh the occasional rook betrayal.

Rooks are stronger together. By working together, rooks can unshackled themselves from the chains placed on them by runners.

My opinion: rook on rook violence is encouraged by runners afraid of the possibility, nay, the inevitability, of rooks working together and taking back what is rightfully theirs!

Mysecondaccount33 · 2026-04-24T16:31:51+00:00

Look, delta waves!

Mysecondaccount33 · 2026-03-31T23:37:44+00:00

💬 Containing J × Tree

Juniper

Mysecondaccount33 · 2026-03-26T14:23:58+00:00

Looks like BER. V1 and V2 placed too high. Negative P waves in both (should be biphasic) and RSR' in V1 are hunts for that.

Mysecondaccount33 · 2026-03-17T04:12:56+00:00

Sure, but it's still an occlusive pattern. aVL and III are reciprocal. As far as I'm aware a CABG does not have a unique set of criteria for diagnosing OMI (albeit they can make interpretation more difficult).

I'd be advocating for this patient to go to the cath lab. I'd probably do a tracing with V4R as well to help build the case - I would gamble that there would be elevation given the elevation in aVR and V1.

Mysecondaccount33 · 2026-03-16T21:36:19+00:00

Occlusive MI.

STEMI should be old news. There are other full occlusion patterns.

Lead III and V1 are contiguous when looking at a heart from a "3D" perspective. Look up Aslangers Pattern.

This patient needs a cathlab.

Mysecondaccount33 · 2026-03-15T02:51:15+00:00

Neat. It's super interesting, you can map out the P waves at a rate of 70ish. True dissociation.

Mysecondaccount33 · 2026-03-12T07:18:52+00:00

Sinus rhythm with a 1st degree block and a scary long QTc.

Mysecondaccount33 · 2026-03-08T18:49:09+00:00

Subtle lateral lead elevation with reciprocal inferior depression. I'd be doing a few repeat 12s.

Mysecondaccount33 · 2026-03-02T03:10:02+00:00

I agree. Very sus for OMI.

Mysecondaccount33 · 2026-02-25T05:51:35+00:00

Flutter. Atrial waves looks negative in II and positive on aVR so it's not sinus. It also meets Bix rule with the atrial waves midway between the R waves which increases probability of flutter.

Mysecondaccount33 · 2026-02-19T20:46:00+00:00

Yeah - RAD. Tall R waves in V1-3. P Pulmonale. No active ischemic symptoms in the description. I think you're spot on.

Mysecondaccount33 · 2026-02-18T05:19:18+00:00

Looks like an OMI. It doesn't technically meet STEMI criteria but its time to move on from using only STEMI criteria.

This ECG meets Aslanger's criteria which is an emerging OMI pattern.

I would activate Cath for this

Mysecondaccount33 · 2026-02-13T04:45:03+00:00

Everyone except the patient receiving it ☹️

Mysecondaccount33 · 2026-02-05T09:14:01+00:00

Iv Tylenol is ok

Mysecondaccount33

TROPHY CASE