Cast as wide a net as you can STEMI care starts with recognition, which requires capturing a 12-lead ECG as early as possible on any patient with possible ACS.

Perform a 12-lead ECG with the first set of vital signs on patients with any of these symptoms: chest discomfort (often described as a heaviness or pressure that may radiate into the left arm, jaw or shoulder), shortness of breath, nausea, vomiting, weakness, or syncope. STEMIs can sometimes present with atypical symptoms; especially in elderly, female, and diabetic patients. STEMIs also evolve and may not be evident on an initial ECG, so keep the leads connected and perform additional 12-leads during transport.

Also, keep in mind that prehospital ECG abnormalities may resolve by the time the patient receives a 12-lead in the Emergency Department. As a result, prehospital ECGs also have the potential to change the ED management of patients who are not experiencing a STEMI.

Also, remember to repeat an 12-lead when pain increases and mark on the 12-lead the patients pain scale, for example: with x/10 pain). This helps interpret the 12-leads in hospital, even if there is no **ACUTE MI** or **STEMI**.

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