Hesham,
There’s just a tiny bit of ST depression….less than a 1/2 mm. I’m not sure what to make of that. Normally if I clearly see ST depression, I feel that it strongly rules out pericarditis and points toward true STEMI, but this is so small, I’m not sure I would make a definitive decision based on that. Also, then, you’ve got the Spodick sign to deal with, and some PR depressions. It’s not easy, and very easy to talk yourself into or out of something. But the key here, and in the other cases, is much more simple: LV + tachy = pericardial effusion until proven otherwise. Take a look with the U/S or even a dry CT.

Jonathan,
I would probably only routinely do the u/s before lytics if I saw LV, but it certainly would be reasonably to do a (quick!) u/s in all of your presumed STEMI patients before lytics, as long as you aren’t delaying things too much.
Thanks everyone.
Amal

hey, good point about Baymax! No doubt he has low voltage also!