UPDATED: 2/21/2008 - Patient Follow-Up Posted.  CLICK HERE FOR THE ANSWER

CALL FOR SUBMISSIONS! Do you have a cardiac-related case in your head that you think would challenge other responders? The EKG Club wants to hear from you. The EKG Club is currently looking for case submissions to be featured on EMS1. Don't worry about your writing skills — just send us the facts. To submit a cardiac case idea, email EKGcase@EMS1.com.

EKG Case Presentation:
One fine afternoon you are dispatched to the home of a 74-year-old female, who has impaired mobility, to aid in her transfer to your regional hospital.

After arrival, you are greeted at the door by a pleasant elderly female who uses a walker to move around. As you sit down to assess her medical condition, you notice that she carefully moves from place to place and indeed requires assistance to stay mobile. She quickly notes that she has had previous falls over the last few years and now relies on a walker.

The patient calmly explains to you that she visited her cardiologist three days ago for a routine check of her hypertension, which has been successfully treated by the same physician for the last 15 years. Stemming from this visit, the cardiologist ordered a holter test, although the patient did not recall any recent episodes of palpitations, dizziness or chest pain. She dutifully carried out the doctor's orders and returned the holter machine the next day.

About 45 minutes ago, the cardiologist called her and asked her about the previous 24-hour period and, specifically, the holter test. Your patient says that she felt the test went fine and that it would prove to be non-diagnostic. The patient says that the cardiologist calmly explained to her that he wanted to carry out some further tests on her as soon as possible.

The patient summoned your help because her only daughter is out-of-town and is unable to return on such a short notice due to distance. She also mentions the fact that she does need physical assistance.

Initial Assessment:
You reassess your patient and determine that you still standing in front of a healthy looking 64-year-old female, in no apparent distress, without a particular chief complaint, or any signs or symptoms that warrant your immediate treatment. Nonetheless, you and your partner are more than happy to help such a sweet woman, especially since it has been an uncommonly uneventful day.

You document your patient care report with the proper information and the following vital signs:

HR 31
RR 18
BP 146/78
SpO2 98%

Past Medical History:
Hypertension 
Diabetes Type 2 
Osteoporosis

Allergies: 
Aspirin

Meds: (generic names) 
Metformin 850mg 
Enalapril 20mg 
Amlodipine 5mg

Initial Assessment:
You double-check the screen's interpretation with your actual physician measurement and confirm the patient's radial pulse is at 31 bpm. You utter the words, "Ma'am, are you feeling ok?” She denies any signs and/or symptom in any shape or form. Nonetheless, you quickly place the EKG leads and this is your print out:

Initial EKG (click for larger image):

 

This is the EKG that you are given. The computed interpretation is not available. (*Note: The EKG Club encourages you to print out the EKG and use calipers to completely analyze the EKG.)

 

 

Routine EKG Interpretation: Rate & Rhythm P-wave PR interval QRS interval QRS complex & mean axis ST segment T wave U wave QT interval

Case 13 Discussion Questions:

• Your quick-combo pads are able to monitor, defibrillate, cardiovert and pace each and all patients. Which of these, if any, would you carry out? Why?
• What is the rhythm being displayed?
• What treatments should be considered and why would you choose a particular treatment?
• Does this patient require a red lights and siren rapid transport to the hospital? Why or why not?
  
  

UPDATED: 2/21/2008 - Patient Follow-Up Posted.  CLICK HERE FOR THE ANSWER