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Home > Topics > Cardiac Care
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EMS 12-Lead
by Tom Bouthillet

ECG Challenge: Winter, spring or summer

How would you treat 68-year-old male complaining of chest pain, grayish in color but very warm and diaphoretic?

By Tom Bouthillet

EMS is called to the residence of a 68-year-old male complaining of chest pain.

The patient was working in the yard when symptoms began.

At the time of EMS arrival, the patient appears acutely ill. He is grayish in color but very warm and diaphoretic. He is nauseated and has vomited prior to EMS arrival.

Past medical history: Hypertension, dyslipidemia
Medications: Hyzaar (HCTZ and losartan), Mevacor (lovastatin)
Onset: 30 minutes prior to EMS
Quality: Pressure or heaviness
Radiate: The pain does not radiate
Severity: 9/10

Nothing makes the pain better or worse. The patient says he has had no previous episodes, "at least not like this." 

Vital signs are assessed:

  • RR: 20
  • HR: 74
  • NIBP: 110/75
  • SpO2: 92 on RA

The patient admits to mild dyspnea although breath sounds are clear bilaterally.

The cardiac monitor is attached.

A 12-lead ECG is obtained.

You are 20 minutes from the local community hospital and 40 minutes from a PCI center.

What is your interpretation of this ECG?

Should you call a Code STEMI?

How would you treat the patient?

About the author

Tom Bouthillet is a Fire Captain/Paramedic with Hilton Head Island Fire & Rescue, Editor-in-Chief of the, Chief Content Architect of, host of the Code STEMI web series at First Responders Network, a member of the Editoral Advisory Board of EMS World Magazine, and developer of the 12-Lead ECG Challenge smartphone app. He has taught nationally in the Critical Care Transport (CCEMT-P) program out of UMBC and his writings have been referenced in the American Heart Journal, the Journal of the American College of Cardiology: Cardiovascular Interventions and the EP Lab Digest. Contact Tom at
The comments below are member-generated and do not necessarily reflect the opinions of or its staff. If you cannot see comments, try disabling privacy and ad blocking plugins in your browser. All comments must comply with our Member Commenting Policy.
Mohamed Wafiq Shoukry Mohamed Wafiq Shoukry Tuesday, April 15, 2014 4:43:19 AM Diffuse ischemia ... LMCA vs multi vessels disease . Activate Cath lab
Casey Cardwell Casey Cardwell Tuesday, April 15, 2014 5:05:56 AM Winter, spring or summer? Dewinter.
Joel Bashore Joel Bashore Tuesday, April 15, 2014 6:18:15 AM Cardwell is spot on. DeWinter T waves = STEMI equivalent. High LAD occlusion. Life In The Fast Lane recently had a great article on this:
Maziar Sadri Maziar Sadri Tuesday, April 15, 2014 4:01:13 PM Time is muscle guys. More agree with Thrombolytic if no contraindication.
Nesrine Ben Ahmed Nesrine Ben Ahmed Wednesday, April 16, 2014 3:24:16 AM
David Martinez Pueyo David Martinez Pueyo Saturday, August 30, 2014 5:17:34 AM Could be a left common trunk oclusion? ST elevation in aVr and V1 (first higer than second) with difuse ST depression.
Phil Smith Phil Smith Saturday, August 30, 2014 9:00:05 AM Left main stem blockage due to elevation in AVR
Gold Sunday Palm Tampubolon Gold Sunday Palm Tampubolon Monday, September 01, 2014 6:04:32 AM What about Right ventricular infarction? Need to be catetherized for stenting and measuring chamber pressure at once.

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