Make this page my home page
  1. Drag the home icon in this panel and drop it onto the "house icon" in the tool bar for the browser

  2. Select "Yes" from the popup window and you're done!

Home > Columnists > Tom Bouthillet
All Articles

EMS 12-Lead
by Tom Bouthillet

ECG Challenge: Nitroglycerin, right?

To give or not to give, that is the question

By Tom Bouthillet

Editor's note: Check out this month's ECG case study and submit your treatment plan in the comments below. If Tom selects your plan as the best, you could win an EMS1 T-shirt and bottle opener. Good luck!

EMS is called to the residence of a 67-year-old male complaining of shortness of breath.

At the time of EMS arrival the patient walks out of the bedroom into the living room and slumps over onto the gurney in obvious distress.

Past medical history: Hypertension, GERD, Prostate CA
Medications: Prinivil (lisinopril), Norvasc (amlodipine), Prevacid (lansoprazole)

The patient appears anxious. His skin is dusky and diaphoretic.

He states that he was short of breath "on and off" all night and had planned on playing tennis in the morning but "felt way too bad."

Vital signs are assessed.

  • RR: 18
  • HR: 34
  • NIBP: 108/50
  • SpO2: 97

The patient states that he became "much worse" after ambulating from the bedroom to the living room. As he calms down his respiratory rate comes down to about 28.

Breath sounds: diminished bilaterally

The patient is placed on oxygen via NRB mask @ 15 LPM as the cardiac monitor is attached.

A 12-lead ECG is obtained.

What is the heart rhythm?

What do you think of the 12-lead ECG?

Would you activate the cardiac cath lab?

How would you treat this 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.

EMS1 Offers

Breaking EMS News

Line-Of-Duty Deaths

Featured Columnists

EMS Pioneers

Mike Rubin - EMS Pioneers

After 30 years in EMS, Harry Murphy is still a student

The La. medic has learned to bring his principles and ethics to work and shape a job around that, rather than...


Product Categories