ECG Challenge: A horse or a zebra?
EMS responds to a 68-year-old male with chest discomfort. Should the treating paramedic call a Code STEMI? Part 1 of 2
By Tom Bouthillet
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EMS is called to the residence of a 68-year-old male with a chief complaint of chest discomfort.
On arrival the patient is found tripoding at the edge of his bed. He is awake, alert and oriented to person, place, time and event.
- Onset: At rest while using the computer
- Provoke: Nothing makes the pain better or worse
- Quality: Patient describes the pain as a “pressure on his chest” at the nipple line
- Radiate: Tingling in the right arm
- Severity: Severity rated 5/10
- Time: Pain started 30 minutes prior to 911 call
The patient is observed to be anxious and diaphoretic. He denies nausea and vomiting.
Past medical history: GERD, Bladder CA, Mild HTN, Recent sore throat and cough
Medications: Omeprazole (Prilosec), Ranitidine (Zantac)
Vital signs are assessed.
- RR: 18
- HR: 100
- NIBP: 158/92
- Temp: 99.2°F
- SpO2: 97 on RA
Breath sounds: clear bilaterally
The cardiac monitor is attached.
A 12-lead ECG is obtained.
Should the treating paramedic call a Code STEMI?