EMS1.com News

November 21, 2010

EMS 12-Lead
by Tom Bouthillet

Early bird gets the worm

Can you interpret these ECGs?

By Tom Bouthillet

UPDATED: 12/07/2010 - Patient Follow-Up Posted. CLICK HERE FOR THE ANSWER

EMS is called a "Wellness Center" (it would prove to be a chiropractor's office) for a 20-year-old male with a near syncopal episode.

On arrival the patient is found sitting in a chair with his head between his legs. He is pale and diaphoretic and appears acutely ill.

The patient's chiropractor states that he was adjusting the patient's spine when the patient complained that he didn't feel well.

The chiropractor sat the patient down on the end of the exam table and the patient suddenly "went limp."

The chiropractor caught the patient and laid him down flat. The patient recovered, sat up, insisted on standing, promptly "went limp" again and was placed in a chair.

The chiropractor contacted 911.

Past medical history: "Back problems"

Medications: Vicodin, Skelaxin, Flexeril

Vital signs are assessed.
RR: 18
Pulse: 56
BP: 92/48
SpO2: 99 on RA
BGL: 118

The patient denies chest discomfort. He admits to nausea but has not vomited.

Breath sounds are clear bilaterally.

A 12-lead ECG is captured.

And another.

You are 15-minutes from the local non-PCI hospital and 45-minutes from a STEMI Receiving Center.

How would you treat this patient and why?

About the author

Tom Bouthillet is a Fire Captain/Paramedic with Hilton Head Island Fire & Rescue, Editor of the EMS 12-Lead blog, 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 tom.bouthillet@ems1.com.

Comments

The comments below are member-generated and do not necessarily reflect the opinions of EMS1.com or its staff.

Dawn Altman Monday, March 05, 2012 2:00:49 PM Although he has the ST segments to support acute pericarditis, he should not be fainting as a result. He also does not have PR segment depression, although he does have PR elevation in aVR. Do not know if he is febrile. Due to the fact that he has a relatively low BP, takes pain meds and a muscle relaxant, has no chest discomfort, appears poorly perfused, and loses consciousness upon sitting and standing, I vote for postural hypotension. I would try fluid replacement first, and followup at the closest hospital.