Early bird gets the worm
Can you interpret these ECGs?
By Tom Bouthillet
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.
SpO2: 99 on RA
The patient denies chest discomfort. He admits to nausea but has not vomited.
Breath sounds are clear bilaterally.
A 12-lead ECG is captured.
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?