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EMS 12-Lead
by Tom Bouthillet

ECG Challenge: The Right Stuff

EMS is called to residence of an 84 year old female complaining of chest pressure. Sensation resolved by EMS arrival.

By Tom Bouthillet

Editor's note: Check out this month's ECG case study and submit your treatment plan in the comments below. Get it right and you could win an EMS1 T-shirt and bottle opener. Good luck!

--> UPDATED: 07/12/2011 - Patient Follow-Up Posted. CLICK HERE FOR THE ANSWER

This case was submitted by a faithful reader named Patrick from Cape Code, MA. Some minor changes have been made to help preserve patient confidentiality.

EMS is called to residence of an 84 year old female complaining of chest pressure. Sensation resolved by EMS arrival.

Onset: 15 minutes prior to 9-1-1 call.
Provoke: Rest and deep breathing seems to have resolved the symptoms.
Quality: Sensation described as "pressure."
Radiate: The sensation did not radiate.
Severity: 5/10
Time: No previous episodes. Episode lasted about 20 minutes.

Past medical history: Stroke with mild left-sided weakness, HTN, pacemaker
Medications: ASA, Coumadin, Toprol XL

The patient also states she felt like she "had something in her throat," became nauseated, had dry heaves, and had become sweaty.

She states that she feels better now and states that she doesn’t want to go to the hospital.

Skin is slightly pale and moist.

Vital signs are assessed.

RR: 18
Pulse: 60
BP: 108/56
Temp: 98.1

SpO2: 98 on RA

BGL: 118

The patient is placed on the cardiac monitor.

A 12-lead ECG is captured.

What is your interpretation of these ECGs?

Should this patient go to the hospital?

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-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.
Adam Lomax Smith Adam Lomax Smith Wednesday, March 12, 2014 6:46:02 AM Paced rhythm, atrial pacemaker 1st degee Av block. Heart rate approximately 60, Left axis deviation and reversed R-wave progression. Sgarbossa criteria for wide paced -inappropriate concordant ST elevation in V1 and V2 probable MI. Check lead position and telemetry to PPCI lab. I could very wrong but could this patient have dextrocardia or the leads are in the wrong place?
Kelly C Lind Kelly C Lind Wednesday, March 12, 2014 7:09:40 AM Septal MI with inverted T waves in Lead 3. 1st degree AV Block. Possible atrial hypertrophy with inverted P waves in leads V1 through V3.

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