|
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?
Eric Kindle Wednesday, August 01, 2012 12:34:28 PM STEMI! STE, q-waves, N/V, chest discomfort, diaphoresis, cardiac history..Being elderly, female, and having had a stroke I would expect atypical or even no discomfort, so the fact that it is gone upon EMS arrival wouldn't make me feel warm and fuzzy. So, yeah, transport! Serial EKG's, 1-2 IV's, fluids based on BP/lung sounds, ASA/Nitro per protocol (hesitant with nitro), Zofran for N/V. Dopamine if cardiovascular status goes way downhill? especially if you have an extended transport time. 
Eric Kindle Wednesday, August 01, 2012 1:31:45 PM Bob, click "ECG Challenge: The Right Stuff" link above for the case study/vitals/ECG's. This page and 'Prehospital 12-lead ECG blog' are great learning tools for ECG/Cardiology!!!
Ben Williams Thursday, January 17, 2013 7:03:07 AM Occlusion of either the septal branch coming off the LAD or possibly the conal branch coming off the RCA...so some vitamin diesel/ASA/O2 and a cath 
Branka Ilic David Sunday, January 20, 2013 5:40:50 AM it seems like he need a new battery for pacemaker. 
