|
ECG Challenge: Just a little depression
EMS is called to a 66 year old male complaining of chest pain. On arrival the patient is found sitting in a chair outside his residence. He had apparently been gardening when he became acutely ill.
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 month we're trying something a little different and withholding the computerized interpretation until the solution is posted.
EMS is called to a 66-year-old male complaining of chest pain.
On arrival the patient is found sitting in a chair outside his residence. He had apparently been gardening when he became acutely ill.
Onset: 30 minutes prior to EMS arrival
Provoke: Nothing makes the pain better or worse
Quality: "Crushing pressure"
Radiate: The pain does not radiate
Severity: 10/10
Time: He admits to having an episode of chest pain 1 week ago "but not like this"
Past medical history: HTN, high cholesterol, cholecystitis
Medications: ASA, lisinopril, rosuvastatin
Skin is cool, pale and diaphoretic.
Breath sounds are clear bilaterally.
The patient denies shortness of breath but admits to nausea. He has not vomited.
Vital signs are assessed.
RR: 12
Pulse: 68
BP: 98/54
Temp: 98.0
SpO2: 98 on RA
BGL: 108
The patient is placed on the cardiac monitor.
A 12-lead ECG is captured with the following computer measurements.
HR: 66
PR: 170
QRS: 116
QT/QTc: 440/461
P-QRS-T: 37 -49 177
What do you think of this 12-lead ECG?
Would you call a STEMI Alert based on this 12-lead ECG? Why or why not?
How would you treat this patient?
Sanskrit Pranamedic Monday, March 18, 2013 10:09:54 AM 3-vessels disease - STEMI equivalent. 6+ leads depression (I, II, aVL, V4, V5, V6, marginal in aVF and V3), >1mm elevation in aVR and V1 with aVR > V1; plus pt presentation, plus pt c/c - activate STEMI.
treat - check allergies, 2 IVs, 250ml bolus NS titrate > 100mmHg systolic, ASA 324mg PO (depending on if/how much pt has taken of his own), if no viagra, etc., 1mcg/kg Fentanyl, consider contacting Med Control if no pain relief /c Fentanyl and BP titratable > 100systolic to consider NTG 0.4 SL. Continue to check LS, check BGL, etc., /c serial V/S check and 12 Lead ECGs. 
