Mirror on the wall

Can you interpret these ECGs?

Editor’s Note:

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: 03/31/2011 - Patient Follow-Up Posted.  CLICK HERE FOR THE ANSWER

Here's a great case submitted by a faithful reader named Joshua Nackenson, NREMT-P from New York (@MedicJosh on Twitter). Some changes have been made to preserve patient confidentiality.

EMS is called to the residence of a 68-year-old female with chest pain.

On arrival the patient is found lying in a left lateral recumbent position in the hallway outside the bedroom.

Fire department first responders are on scene and have already applied oxygen via NRB @ 15 LPM.

The patient appears acutely ill.

Skin is warm but pale and diaphoretic.

Past medical history: Hypertension, MI with stents x2 years ago
Medications: Not available at the time of assessment

The patient confirms that she is having severe chest pain.

Onset: Sudden onset while watching TV
Provoke: Nothing makes the pain better or worse
Quality: Poorly localized pressure in the center of the chest
Radiate: The pain does not radiate
Severity: 7/10
Time: 30 minutes duration with no previous episodes

Vital signs are assessed.

RR: 20
Pulse: 140 and irregular
BP: 82/42
SpO2: 100 on O2 via NRB @ 15 LPM

Breath sounds: clear bilaterally

No jugular venous distension or pitting edema is noted.

The cardiac monitor is attached.

A 12-lead ECG is captured..

What is your interpretation of this ECG? Describe your treatment plan in the comments below.

About the author

Tom Bouthillet is a Fire Captain/Paramedic with Hilton Head Island Fire & Rescue, Editor-in-Chief of the EMS12Lead.com, Chief Content Architect of ECGMedicalTraining.com, 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.

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