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.
