Not so fast...

Can you interpret these ECGs?

January 05, 2011 06:47 AM •

Editor’s note: We’re pleased to introduce a new competition this month connected to “EMS 12-Lead.” Think you know what’s going on in this latest scenario? Read the details and the 12 Lead ECG below and submit your diagnosis and how you would treat this patient – get it right and you could win an EMS1 T-shirt and bottle opener. Enter your thoughts in the comments section. And good luck!

UPDATED: 01/20/2011 - Patient Follow-Up Posted. CLICK HERE FOR THE ANSWER

Here’s an interesting case submitted by Stephen Moorhead of Greenville County EMS.

EMS is called in the early morning to the residence of a 85-year-old male with a chief complaint of chest pain.

On arrival the patient is found sitting on the edge of his bed. He appears anxious and acutely ill.

His skin is pink, warm, and moist.

He states that he was awoken from sleep with severe chest pain.

Onset: 20 minutes prior to EMS arrival
Provoke: Nothing makes the pain better or worse
Quality: “Heaviness” and “constricting”
Radiate: The patient does not radiate
Severity: 10/10
Time: No previous episodes

Past medical history: HTN, dyslipidemia, MI, CABG, pacemaker

Medications: Lisinopril, metropolol, niacin, calcium

Vital signs:

RR: 20
Pulse: 136
BP: 150/96
SpO2: 96 on RA

The cardiac monitor is attached.

A 12-lead ECG is captured.

How would you treat this patient and why? Tell us in the comments below— get it right and you could win an EMS1 T-shirt and bottle opener.

Clinical

Tom Bouthillet, NREMT-P

Tom Bouthillet, NREMT-P, is the battalion chief of EMS for Hilton Head Island Fire Rescue. He is a member of NHTSA’s High Performance CPR Working Group, program director of the South Carolina Resuscitation Academy, member of the Editorial Advisory Board of EMS World, content reviewer for the British Paramedic Journal, co-producer of the Code STEMI web series, and editor of EMS12Lead.com. Tom is interested in system performance, process improvement, and evidence-based performance measures for time-sensitive diagnoses.

He graduated with a paramedic/paramedicine degree from Parma Community Hospital EMS Education Program. 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.