ECG Challenge: The court's verdict?

How would you treat this patient and why?

Editor’s Note:

Editor's note: Check out this month's ECG case study and submit your treatment plan in the comments below. If Tom selects your plan as the best, you could win an EMS1 T-shirt and bottle opener. Good luck!

EMS is called to a local tennis court for a 63-year-old male complaining of chest pain.

At the time of EMS arrival, the patient is found sitting on a bench.

Past medical history: Cataract, erectile dysfunction

Medications: Cialis (tadalifil)

The patient appears acutely ill. He is pale, warm, and diaphoretic.

Vital signs are assessed.

  • RR: 18
  • HR: 74
  • NIBP: 127/65
  • SpO2: 97 on RA

Breath sounds: clear bilaterally

The patient is placed on oxygen via NC mask @ 4 LPM as the cardiac monitor is attached.


A 12-lead ECG is obtained.

What do you think of the 12-lead ECG?

Is the local community hospital appropriate or should the patient be transported straight to a PCI-capable facility?

How would you treat this patient?

About the author

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

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