ECG Challenge: Winter, spring or summer

How would you treat 68-year-old male complaining of chest pain, grayish in color but very warm and diaphoretic?

EMS is called to the residence of a 68-year-old male complaining of chest pain.

The patient was working in the yard when symptoms began.

At the time of EMS arrival, the patient appears acutely ill. He is grayish in color but very warm and diaphoretic. He is nauseated and has vomited prior to EMS arrival.

Past medical history: Hypertension, dyslipidemia
Medications: Hyzaar (HCTZ and losartan), Mevacor (lovastatin)
Onset: 30 minutes prior to EMS
Quality: Pressure or heaviness
Radiate: The pain does not radiate
Severity: 9/10

Nothing makes the pain better or worse. The patient says he has had no previous episodes, "at least not like this." 

Vital signs are assessed:

  • RR: 20
  • HR: 74
  • NIBP: 110/75
  • SpO2: 92 on RA

The patient admits to mild dyspnea although breath sounds are clear bilaterally.

The cardiac monitor is attached.

A 12-lead ECG is obtained.

You are 20 minutes from the local community hospital and 40 minutes from a PCI center.

What is your interpretation of this ECG?

Should you call a Code STEMI?

How would you treat the 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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