ECG Challenge: A horse or a zebra?

EMS responds to a 68-year-old male with chest discomfort. Should the treating paramedic call a Code STEMI? Part 1 of 2

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EMS is called to the residence of a 68-year-old male with a chief complaint of chest discomfort.

On arrival the patient is found tripoding at the edge of his bed. He is awake, alert and oriented to person, place, time and event.

  • Onset: At rest while using the computer
  • Provoke: Nothing makes the pain better or worse
  • Quality: Patient describes the pain as a “pressure on his chest” at the nipple line
  • Radiate: Tingling in the right arm
  • Severity: Severity rated 5/10
  • Time: Pain started 30 minutes prior to 911 call
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The patient is observed to be anxious and diaphoretic. He denies nausea and vomiting.

Past medical history: GERD, Bladder CA, Mild HTN, Recent sore throat and cough

Medications: Omeprazole (Prilosec), Ranitidine (Zantac)

Vital signs are assessed.

  • RR: 18
  • HR: 100
  • NIBP: 158/92
  • Temp: 99.2°F
  • SpO2: 97 on RA

Breath sounds: clear bilaterally

The cardiac monitor is attached.
















A 12-lead ECG is obtained.












Should the treating paramedic call a Code STEMI?

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