Trending Topics

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

EMS1ChallengeCoin-8.png

EMS1 Challenge Coin

Editor’s Note: Respond in the comment section, and whoever our columist determines has the best answer will receive an exclusive EMS1 Challenge Coin

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

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?

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.

RECOMMENDED FOR YOU