ECG Challenge: Just a little depression

EMS is called to a 66 year old male complaining of chest pain. On arrival the patient is found sitting in a chair outside his residence. He had apparently been gardening when he became acutely ill.

July 27, 2011 09:35 AM •

Editor’s Note: Check out this month’s ECG case study and submit your treatment plan in the comments below. Get it right and you could win an EMS1 T-shirt and bottle opener. Good luck!

UPDATED: 07/12/2011 - Patient Follow-Up Posted. CLICK HERE FOR THE ANSWER

This month we’re trying something a little different and withholding the computerized interpretation until the solution is posted.

EMS is called to a 66-year-old male complaining of chest pain.

On arrival the patient is found sitting in a chair outside his residence. He had apparently been gardening when he became acutely ill.

Onset: 30 minutes prior to EMS arrival
Provoke: Nothing makes the pain better or worse
Quality: “Crushing pressure”
Radiate: The pain does not radiate
Severity: 10/10
Time: He admits to having an episode of chest pain 1 week ago “but not like this”

Past medical history: HTN, high cholesterol, cholecystitis
Medications: ASA, lisinopril, rosuvastatin

Skin is cool, pale and diaphoretic.

Breath sounds are clear bilaterally.

The patient denies shortness of breath but admits to nausea. He has not vomited.

Vital signs are assessed.

RR: 12
Pulse: 68
BP: 98/54
Temp: 98.0
SpO2: 98 on RA

BGL: 108

The patient is placed on the cardiac monitor.

A 12-lead ECG is captured with the following computer measurements.

HR: 66
PR: 170
QRS: 116
QT/QTc: 440/461
P-QRS-T: 37 -49 177

What do you think of this 12-lead ECG?

Would you call a STEMI Alert based on this 12-lead ECG? Why or why not?

How would you treat this patient?

EKG Monitoring

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.