EMS is called to a community event for a patient who experienced a syncopal episode. On arrival, the patient is found slumped back in a chair with a cold, moist towel on his head. His eyes are closed, he is groaning, and appears acutely ill with pale and diaphoretic skin.
Bystanders say that he passed out and hit his head. There are minor abrasions to the top of his head. When asked whether or not he passed out, the patient says, “I think so.”
His chief complaint is chest discomfort.
- Onset: Symptoms started about 30 minutes ago while setting up a concession stand.
- Provoke: Nothing makes the pain better or worse.
- Quality: Pain is described as a constant pressure.
- Radiate: The pain does not radiate.
- Severity: The patient gives the pain a 5/10.
- Time: No previous episodes.
Past medical history: Unknown. Patient states he has never been to the doctor.
Vital signs are assessed.
- RR: 18
- HR: 64
- NIBP: 108/78
- SpO2: 97% on room air
The patient is placed on oxygen via nasal cannula @ 2 LPM.
The cardiac monitor is attached.
A rhythm change is noted on the monitor.
Now there are bigeminal PVCs — very close to R-on-T. Combipads are placed but paramedics hold off on antiarrhythmics.
For the conclusion including angiograms: