Skip to content

Archives for

See all posts in the network tagged with

58 year old female CC: Chest pain – Conclusion

8 comments

Here’s the conclusion to the 58 year old female with chest pain and left bundle branch block.

To refresh your memory here is the 12-lead ECG.

And for those of you who requested lead V4R.

This ECG meets all 3 of Sgarbossa’s criteria to identify acute STEMI in the presence of left bundle branch block.

Keep in mind, it only has to meet one criterion in one lead!

(Please note: One criterion has been modified from its original form. Instead of discordant ST-elevation > 5 mm we are looking for discordant ST-elevation > 0.2 the depth of the S-wave. This is known as the ST/QRS ratio. Credit to Dr. Smith of Dr. Smith’s ECG Blog.)

Angiography revealed 100% occlusion of the LCX and 99% occlusion of the RCA.

Thanks to everyone who commented on the case!

See also:

80 year old male CC: Chest pain

Excessive discordance as a marker of acute STEMI in LBBB

80 year old male CC: Chest pain – Conclusion

62 year old male CC: Chest pain (LBBB with ST-elevation > 0.2 the QRS complex)

Identifying AMI in the presence of LBBB – Sgarbossa’s Criteria Part I

Identifying AMI in the presence of LBBB – Sgarbossa’s Criteria Part II

“New” LBBB – What’s the big deal?

Discordant ST-segment elevation in LBBB or paced rhythm

Sgarbossa’s Criteria – New Graphic

Found on the Lifenet Receiving Station (LBBB with concordant ST-depression in leads V3 and V4)

Posted by on July 25, 2010 • Filed under: ems-topics, patient-management • Tagged: , , , , , , , , , , , , , , , , , , ,

58 year old female CC: Chest pain

22 comments

Here’s another case study from an international reader who wishes to remain anonymous.

Presenting Complaint – Chest Pain

History of Present Complaint – 58 year old female, nil cardiac history, mild smoker, social drinker and overweight.

Complaining of acute central chest pain @ rest. Awoken by pain.

On Arrival – Sat upright on settee (Editor’s note: One of you Brits will have to interpret that for me!)

On examination:

Alert, orientated and communicable (GCS 15)
Pale, cool dry skin.

Nil SOB, clear bi-lateral air entry – nil adventitious breath sounds
R/R 19, SpO2 99%

H/R 68 and irregular, BP 125/74

Temp 36.8
B.M 7.2 (Editor’s note: B.M. is BGL measured in millimoles. 1 mmol/L of glucose is equivalent to 18 mg/dL. Hence, this patient’s sugar is about 130).

C/O chest pain.

O – Acute. Awoken from sleep.
P – Nothing makes pain better. Not affected by breathing
Q – Non specific compressing type pain
R – Central chest pain radiating left arm
S – Pain score 6/10
T – 30 mins
I – No pain intervention sought.

Slight nausea, nil vomit

The cardiac monitor is attached.

A 12-lead ECG is captured.

How would you treat this patient?

See also:

80 year old male CC: Chest pain

Excessive discordance as a marker of acute STEMI in LBBB

80 year old male CC: Chest pain – Conclusion

62 year old male CC: Chest pain (LBBB with ST-elevation > 0.2 the QRS complex)

Identifying AMI in the presence of LBBB – Sgarbossa’s Criteria Part I

Identifying AMI in the presence of LBBB – Sgarbossa’s Criteria Part II

“New” LBBB – What’s the big deal?

Discordant ST-segment elevation in LBBB or paced rhythm

Sgarbossa’s Criteria – New Graphic

Found on the Lifenet Receiving Station (LBBB with concordant ST-depression in leads V3 and V4)

Posted by on July 23, 2010 • Filed under: ems-topics, patient-management • Tagged: , , , , , , , , , , , , , , , , ,

Chronicles of EMS – Here Are the Finalists! VOTE NOW!

No comments

As you may have heard, the finalists are in for the Chronicles of EMS “Change the Name” competition! The field has now been narrowed from over 500 entries to just 5!

It just so happens that my girlfriend Kelly is one of the finalists.

Now, I don’t want to influence your decision in any way….

create avatar

So please CLICK HERE to cast your vote NOW!

Select one of the following:

Beyond the Lights and Sirens

Mobile Medicine

Frontline Medicine

Medicine in the Streets

Real Life, Real Emergencies

Again, just choose from your heart.

Don’t be influenced by the fact that this could mean a to Europe for Kelly and me! :)

See also:

Chronicles of EMS – “Change the Name” Competition! 

Name That Show Competition Finalists! at The Happy Medic

Posted by on July 23, 2010 • Filed under: Uncategorized • Tagged:

69 year old male CC: “Indigestion”

15 comments

Here’s a case from a faithful reader who wishes to remain anonymous.

In his own words:

Presenting Complaint – Chest Pain

History of Present Complaint – 69 year old male, nil cardiac history, none smoker, social drinker.
Complaining of indigestion last 2-3 weeks with noticably increase in belching.
This a.m acute onset of burning heavy central chest pain radiating to neck.

On Arrival – Semi-recumbent in bed

On examination:
Alert, orientated and communicable (GCS 15)
Pallor
Diaphoretic

Nil SOB, clear bi-lateral air entry – nil adventitious breath sounds
R/R 16, SpO2 98%

H/R 90 and irregular, Hypertensive 168/110

Temp 36.5 C (97.7 F)
B.M 9.0

C/O chest pain..
O – Acute
P – Nothing makes pain better. Not affected by breathing
Q – Heavy in chest, burning in throat
R – Retrosternal and radiating to neck
S – Pain score 10/10
T – 15 mins
I – No pain intervention sought.

Nil nausea, nil vomit

The cardiac monitor is attached.

A 12-lead ECG is captured.

What is your impression?

*** UPDATE ***

The patient lost consciousness and the monitor showed ventricular fibrillation. A shock was delivered at 200J.

The patient experienced return of spontaneous circulation.

A few minutes later the heart rhythm returned to baseline.

Emergent cath revealed 100% occlusion of the LAD.

Posted by on July 17, 2010 • Filed under: ems-topics, patient-management • Tagged: , , , , , , , , , , ,

79 year old male CC: Shortness of breath

18 comments

Here’s another interesting case submitted by Geoff Dayne.

79 y/o male c/o non-provoked SOB without CP.

Patient was found sitting upright, tripodding, 1 word dyspnea.

Lung sounds: extremely decreased tidal volume. EMS crew was unable to tell if there was rales or wheezing.

Past medical history: HTN, dyslipidemia, CHF, pacemaker (recently implanted within a week or so), diabetes, emphysema.

Drug allergies: Sulfa

Current meds: Glipizide, Omerprazole, Hydralizine, Lovastatin, Lasix, Albuterol

Vital signs:

B/P: 154/84
Pulse: 134 Strong/Irregular
Resp: 30
SpO2: 84 on RA

They treated w/ O2 and put him on the patient’s home BiPAP and transported.

A 12-lead ECG was captured.



And a rhythm strip.



I think this case is an excellent example of the real-life difficulties paramedics face in the field when it comes to the triage of possible ACS patients.

What would you do next as the treating paramedic?

See also:

Identifying AMI in the presence of LBBB – Sgarbossa’s Criteria Part I

Identifying AMI in the presence of LBBB – Sgarbossa’s Criteria Part II

Discordant ST-segment elevation in LBBB or paced rhythm

Found on the Lifenet Receiving Station (LBBB with concordant ST-depression in leads V3 and V4)

62 year old male CC: Chest pain (LBBB with ST-elevation > 0.2 the QRS complex)

58 year old female CC: Chest pain

58 year old female CC: Chest pain – Conclusion (meets all 3 of Sgarbossa’s criteria)

Posted by on July 11, 2010 • Filed under: ems-topics, patient-management • Tagged: , , , , , , , , , , ,