EMS is called to the beach for a 76 year old female complaining of shortness of breath. Past medical history of emphysema.
On arrival, the patient is found sitting in a beach chair alert and oriented to person, place, time, and event. She does not appear to be in any acute distress.
The patient states that she was out wake-boarding when she fell and “got a mouth full of water.” She coughed profusely and then experienced some chest discomfort.
She denies having experienced any shortness of breath.
She denies any other significant medical history other than a little bit of emphysema and states that she takes an inhaler but rarely uses it.
The patient is embarrassed but consents to further evaluation in the back of the ambulance. It takes some convincing for the patient to allow EMS personnel to carry her off of the beach (she wants to walk the 100 yards to the ambulance).
In the back of the ambulance, vital signs are assessed.
SpO2: 94 on RA
The cardiac monitor is attached.
A 12-lead ECG is captured.
The patient states she feels better and wants to know if it’s really necessary for her to go to the hospital.
What should the paramedics tell her and why?
*** Update 09/06/2010 ***
By request, here are the serial prehospital 12-lead ECGs for the case.