Christopher A. Watford from the My Variables Only Have 6 Letters blog has submitting a very interesting case study (actually he submitted two but you’ll have to wait for the other one).
EMS is called to the residence of a 69 year old male complaining of chest pain.
On arrival the patient is found sitting in a kitchen chair.
He appears acutely ill.
Skin is ashen, cool, and very diaphoretic.
Levine’s sign is present.
It is obvious that the patient is anxious and in severe pain.
Onset: Sudden onset approx 20 minutes before EMS arrival
Provoke: Nothing makes the pain better or worse
Quality: Severe pressure
Radiate: The pain does not radiate
Time: No previous episodes
Breath sounds are clear bilaterally.
Vital signs are assessed.
Pulse: 60 R
SpO2: 90 on RA (increases to 96 with oxygen via NRB @ 15 LPM)
No known drug allergies.
Denies any significant medical history other than “indigestion”.
The cardiac monitor is attached.
A 12-lead ECG is captured.
Another 12-lead ECG is captured with modified chest leads V4R, V5R and V6R.
How would you treat this patient?
Is there anything about this case that surprises you?
*** Update 12/13/2010 ***
What Christopher and I both found unusual about this case is that the GE-Marquette 12SL interpretive algorithm was not giving the ***ACUTE MI SUSPECTED*** message, even though it was giving messages like “ST-elevation consider anterolateral or acute infarct” and “inferior injury pattern” which I had always thought automatically trigged an accompanying ***ACUTE MI SUSPECTED*** message.
This is especially important because some EMS systems require the ***ACUTE MI SUSPECTED*** message in order for paramedics to bypass the local non-PCI hospital for the STEMI Receiving Center!
So, I contacted a friend at Physio-Control who put me in touch with the person responsible for the computerized interpretive algorithm. He was also surprised that the ***ACUTE MI SUSPECTED*** message was not present on these 12-lead ECGs. So he turned to a “veteran 12SL designer”.
Together they figured out the problem.
Mystery solved! The 12SL expert said that the 12SL algorithm would definitely give the Acute MI statement for the first cse that you sent me. So I turned to the setup choices (LP12 Operating Instructions, chapter 9). One of the setup menu items is “ACUTE MI”. The description is “Print Acute MI message”. Further explanation says, “ON: Prints on the 12-lead reports when criteria are met.”
I think that the LP12 is set up with the ACUTE MI option turned off. I suggest that you get back to the customer and have them turn ACUTE MI on in the setup menu for this LP12 and any others that they have.
So, if you have a Lifepak 12 and you’re not receiving the ***ACUTE MI SUSPECTED*** message for obvious acute STEMIs, you might want to check this parameter.