Here is a case submitted by a faithful reader from the UK who wishes to remain anonymous.
Call is received into control via 999 from a General Practitioners Surgery. Call is received as 76 year old male with possible MI.
Presenting Complaint – Chest Pain
History of Present Complaint – 76 year old male, nil cardiac history, known COPD, ex smoker, social drinker.
Awoken at 2 a.m by an acute central chest pain radiating to his left arm.
Male waited till surgery opened and made an emergency appointment.
GP had 12-lead ECG done on patient – noticed ST-elevation and administered 1x400mcg GTN spray SL, 300mg Aspirin PO and O2 therapy. Ambulance contacted via 999.
Here is the first 12-lead ECG taken by the GP.
The second 12-lead ECG taken by the GP was after NTG.
On Arrival – Patient supine on bed, O2 therapy via NRB administered by GP
Alert, orientated and communicable (GCS 15)
Nil SOB, clear bi-lateral air entry – nil adventitious breath sounds
R/R 20, SpO2 99% on O2
H/R 89 and regular, BP 149/99
C/O chest pain..
O – Acute
P – Not affected by breathing. Eases slightly leaning forward. Pain++ on palpation of sternum.
Q – Sharp in chest
R – Central chest radiating left arm
S – Pain score 7/10 eases slightly with GTN
T – 11 hours ago
I – No pain intervention sought.
Nil nausea, nil vomit
Meds – Usual COPD drugs
PMH – COPD
Allergies – NKA
Paramedics switched the patient over to their 12-lead ECG monitor.
What’s going on with this patient?
What is your treatment plan?
Where would you transport this patient?
Is there anything unusual about this case?