Here’s a case study submitted by a faithful reader named Brian from Southern California.
This patient is a 67 year old male with a cheif complaint of chest pain.
Upon arrival EMS found the patient is found sitting in a reclining chair. He is alert and oriented to person, place, time, and event. He appears calm and his skin signs are pale but otherwise normal.
The patient denies having any shortness of breath or nausea/vomiting. There is no JVD or pedal edema. Lung sounds are clear bilaterally.
History: Pericaditis several years ago and open heart surgery to remove the infected tissue.
Onset: Sudden after an argument with his mailman
Provoke: Nothing makes the pain better or worse
Quality: Severe substernal pressure
Radiate: The pain does not radiate
Time: 20 minutes prior to EMS arrivial
SpO2: 97 on room air
The first 12-lead ECG was taken on scene.
What do you think is wrong with the patient?
What is your treatment plan?
You are 25 minutes from a STEMI Receiving Center and 5 minutes away from the local non-PCI hospital.