Here’s a really interesting case submission from David Baumrind.
EMS is called out in a rain storm to evaluate a 60 year old male with a chief complaint of shortness of breath.
The patient was released from the rehab center 8 days prior after having experienced a stroke while having his “carotids done”.
He suffers from persistent left-sided hemiparesis.
For approximately 36 hours prior to contacting 9-1-1 the patient experienced increasing shortness of breath made worse by lying flat or with physical activity (paroxysmal nocturnal dyspnea and new exertional dyspnea).
The patient is found sitting in a living room chair. He is in no acute distress at the time of evaluation.
Skin is slightly “dusky” but warm and dry.
The patient denies chest discomfort. He admits to some nausea but has not vomited. He denies light-headedness and palpitations.
Past medical history: NIDDM, CABG x 4 years ago, myocardial infarction, left bundle branch block, ICD placement
Medications: Numerous but unavailable at the time of evaluation
Pulse: 96 and irregular
SpO2: 92 on RA
The cardiac monitor is attached.
A 12-lead ECG is captured.
Here is the computerized interpretive statement.
What do you think is going on with this patient?
Are you concerned about his 12-lead ECG?
You are 15 minutes from the local non-PCI hospital and the STEMI Receiving Center is 45 minutes in the opposite direction.