Here’s another great case courtesy of Mike from Massachusetts.
EMS is dispatched to a large health clinic affiliated with a local university, for the “sick male.” Initial dispatch is an ALS ambulance, ALS rescue company, and BLS engine company. Rescue company and engine company are canceled on ambulance’s arrival.
Upon arriving on scene, we find a 39-year-old male patient seated upright on an examination bench. He is alert and oriented x4, with slightly moist and warm skin, otherwise appearing free of distress.
He describes coming to the doctor’s today to be seen for a “malaise” and mild fever he had been experiencing over the past two weeks (100.2 F, taken at the office).
While being interviewed by the physician, he casually mentioned that he had been experiencing occasional episodes of “sharp” pain in his chest, the last episode a week ago and when he laid down for bed. A 12-lead ECG was obtained by the physician, and she reports having concern about “near global ST elevation.” This prompted EMS activation.
Patient has no significant past medical history, takes no medications, and has no medication allergies. He denies any recent history of trauma or infectious exposures that he can recall.
The cardiac monitor is applied, showing sinus rhythm @ 54 bpm. Patient is placed on oxygen by nasal cannula. Vital signs are obtained:
- Blood pressure: 136 / 64
- Heart rate: 58 bpm
- Respiratory rate: 16
- Temperature (oral): 100.2 F
While assessing lung sounds, patient takes a deep breath, noticably flinches and states, “There it is again.” He describes the sharp pain (localized in the sub-sternum) that he previously reported to the physician, which resolves shortly after. His lung sounds are clear and equal bilaterally, and this is reproducable with subsequent deep breaths.
IV access and a 12-lead ECG are obtained.
Patient is assisted onto stretcher without incident, moved to ambulance. Patient is transported to the hospital of the university’s preference, which is also a level 1 trauma center (< 10 minute transport time).
What do you think of the ECG?