EMS is called to a residence on a horse farm for a 77 year old female with chest pain.
On arrival, the patient is found sitting on a wooden bench. She appears anxious and acutely ill.
Skin is warm, flushed and diaphoretic. She is rubbing her chest.
Onset: 20 minutes prior to 9-1-1 call
Provoke: Slightly worse with deep inspiration
Quality: Unable to describe but when pressed “more sharp than dull”
Radiate: The pain does not radiate
Time: She’s had chest pains before but not recently and “nothing this bad”
Past medical history: Hypothyroidism, dyslipidemia
Medications: Synthroid, Lipitor
Vital signs are assessed.
SpO2: 97 on RA
She admits to feeling short of breath.
Breath sounds are clear bilaterally.
The cardiac monitor is attached.
A 12-lead ECG is captured.
What would you do next?
*** UPDATE ***
By request here is another 12-lead ECG taken approximately 15 minutes later.