Tom, our Editor-in-Chief, and David, an Associate Editor, are gone on vacation. As a send-off, I am presenting the following case. I hope you enjoy it!
It is just after 3am when you are called to intercept a BLS unit on scene with a 54 year old female with a low heart rate.
Upon your arrival, you find two EMT-Basics attending to a small woman lying in bed, who appears acutely ill.
<p.The EMTs state that they cannot get a blood pressure and her pulse is slow and weak at her carotid. They have placed their house bag under her legs and have her on oxygen via NRB at 15 L/min.
The patient is alert, oriented, and answers all of your questions appropriately. She states that she woke up not feeling well and called 911 when she could not get out of bed.
Past Medical History: hysterectomy, cholecystectomy, breast cancer
Medications: Ambien and Zoloft (she denies depression)
Allergies: Aspirin gives her heartburn
You ask her if anything else is going on and she states that her chest, “feels funny”.
Onset: woke her up from her sleep
Provocation/Palliation: nothing makes it better or worse
Quality: she points to the middle of her chest as the source of the funny feeling
Radiation: when asked, she mentions her left leg is tingling
Severity: repeated questioning only elicits, “it isn’t that bad”
Time: 20 minutes
Her vital signs are reassessed in the Trendelenburg position.
Pulse: 44, regular, no radial pulses present, however weak brachials are palpable
Respirations: 12, unlabored, bilaterally clear breath sounds
BP: 54/0, unable to accurately auscultate the diastolic
SpO2: 96% on O2 via NRB at 15 L/min
Besides her cold, ashen gray skin, her physical examination is unremarkable.
The cardiac monitor is attached.
A 12-Lead ECG is acquired.
A final 12-Lead ECG is acquired as you arrive at the receiving facility.
What is your interpretation of the initial 3-Lead and 12-Lead? How would you treat this patient?
Given the final 12-Lead, does this change your interpretation?