Here's an interesting case sent in by faithful reader Carl R. Christiansen, Paramedic, from Norway. As usual, changes have been made to protect patient confidentiality.
It's an early Sunday morning when you are dispatched to a hotel for a 41 year old female with chest pain.
You and your partner enter the hotel room and find the woman lying in bed. As she sits up to greet you, you notice the color of her face is pink, but she seems to be slightly uncomfortable and restless. She tells you that she woke up at about 8 am with chest pain in the center of her chest, which does not move anywhere. She isn't short of breath or lightheaded…no nausea or vomiting, or anything else out of the ordinary other than the chest pain. The pain doesn't change with breathing, movement, or palpation. She adds that she's had some similar pain come and go over the last three or four days, but never as bad as this. You ask her to rate her discomfort, and she tells you 9/10.
As you assess her appearance, you don't see anything abnormal… no JVD, no edema. Her pulse feels rapid but regular, and her lung sounds are clear bilaterally. Inspection and palpation of her chest and back are normal. You do a FAST screening, which shows nothing abnormal. All she can tell you is that she had a couple of glasses of wine with dinner the night before, and slept through the night until the pain woke her up this morning.. She has no relevant medical history, and takes no medications.
While you are getting the history, your partner takes a set of vitals:
- Pulse: 104 and regular
- BP: 210/155
- RR: 18 and regular
- CTC: Pink, warm and dry
- SpO2: 99%
You acquire the following 12 Lead ECG:
What do you think? What would you do next?
The treating paramedic gave the following treatments:
- One SL NTG
- 300 mg ASA
- IV established
- 2.5 mg of Morphine IV
- 600 mg Plavix orally
As the above are being done, a second 12 Lead is acquired:
After the treatments were given, the patient's blood pressure dropped to 129/84, and her heart rate dropped to and remained at about 80. The Paramedic called a Code STEMI and transported the patient to a PCI center. Upon arrival there, this last 12 Lead was acquired by the crew:
What do you see on these 12 Leads?
Would you have called a Code STEMI?
What would your treatment have been for this patient?