Â It’s a sunnyÂ morning, and your EMS unitÂ is dispatchedÂ to a residence for an 87 year old male with difficulty breathing.
Â YouÂ arrive on scene before the fire engine and enter the residence. Upon entering the bedroom,Â you find an elderly male, sitting on the edge of the bed, vomiting. HeÂ is alert and oriented x 4 (person, place, time, event) and with a GCS of 15. He appears to beÂ in moderate respiratory distress, diaphoretic, with rapid and slightly labored breathing and muscle retraction, but yet, he’s smiling at you and tries to explain what happened. He tells you, he woke up 15 minutes ago because he could not breath while laying down.
- Patent airway
- Shallow and labored breathing with bilateral rales upon auscultation
- Weak and slightly irregular radial pulses
- Skin: cool toÂ touch, pale and diaphoretic with >2 sec. capillary refill time
- No signs of external bleeding
Â He isÂ also complaining of chest discomfort throughout his entire chest, rated 7/10, non-radiating which started at the same time he woke up from his sleep. Nothing makes this discomfort better or worst.
Past Medical History:
- Hypertension (HTN)
- Amlodipine (Norvasc)
- Metoprolol (Lopressor)
- Levothyroxine (Syntrhoid)
- Atorvastatin (Lipitor)
- Daily vitamins
- No known allergies
Â Your partner places the patientÂ on O2 at 15 lpm via Non-Rebreather mask with ETCO2 monitoring and a 12 lead ECG was obtained as well as vital sings and blood glucose.
Â The first 12 lead ECGs was “too dirty” to evaluate. The second 12 Lead ECG is shown below:
Pretty alarming, isn’t it?
Vital signs as followed:
Blood Pressure: 230/125 mmHg
Heart Rate: 130 beats/min
Respiratory Rate: 36 breaths/min
SpO2: 71% on Room Air
ETCO2: 55 mmHg
BGL: 122 mg/dl
The closest initial receiving hospital is a bit over 30 minutes away.
What is your 12 Lead ECG interpretation?
What interventions would you perform next?
Would you activate the cath lab?
Here is the conclusion: