A recent graduate of our hospitalâ€™s paramedic program brought this case to me. Leigh works for Stratford EMS, an excellent local service in Southwestern Connecticut.(A quick note on the specific details of the case: This patient did not necessarily come to my hospital. Additionally, several features of the case have been altered; some to preserve anonymity, others to simplify the case. The ECGs and other essential aspects are unchanged.)
EMS was dispatched for a 68-year-old male with altered mental status. On arrival, however, they found the gentlemen to be alert but disoriented. Per the patient, his legs just â€œgave way,â€ and he fell onto the floor. His family found him 30 minutes later, still on the floor, too weak to stand. They called 911.
PMHx: Atrial fibrillation, COPD, CHF, DM2
Meds: Carvedilol, HCTZ, furosemide, metolazone, spironolactone, warfarin, Januvia, Advair, Spiriva
- HR â€“ 91
- BP â€“ 134/78
- RR – 24
- SaO2 â€“ 93% RA
- BG â€“ 74 mg/dL (4.1 mmol/L)
- Gen: Appears ill
- Skin: No bruises/abrasions
- Lungs: Diminished bilaterally
- Cardiac: No gross murmurs
- Neuro: Weakness bilateral legs
A rhythm strip was obtained:
A 12-lead was obtained:
The *** MEETS ST ELEVATION MI CRITERIA *** notification catches your eye, of course!
The nearest 24/7 PCI center is 20 minutes away, while a smaller community hospital (fibrinolysis only, but has an ICU, etc.) is â€œjust around the corner.â€ What is your transport destination?
Update: The conclusion, with the diagnosis, is now available. Click to go there!