You respond to an office workplace for a 43-year-old female with a chief complaint of chest discomfort.
On arrival you are greeted by the patient who is pleasant and well-appearing. Her skin is warm, pink, and dry and pulse strong at the radials. Respiratory effort is normal with clear lung sounds bilaterally and she does not seem to be in any distress aside from some mild anxiety about having the ambulance pick her up at work.
She had just finished eating lunch (soup and a sandwich) when she began to experience retrosternal chest pain that she describes as “like a crampâ€”as if there’s something stuck in there.” She happened to mention the sensation to her boss who then called EMS, worried that there was “something lodged in her throat.”
- HR â€“ 85 bpm, regular
- SpO2 â€“ 98% on room air
- BP â€“ 138/82 mmHg
- RR â€“ 15, non-labored
- Temp â€“ 36.9 C (98.4 F)
She denies any shortness of breath, lightheadedness, dizziness, vomiting, or diaphoresis; though she is mildly nauseated.
- S â€“ As above
- A â€“ No known drug allergies
- M â€“ Levothyroxine
- P â€“ Hypothyroidism
- L â€“ Lunch 30 min ago
- E â€“ Just finished eating lunch when the pain started
Blood glucose is 102 mg/dL.
- O â€“ Fairly abruptly, less than 5 minutes after she finished her sandwich
- P â€“ Nothing makes it better or worse
- Q â€“ Like a knot behind her lower sternum
- R â€“ The pain seems to ache to her left shoulder blade as well
- S â€“ 5/10, “not too bad but not comfortable”
- T â€“ Constant for 30 minutes
You perform a 12-lead ECG:
It is a five minute drive to the local community hospital and thirty minutes to the region’s PCI center.
Which hospital are you going to suggest?
Is this patient experiencing a STEMI?