It is a beautiful September morning when the tones go off for a 86 year old female, “altered mental status”.
“Guess breakfast will have to wait”, as you and your partner head towards the residence.
As you enter the one level home, you are directed to a back bedroom where you find your patient lying in bed.
She is alert and oriented, but her color seems pale. She seems uncomfortable. Her radial pulse is strong, and she is breathing normally.
You ask what happened…
” I was sitting at the kitchen table having some tea when I got really dizzy. My friend helped me to bed, but it hasn’t gotten much better over the last hour so my friend called 911.”
She denies any chest pain or shortness of breath, but she says has been nauseous and has vomited twice.
- HR: 66 and regular
- BP: 164/78
- RR: 16, Lungs are clear
- SpO2: 96% on RA
- Skin: Cool and moist
- BGL: 108 mg/dl
Her history is significant for hypertension and lymphoma.
- A: No known drug allergies
- M: She takes a beta blocker for hypertension, and meds for chronic lymphoma
- P: As stated above
- L; Eggs and toast for breakfast
- E: Having tea
You acquire a 12 lead ECG:
You are 15 minutes from the local ER, and 1 hour from the PCI center by ground. Medevac to PCI is available.
- Is there anything else you would like to ask the patient?
- What is your interpretation of the ECG? Are you concerned about a STEMI?
- Where are you going to take your patient?
YOU MAKE THE CALL!