Here’s an interesting case that illustrates the value of prehospital 12 lead ECGs.
A 66 year old male became suddenly ill while playing tennis. Bystanders state that he struck the ball with his racket, staggered a few steps, placed his hand over his chest, and sat down on the tennis court.
9-1-1 was contacted immediately.
Past medical history is significant for hypertension, hyperlipidemia, and a “previous episode of chest pain” for which the patient carries SL NTG which he rarely takes PRN for chest discomfort.
A paramedic from out-of-town was present on scene and gave the patient his own NTG.
On EMS arrival, the patient appears acutely ill. He is diaphoretic and weak, complaining of chest pain.
Vital signs are assessed.
- HR: 72
- RR: 20
- NIBP: 88/58
- SpO2: 98% on room air
The cardiac monitor is attached.
Even in monitor mode, you can see ugly looking ST segment elevation in lead III with reciprocal ST segment depression in lead I.
A 12 lead ECG is captured.
The ECG shows acute inferior STEMI. There are Q waves in leads III and aVF with ST segment elevation. There are downsloping ST segments in leads I and aVL which represent reciprocal changes.
The 12 lead ECG was transmitted to the hospital and the cardiac cath lab was activated.
Paramedics placed the patient on oxygen, gave 4 baby aspirin, started an IV, and administered a fluid bolus (I do not have the next set of vital signs but we can assume the pressure came up with the fluid bolus). The patient was given SL NTG and 5 mg of morphine.
An additional 12 lead ECG was captured less than 10 minutes later.
The ECG is now non-diagnositc.
If not for the prehospital 12 lead ECG, there’s no telling how long this patient would have sat in the emergency department.
Instead, the patient had a 39 minute door-to-balloon time.
If you know any old-school paramedics, medical directors, or administrators who care about patients but still aren’t sure prehospital 12 lead ECGs are necessary, be sure to share this case with them!