Here’s another case study from an international reader who wishes to remain anonymous.
Presenting Complaint – Chest Pain
History of Present Complaint – 58 year old female, nil cardiac history, mild smoker, social drinker and overweight.
Complaining of acute central chest pain @ rest. Awoken by pain.
On Arrival – Sat upright on settee (Editor’s note: One of you Brits will have to interpret that for me!)
Alert, orientated and communicable (GCS 15)
Pale, cool dry skin.
Nil SOB, clear bi-lateral air entry – nil adventitious breath sounds
R/R 19, SpO2 99%
H/R 68 and irregular, BP 125/74
B.M 7.2 (Editor’s note: B.M. is BGL measured in millimoles. 1 mmol/L of glucose is equivalent to 18 mg/dL. Hence, this patient’s sugar is about 130).
C/O chest pain.
O – Acute. Awoken from sleep.
P – Nothing makes pain better. Not affected by breathing
Q – Non specific compressing type pain
R – Central chest pain radiating left arm
S – Pain score 6/10
T – 30 mins
I – No pain intervention sought.
Slight nausea, nil vomit
The cardiac monitor is attached.
A 12-lead ECG is captured.
How would you treat this patient?
62 year old male CC: Chest pain (LBBB with ST-elevation > 0.2 the QRS complex)
Found on the Lifenet Receiving Station (LBBB with concordant ST-depression in leads V3 and V4)