From the archives.
EMS is called to the vacation residence of a 49 year old male complaining of chest pain.
On arrival the patient is found sitting at the kitchen table. He appears anxious and acutely ill.
Past medical history: Healthy
Skin is cool, pale and diaphoretic.
He confirms that he is experiencing chest pain.
Onset: Sudden while moving furniture 30 minutes prior to contacting 9-1-1
Provoke: Nothing makes the pain better or worse
Radiate: The pain does not radiate
Time: No previous episodes
Breath sounds are clear bilaterally.
No JVD or pitting edema.
Vital signs are assessed.
SpO2: 98 on RA
The cardiac monitor is attached.
Sorry about the fading but this is what happens to ECGs over time (which is why they need to be copied or digitally scanned to preserve them for posterity).
A 12-lead ECG is captured.
A second 12-lead ECG is captured with lead V4 in the position of V4R.
Do you think this patient is having a STEMI?
Why or why not?
Describe how you would treat this patient and why.