Here's an awesome case submitted by Phil, an Intensive Care Paramedic from Australia. Some minor changes have been made to ensure patient confidentiality.
EMS is called to a track and field event for a 47 year old male patient with chest pain.
On arrival the patient is found lying on the grass with a cold, wet towel on top of him. He appears pale and acutely ill. Otherwise he appears to be in excellent physical condition.
- Onset: 30 minutes prior to EMS arrival
- Provoke: Nothing makes the pain better or worse
- Quality: He describes the pain as "crushing"
- Radiate: He describes an ache to his jaw and left arm
- Severity: 8/10
- Time: No previous episodes
Past medical history: CAD, dyslipidemia, mild hypertension, stents x3 approximately 4 years ago
Medications: Numerous but not immediately available
Vital signs are assessed.
- RR: 22
- HR: 90
- BP: 210/90
- SpO2: 95 on RA
- Temp: 36.9 C (98,4 F)
- BGL: 10.8 mmol/l (194 mg/dl)
Breath sounds are clear bilaterally.
The cardiac monitor is attached.
A 12-lead ECG is captured.
A rhythm change is noted on the monitor.
The patient is still conscious.
What's going on with this patient?
What is your next move and why?