Thanks go to Michael Herbert for this great case! As always, some details have been changed to protect patient privacy.
It’s late into your shift when the tones go off for breathing problems at a local extended care facility. Enroute you’re advised it is a 64 year old female with a “low O2 sat,” and to, “use the main entrance.”
As you arrive a staff member is waiting for you at the door and directs you to a familiar room. The patient, a larger woman well known to your unit, is noticably anxious and struggling to breathe even on a nasal cannula.
The staff informs you she’s not been feeling well all day, and only recently developed shortness of breath. Your partner places the patient on a non-rebreather at 15 L/min and grabs a quick set of vitals.
A quick look at the patient reveales pale skin, circumoral cyanosis, pink frothy sputum, and a respiratory rate in excess of 30. She has a long cardiac history, and is often transported by your service. Your partner relays her vitals:
- Pulse: 120 bpm, weak radials
- B/P: 110/74
- SaO2: 78% on 2 L/min via NC
- Resps: 36, shallow
- BGL: 224 mg/dL
Auscultation of her lungs reveals rales in all fields.
Your partner asks if you’d like to put her on the monitor and you reply, “let’s get moving and get it in the truck.”
Once in the back of the truck you begin attaching the monitor, while your partner prepares CPAP. Her oxygen saturations have improved to 89% and her pulse and respirations have decreased noticably on the non-rebreather.
The rhythm strip is obscured due to patient movement, however, the 12-Lead prints out without issue.
You’re 20 minutes from a PCI capable center and 5 minutes from a community hospital where the patient’s physician often has her transported.
What does this 12-Lead ECG show?
What interventions does this patient need?
Do you need anymore information to make the appropriate treatment and transport decision?