EMS is called to a 88 year old male with a chief complaint of chest discomfort.
On arrival the patient meets EMS at the front door. His skin is slightly pale and moist. He appears anxious.
- Past medical history: "Cardiac", pacemaker, hypertension, dyslipidemia
- Medications: Numerous, unavailable at the time of EMS evaluation
Paramedics lead the man to a chair and the assessment begins.
- Onset: 30 minutes prior to EMS arrival
- Provoke: Nothing makes the pain better or worse
- Quality: Poorly localized pressure
- Radiate: Does not radiate
- Severity: 7/10
- Time: Admits to previous episodes but unable to give details
Vital signs are assessed.
- RR: 18
- Pulse: 70
- NIBP: 140/92
- SpO2: 90 on RA
Breath sounds: Clear in the apexes, diminished in the bases.
No JVD or pitting edema.
The patient is placed on the cardiac monitor.
A 12-lead ECG is obtained.
The patient is placed on oxygen via NC @ 4 LPM and is removed to the back of the ambulance. An IV is initiated and the patient is given 0.4 mg NTG spray SL.
The pain subsides to 3/10.
En route an additional 12-lead ECGs is obtained.
And one more just prior to arrival.
Do you see anything here to be concerned about?