This is part one of today's case study. As usual some information has been changed to protect patient confidentiality.
EMS is called to the residence of a 59 year old male, who's chief complaint is chest discomfort.
As the crew enters the kitchen, they find the patient sitting in a chair surrounded by family members. He is not happy to see the crew.
He tells them he was doing some lifting of boxes all afternoon, and developed some chest pain, slightly left of center.
He took a break, and it started to get better. Now, 3/10 on the pain scale. He states he has no significant medical history.
The crew ask who called EMS, and he tells them his wife called because she thought he did not look good. He makes it clear that he is not happy with the EMS presence.
As they continue to speak with the patient, they put him on O2 and give him 4 baby ASA just in case. He tells them the discomfort happened earlier in the day when he was lifting boxes, and totally went away when he took a break. He expects nothing different this time. The discomfort does not move anywhere, no shortness of breath, no dizziness or lightheadedness. His wife tells them he was sweating, but he states that of course he was because he was lifting heavy boxes!
The crew takes a quick set of vitals:
- HR: 90 and regular
- BP: 148/86
- RR: 18 regular
- skin: unremarkable
- Lungs: clear bilaterally
- Spo2: 98% on O2
The patient's wife convinces him to go and get checked out for her sake. He relents. The crew decides to get him into the rig before he changes his mind, and defers further assessment until then. The patient is ambulatory, and insists on walking to the rig. On the way, he insists on going to the bathroom. Then changes his clothes for the hospital. The crew protests, but he states he will not go otherwise.
Once in the rig, the crew acquires the following 12 lead ECG:
The crew does not note anything too concerning, and considering the patient's story and lack of history, they transport him to the community hospital, without any additional ECGs.
- What are your interpretations of this ECG?
- What if this was your patient? What would you have done differently?
- Do you agree or disagree with how this call was handled?