Thanks go to a long time reader Nicholas Eisele for this holiday case! As always, details have been changed to protect patient privacy.
It is a blustery Christmas morning when you and your partner are dispatched for a 47 year old male with chest pain. Firefighters are already on scene obtaining a history and vitals when you arrive.
You check in with the officer in charge, a paramedic, and he reports that the patient has been having a "burning sensation" in the middle of his chest, going to his back. As it is Christmas morning and the patient's family is opening presents, the officer also relays the patient, "is likely going to refuse." He also relays that they witheld ASA due to the patient's "indigestion."
One of the firefighters gives your partner the patient's vitals:
- HR: 70 bpm, regular at the radials
- BP: 144/96
- RR: 18, unlabored, in no apparent distress
- SpO2: 95%
- ECG: "normal sinus, nothing out of the ordinary" (no 12-Lead was captured)
You perform a quick patient assessment prior to making any decisions:
- Onset: 21:00 the prior evening
- Provocation/Palliation: pain went away over night with sleep, came back after breakfast; nothing makes it better now
- Quality: "burning"
- Radiation: "straight thru to my back"
- Severity: 7 of 10
- Timing: constant burning
A focused history reveals no prior cardiac problems and that the patient takes no medications and has no allergies.
Given the patient's symptoms and possibility of a true cardiac problem you advise the patient that a trip to the hospital is worth it just to make sure he's not experiencing something serious.
After he sits down on your stretcher your partner begins placing electrodes for a 12-Lead as you gather four baby aspirin for the patient to chew.
You notice the artifact and hit print again, however, you decide you can run another one in the truck. After loading the patient your partner hands you the second 12-Lead, which is a bit cleaner than the first.
Not completely satisfied, you run a 3rd 12-Lead in the back of the truck.
Your partner asks which facility you'd like to go to.
- What do these 12-Lead's show?
- What are your next steps?
- Is indigestion a contraindication to aspirin administration?
- Are you glad this case does not involve a narrow complex tachycardia?