Good morning. It's 7:45 am on a sunny winter Monday, and you are just finishing up your holiday shopping list– it is getting down to the wire after all!
The tones go off, and you are dispatched to the residence of a 63 year old female, "sick".
You arrive to a well kept two story suburban home. You are met by a well looking gentleman who directs you and your partner into the living room, where you find his wife sitting on the sofa looking slightly uncomfortable.
"How can we help you today?"
"Well, i'm having strange pain in my neck and both arms… feels like pins and needles too.."
"Any chest discomfort?"
"A little bit… a little tightness across the front of my chest."
As you continue with the history, she denies any difficulty breathing, lightheadedness, or nausea. She tells you the discomfort woke her from her sleep at about 6 am… she thought it would go away, but it didn't so her husband called 911. Nothing seems to change the discomfort, and she tells you that she is generally in good health–this has never happened before.
Her past history is significant only for hypertension. She was a two pack a day smoker, but she quit 5 years ago.
Your partner acquired the following set of vitals:
- Pulse: 54, irregular
- BP: 122/68
- RR: 18 regular, lungs clear
- SpO2: 99% RA
- Skin: slightly pale, warm and dry
You acquire the following 12 lead ECG:
Your patient tells you the discomfort is "not that bad", and asks if you could give her something for it now–she doesn't want to go to the hospital.
What do you tell her?
You are 15 minutes from the local hospital, and about 50 minutes from the nearest PCI center.
- What is your field diagnosis (yes, I did use that word)?
- What are the significant findings on the 12 lead ECG?
- What is your treatment plan?
- To which facility will you transport your patient and why?
- Are there any other treatment considerations for this patient?
Thanks for reading, and looking forward to your comments!