53 YOF with AMS: STEMI or Secondary ST-T Changes?

This is the case of a 53 year old female who presented to the Emergency Department (ED) via EMS, with Altered Mental Status (AMS).

EMS was called to a local dialysis center due to the patient being unresponsive after  approximately 3 hours of dialysis.

Upon arrival to the ED, the patient was unable to answer  questions , with  a Glasgow Coma Scale (GCS) of 8 and the following baseline vital sings:

  • Heart Rate: 74 beats/min, strong and regular

  • Respiratory Rate: 15 breaths/min, adequate tidal volume and regular, with clear sounds

  • Non-invasive Blood Pressure: 202/76 mmHg

  • SpO2: 99% on 15 LPM via Non-rebreather

  • Pupils: 3 mm and reactive to light

  • Blood Glucose Level: 68 mg/dL

Known Medical History:

  • Hypertension (HTN)

  • Chronic Renal Failure

No know allergies.

The following 12 lead ECG was obtained by EMS prior arrival to the ED:

lvh osceola web

(Click on the ECG for a full view)

  • What is your detailed ECG interpretation?
  • What is your treatment?





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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Darren Earley
Conclusion: 38 Year Old Male – Chest Pain and Leg Paralysis.
Ventricular pre excitation
2015-10-06 15:19:34
38 Year Old Male – Chest Pain and Leg Paralysis.
#3, drop BP, call chest cutter, fly pt. chest pain + neuro deficit= aortic dissection
2015-10-06 13:17:53
38 Year Old Male – Chest Pain and Leg Paralysis.
LVH with strain St depression in inf leads St elevation in avl ,v1 to v4 Here major problem is high B.P that causes focal neurological deficiet at the same time effect of hypertension on heart may results in st t changes but imp things here pain that's not responding so Aortic Disection also kept in…
2015-10-06 05:44:53
Darren Earley
38 Year Old Male – Chest Pain and Leg Paralysis.
Ventricular pre excitation.
2015-10-05 18:23:40
38 Year Old Male – Chest Pain and Leg Paralysis.
i am with Brian on the aortic dissection. there are a lack of p waves that are possibly due to a 1st. degree heart block.
2015-10-05 17:50:11

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