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?

Click HERE  for the conclusion:

 

 

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EMS 12-Lead

Cardiac Rhythm Analysis, 12-Lead ECG Interpretation, Resuscitation

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Comments
Eric Strong
Axis Determination – Part VI
This is a great discussion of axis determination. One minor suggestion: I think it's potentially misleading to refer to an axis between 0 and -30 as "physiologic left axis deviation", since "axis devitation" implies deviation from normal, and axes between 0 and -30 are perfectly normal, (depending on age and body habitus). It may be…
2014-10-05 17:09:00
Ian
Right ventricular infarction – Part I
Can you give me a little more info on hypervagotonia? I googled around for some info but there doesn't seem to be much info and it's a term I've never heard before. Thanks!
2014-10-05 15:09:24
68 y.o. male w/ weakness: conclusion – “Treat the monitor.” | EMS 12 Lead
HyperK and Shades of Grey: Myths and Facts about Hyperkalemia Part I
[…] Myths about hyperkalemia […]
2014-10-05 01:54:53
68 y.o. male with weakness: “Treat the monitor, not the patient?” | EMS 12 Lead
68 y.o. male w/ weakness: conclusion – “Treat the monitor.”
[…] The conclusion, with the diagnosis, is now available. Click to go […]
2014-10-05 01:36:36
SFL Medic
68 y.o. male with weakness: “Treat the monitor, not the patient?”
Destination: ED with most to offer. He's 68 and weak. I'm in Florida...we have people with their favorite Dx on their car tags around here, so that doesn't bother me. Neither does diminished lungs. Altered mental status does. And the ECG looks like an old oscilloscope...which I've used in the field (MRL)...which tells me high…
2014-10-04 21:44:53

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