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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