It is a bright Sunday morning when you and your partner are dispatched for an “adult male-chest pain”.
You arrive at a well kept residence, noting a ladder and paint cans as you enter.
You find your patient, a 57 year old male, sitting on the sofa in mild distress.
“I was doing some painting, and about 20 minutes ago I felt some pressure here (points to central chest just left of sternum), and my arm started hurting too (rubs left bicep area).”
He rates the discomfort at 7/10. He also says he became very sweaty and nauseous at the time of onset. Oh, and just for good measure, he tells you he had some trouble breathing as well. He denies being nauseous at the moment, and his skin is warm and moist. PD had given him O2 via NRB, and he says his breathing is “better”.
He has not taken anything for this episode. In fact, the reason he called so fast:
“I just saw a show on TV where a guy had a heart attack and waited too long to call 911. I figured I better call fast.”
Pt hx is significant only for hypertension and hypercholesterolemia. He denies ever experiencing this before. He takes Toprol, and has no allergies.
- Pulse: 74 regular
- BP: 180/104
- RR: 20, mild distress
- Spo2: 97% on O2
- Skin: warm and moist
Your patient is a heavy set gentleman, and you acquire the first 12 Lead ECG:
Here is a second 12 Lead ECG taken several minutes later:
- Community Hospital: 20 minutes by ground
- PCI center: Â 50 minutes by ground
What is interpretation of the 12 Lead ECGs?
Are there any changes between #1 and #2?
How do you want to treat your patient, and where do you want to take him?