Sunday, 27 December 2009

57 yom CC: Chest pain

Cross-posted to the Prehospital 12-Lead ECG blog

Here's a very interesting case submitted by FF/medic Tim Porter (c/o a faithful reader).

The patient is a 56 year old male with a chief complaint of chest pain.

Onset: Approximately 30 minutes prior to EMS arrival
Provoke: Nothing makes the pain better or worse
Quality: Described as intense pressure
Radiate: The pain does not radiate to the arms, back, neck, or jaw
Severity: 6/10
Time: Unknown whether the patient has experienced previous similar episodes

The patient denies shortness of breath.

The patient's skin is pink, warm, and dry.

Past medical history is significant for cardiac stent 2 years prior.

Medications: unknown.

Vital signs are assessed:

Resp: 18
Pulse: 1oo
BP: 160/90
SpO2: 97 on RA

A 12-lead ECG is captured.

The patient is loaded for transport.

An additional 12-lead ECG is captured en route to the local non-PCI hospital.

Of particular interest to me, in the absence of an obvious STEMI, this paramedic's EMS system allows bypass to a STEMI center when 2 of 5 secondary criteria are present.

They include:
  • Obesity
  • Smoker
  • Hypertension
  • Diabetes
  • Prior history
In this case, the patient only had prior history.

So, what is your impression?

More to follow...