On arrival, the patient is found sitting in a beach chair alert and oriented to person, place, time, and event. She does not appear to be in any acute distress.
The patient states that she was out wake-boarding when she fell and "got a mouth full of water." She coughed profusely and then experienced some chest discomfort.
She denies having experienced any shortness of breath.
She denies any other significant medical history other than a little bit of emphysema and states that she takes an inhaler but rarely uses it.
The patient is embarrassed but consents to further evaluation in the back of the ambulance. It takes some convincing for the patient to allow EMS personnel to carry her off of the beach (she wants to walk the 100 yards to the ambulance).
In the back of the ambulance, vital signs are assessed.
RR: 18
HR: 80
BP: 132/74
SpO2: 94 on RA
The cardiac monitor is attached.
A 12-lead ECG is captured.
The patient states she feels better and wants to know if it's really necessary for her to go to the hospital.
Should they transport her to the hospital?
yes..st elevation anterior leads
ReplyDelete12L shows NSR @80. NL Axis. STE V2-V5 and ?I,L secondary to artifact. c elevated J Point. Poor R wave Progression in precordium. No reciprocal changes. Re-assess 12L c changes in CP or VS. Note acute changes from old EKG at ED. Definately transport to PCI facility
ReplyDeleteI don't know what she do in her heart byt she do something . I give her a treatment like MI even she feel good with out pain cuse she have any elavation as you say befor but she have reseptocal in III , AVF so I give her aspirin and that all for that time and vein line and transfer her to emrgency room and I ask if they can call to cardiolog to the emrgency room to take decision to take her to PTCA now or not.
ReplyDeleteA 76 yo lady wake boarding? Uh...ok.
ReplyDeleteWhat was the "chest discomfort" like?
Any which way, it doesn't matter. Too many risk factors to discount. Age, sex, maybe she has +stress test in the past.
Def get another EKG in 15 min and get more history.
I've seen less get 2 sets of CEs and a stress. She gets transported to the ED for r/o ACS for sure.