Monday, 1 February 2010

73 yom CC: Chest Pain

Here's a case that was submitted by a reader from the UK.

He's a new EMT in his first 6 months who has chosen to remain anonymous.

In his own words:

Presenting Complaint: Chest Pain

History of Presenting Complaint: 73 year old male with cardiac history complained of retrosternal chest pain whilst getting out bed in the a.m.

The pain radiated left shoulder, left arm.

The male took his gtn sublingual spray and the pain eventually eleviated after x3 spray's.

4 hours later male is persuaded to call ambulance to inform of this episode of pain.

On arrival: Patient self mobile to door - nil obvious difficulties.

On examination:

Alert, orientated with good colour - GCS 15.
R/R 19, with good clear bilateral air entry.
Sats 97% on air. Patient communicable.
Good strong radial H/R 85.
Nil chest pain/discomfort.
Nil diaphoresis.
BP - Systolic elevated - 200/83
All other obs within normal parameters

3 lead - see attachment.

12 lead done in situ - see attachment

Past Medical History: Cardiac hx = Angina, Bypass (12 years), valve replacement (u/k which - 1 years)

Allergies - Clopidogrel

Treatment: 300mg aspirin and transport to A&E

A&E department ecg - see attached.


 What do you think?